"hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|LA,""To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated."",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"
"Specialists Hospital Shreveport ,4/4/25,2.0.0,Specialists Hospital Shreveport ,""1500 Line Ave Ste 206, Shreveport, LA 71101"",208810573,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"
"Service,Category,Code,Description,Revenue code,Charges,AETNA PLAN,AETNA REIMBURSEMENT METHOD,BCBS PLAN,BCBS REIMBURSEMENT METHOD,CHAMP VA PLAN,CHAMP VA REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,COVENTRY PLAN,COVENTRY REIMBURSEMENT METHOD,GILSBAR PLAN,GILSBAR REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,PPO PLUS PLAN,PPO PLUS REIMBURSEMENT METHOD,PRIME HEALTH PLAN,PRIME HEALTH REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,VERITY PLAN,VERITY REIMBURSEMENT METHOD,WORK COMP PLAN,WORK COMP REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE"
"Outpatient Medical Services,HOSPITAL,29805,DX INNERVUE ARTHROSCOPY SHOULDER,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,981,100% of WORK COMP custom fee schedule,981,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29805,""SHOULDER ARTHROSCOPY, DX"",360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,981,100% of WORK COMP custom fee schedule,981,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29806,SHOULDER ARTHROSCOPY/SURGERY,360,13175.08,2500,pays based on per day rate,5458.17,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7905.05,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2210,100% of WORK COMP custom fee schedule,2210,12840.36,5458.17"
"Outpatient Medical Services,HOSPITAL,29807,SHOULDER ARTHROSCOPY/SURGERY,360,10652.2,2500,pays based on per day rate,4412.99,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,6391.32,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2152,100% of WORK COMP custom fee schedule,2152,12840.36,4412.99"
"Outpatient Medical Services,HOSPITAL,29819,SHOULDER ARTHROSCOPY REMOVAL FOREIGN BOD,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1329,100% of WORK COMP custom fee schedule,1329,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29820,SHOULDER ARTHROSCOPY/SURGERY,360,11913.65,2500,pays based on per day rate,4935.59,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7148.19,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1282,100% of WORK COMP custom fee schedule,1282,12840.36,4935.59"
"Outpatient Medical Services,HOSPITAL,29822,SHOULDER ARTHROSCOPY/SURGERY,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1328,100% of WORK COMP custom fee schedule,1328,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29823,SHOULDER ARTHROSCOPY WITH EXT DEBRIDEMEN,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1622,100% of WORK COMP custom fee schedule,1622,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29824,SHOULDER ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,773.72,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1412,100% of WORK COMP custom fee schedule,1412,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29825,SHOULDER ARTHROSCOPY LYSIS AND RESECTION,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1466,100% of WORK COMP custom fee schedule,1466,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29826,SHOULDER ARTHROSCOPY/SURGERY,360,6613.08,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2975.89,45% Of total billed charges,3967.85,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3967.85,60% of total billed charges,5290.46,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,1687,100% of WORK COMP custom fee schedule,1687,5290.46,N/A"
"Outpatient Medical Services,HOSPITAL,29827,ARTHROSCOPY ROTATOR CUFF REPR,360,10652.2,2500,pays based on per day rate,4412.99,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3050,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,773.72,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,6391.32,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2241,100% of WORK COMP custom fee schedule,2241,12840.36,4412.99"
"Outpatient Medical Services,HOSPITAL,29828,BICEPS TENODESIS,360,9390.75,2500,pays based on per day rate,3890.4,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,1871.58,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,5634.45,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1926,100% of WORK COMP custom fee schedule,1926,12840.36,3890.4"
"Outpatient Medical Services,HOSPITAL,29830,ARTHOSCOPY ELBOW DIAGNOSTIC +- SYNOVIAL,360,2975.88,2500,pays based on per day rate,1232.85,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1339.15,45% Of total billed charges,1785.53,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1785.53,60% of total billed charges,2380.7,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,834,100% of WORK COMP custom fee schedule,834,3532.08,1232.85"
"Outpatient Medical Services,HOSPITAL,29834,ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOO,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,916,100% of WORK COMP custom fee schedule,916,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29835,ARTHROSCOPY ELBO SX SYNOVECTOMY PARTIAL,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,945,100% of WORK COMP custom fee schedule,945,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29837,ELBOW ARTHROSCOPY/SURGERY,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1004,100% of WORK COMP custom fee schedule,1004,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29838,ELBOW ARTHROSCOPY WITH EXTENSIVE DEBRIDE,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1105,100% of WORK COMP custom fee schedule,1105,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29840,ARTHROSCOPY WRIST DIAG+SYNOCIAL BX SPX,360,2975.88,2500,pays based on per day rate,1232.85,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1339.15,45% Of total billed charges,1785.53,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1785.53,60% of total billed charges,2380.7,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,654,100% of WORK COMP custom fee schedule,654,3532.08,1232.85"
"Outpatient Medical Services,HOSPITAL,29844,WRIST ARTHROSCOPY SX SYNOVECTOMEY PARTIA,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,903,100% of WORK COMP custom fee schedule,903,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29846,ARTHRS WRST EXC RPR TRIANG FIBROCART,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1391,100% of WORK COMP custom fee schedule,1391,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29847,WRIST ARTHROSCOPY/SURGERY,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1040,100% of WORK COMP custom fee schedule,1040,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,29848,WRIST ENDOSCOPY/SURGERY,360,3172.35,2500,pays based on per day rate,1314.24,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1427.56,45% Of total billed charges,1903.41,60% of total billed charges,1444.88,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1903.41,60% of total billed charges,2537.88,80% of total billed charges,1802.52,100% of UHC custom fee schedule,N/A,not separately reimbursable,756,100% of WORK COMP custom fee schedule,756,3700,1314.24"
"Outpatient Medical Services,HOSPITAL,29851,ARTHRS AID TX SPI&/FX KNE W/FIXJ,360,3172.35,2500,pays based on per day rate,1314.24,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1427.56,45% Of total billed charges,1903.41,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1903.41,60% of total billed charges,2537.88,80% of total billed charges,1802.52,100% of UHC custom fee schedule,N/A,not separately reimbursable,1775,100% of WORK COMP custom fee schedule,1314.24,2900,1314.24"
"Outpatient Medical Services,HOSPITAL,29855,ARTHRS AID TIBIAL FRACTURE PROXIMAL UNIC,360,11913.65,2500,pays based on per day rate,4935.59,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2900,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,679.83,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7148.19,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1632,100% of WORK COMP custom fee schedule,1632,12840.36,4935.59"
"Outpatient Medical Services,HOSPITAL,29856,ARTHRITIS AID TIBIAL FX PROX UNI-BI COND,360,21511.2,2500,pays based on per day rate,8911.66,100% of BCBS custom fee schedule,11860.12,pays based on per APC rate,2900,100% of ASC TIER GROUPINGS rate,17790.18,pays based on APC rate,13046.13,pays based on APC rate,17197.16,pays based on APC rate,679.83,100% LA Medicaid fee schedule,11860.12,pays based on APC rate,12906.72,60% of total billed charges,23127.22,pays based on APC rate,13516.8,100% of UHC custom fee schedule,11860.12,pays based on APC rate ,1901,100% of WORK COMP custom fee schedule,1901,23127.22,8911.66"
"Outpatient Medical Services,HOSPITAL,29861,HIP ARTHROSCOPY W/REMOVAL OF FOREIGN BOD,360,2975.88,2500,pays based on per day rate,1232.85,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2900,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,679.83,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,1785.53,60% of total billed charges,12840.36,pays based on APC rate,3532.08,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1402,100% of WORK COMP custom fee schedule,1232.85,12840.36,1232.85"
"Outpatient Medical Services,HOSPITAL,29862,HIP ARTHROSCOPY W/DEBRIDEMENT OF ARTICUL,360,13175.08,2500,pays based on per day rate,5458.17,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,1444.88,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7905.05,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1536,100% of WORK COMP custom fee schedule,1536,12840.36,5458.17"
"Outpatient Medical Services,HOSPITAL,29866,ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOS,360,10652.2,2500,pays based on per day rate,4412.99,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2122.98,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,6391.32,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2181,100% of WORK COMP custom fee schedule,2181,12840.36,4412.99"
"Outpatient Medical Services,HOSPITAL,29870,DX INNERVUE ARTHROSCOPY KNEE,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,679,100% of WORK COMP custom fee schedule,679,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29871,KNEE ARTHROSCOPY INFECTION LAVAGE DRAIN,360,6480.83,2500,pays based on per day rate,2684.88,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2916.37,45% Of total billed charges,3888.5,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3888.5,60% of total billed charges,5184.66,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,993,100% of WORK COMP custom fee schedule,993,5184.66,2684.88"
"Outpatient Medical Services,HOSPITAL,29873,KNEE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1089,100% of WORK COMP custom fee schedule,1089,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29874,KNEE ARTHROSCOPY/SURGERY,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1229,100% of WORK COMP custom fee schedule,1229,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29875,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1193,100% of WORK COMP custom fee schedule,1193,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29876,KNEE ARTHROSCOPY SYNOVECTOMY TWO OR MORE,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1443,100% of WORK COMP custom fee schedule,1443,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29877,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1348,100% of WORK COMP custom fee schedule,1348,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29877,KNEE ARTHROSCOPY SURGICAL DEBRIDEMENT,360,10249.52,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4612.28,45% Of total billed charges,6149.71,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,6149.71,60% of total billed charges,8199.62,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1348,100% of WORK COMP custom fee schedule,1348,8199.62,2575.29"
"Outpatient Medical Services,HOSPITAL,29879,KNEE ARTHROSCOPY/SURGERY,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1315,100% of WORK COMP custom fee schedule,1315,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29880,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1606,100% of WORK COMP custom fee schedule,1606,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29881,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1387,100% of WORK COMP custom fee schedule,1387,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29881,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1387,100% of WORK COMP custom fee schedule,1387,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29881,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1387,100% of WORK COMP custom fee schedule,1387,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29881,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1387,100% of WORK COMP custom fee schedule,1387,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29882,KNEE ARTHROSCOPY/SURGERY,360,5621.13,2500,pays based on per day rate,2328.72,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2529.51,45% Of total billed charges,3372.68,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3372.68,60% of total billed charges,4496.9,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1488,100% of WORK COMP custom fee schedule,1488,4496.9,2328.72"
"Outpatient Medical Services,HOSPITAL,29883,KNEE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1905,100% of WORK COMP custom fee schedule,1835.57,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29884,KNEE ARTHROSCOPY/SURGERY,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1235,100% of WORK COMP custom fee schedule,1235,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29885,ARTHRS KNE DRLS OSTEO DISS GRFG,360,10652.2,2500,pays based on per day rate,4412.99,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,6391.32,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1289,100% of WORK COMP custom fee schedule,1289,12840.36,4412.99"
"Outpatient Medical Services,HOSPITAL,29886,KNEE ARTHROSCOPY DRILLING FOR OSTEOCHOND,360,6216.3,2500,pays based on per day rate,2575.29,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2797.34,45% Of total billed charges,3729.78,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3729.78,60% of total billed charges,4973.04,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1066,100% of WORK COMP custom fee schedule,1066,4973.04,2575.29"
"Outpatient Medical Services,HOSPITAL,29887,KNEE ARTHROSCOPY/SURGERY,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1474,100% of WORK COMP custom fee schedule,1474,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,29888,KNEE ARTHROSCOPY/SURGERY,360,11913.65,2500,pays based on per day rate,4935.59,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7148.19,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2463,100% of WORK COMP custom fee schedule,2463,12840.36,4935.59"
"Outpatient Medical Services,HOSPITAL,29889,ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNT,360,24801.15,2500,pays based on per day rate,10274.62,100% of BCBS custom fee schedule,11860.12,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,17790.18,pays based on APC rate,13046.13,pays based on APC rate,17197.16,pays based on APC rate,550.32,100% LA Medicaid fee schedule,11860.12,pays based on APC rate,14880.69,60% of total billed charges,23127.22,pays based on APC rate,13516.8,100% of UHC custom fee schedule,11860.12,pays based on APC rate ,1607,100% of WORK COMP custom fee schedule,1607,23127.22,10274.62"
"Outpatient Medical Services,HOSPITAL,29891,ANKLE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1323,100% of WORK COMP custom fee schedule,1323,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29892,ANDLE ARTHROSCOPY/SURGERY,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,550.32,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1370,100% of WORK COMP custom fee schedule,1370,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,29894,ANKLE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1285,100% of WORK COMP custom fee schedule,1285,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29895,ANKLE ARTHROSCOPY/SURGERY,360,5025.93,2500,pays based on per day rate,2082.14,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2261.67,45% Of total billed charges,3015.56,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3015.56,60% of total billed charges,4020.74,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1221,100% of WORK COMP custom fee schedule,1221,4020.74,2082.14"
"Outpatient Medical Services,HOSPITAL,29897,ANKLE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1316,100% of WORK COMP custom fee schedule,1316,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29898,ANKLE ARTHROSCOPY/SURGERY,360,4430.75,2500,pays based on per day rate,1835.57,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1993.84,45% Of total billed charges,2658.45,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2658.45,60% of total billed charges,3544.6,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1510,100% of WORK COMP custom fee schedule,1510,3544.6,1835.57"
"Outpatient Medical Services,HOSPITAL,29906,ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEM,360,6613.08,2500,pays based on per day rate,2739.66,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2975.89,45% Of total billed charges,3967.85,60% of total billed charges,1317.99,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,3967.85,60% of total billed charges,5290.46,80% of total billed charges,3532.08,100% of UHC custom fee schedule,N/A,not separately reimbursable,1509,100% of WORK COMP custom fee schedule,1509,5290.46,2739.66"
"Outpatient Medical Services,HOSPITAL,29907,ARTHROSCOPY SUBTALAR JOINT WITH ARTHRODE,360,25307.3,2500,pays based on per day rate,10484.31,100% of BCBS custom fee schedule,11860.12,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,17790.18,pays based on APC rate,13046.13,pays based on APC rate,17197.16,pays based on APC rate,5043.74,100% LA Medicaid OP CCR which is 19.93 percent of charges,11860.12,pays based on APC rate,15184.38,60% of total billed charges,23127.22,pays based on APC rate,13516.8,100% of UHC custom fee schedule,11860.12,pays based on APC rate ,1820,100% of WORK COMP custom fee schedule,1820,23127.22,10484.31"
"Outpatient Medical Services,HOSPITAL,29914,ARTHROSCOPY HIP W/FEMOROPLASTY,360,9390.75,2500,pays based on per day rate,3890.4,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,679.83,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,5634.45,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2112,100% of WORK COMP custom fee schedule,2112,12840.36,3890.4"
"Outpatient Medical Services,HOSPITAL,29916,ARTHROSCOPY HIP W/LABRAL REPAIR,360,11913.65,2500,pays based on per day rate,4935.59,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,679.83,100% LA Medicaid fee schedule,6584.8,pays based on APC rate,7148.19,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2152,100% of WORK COMP custom fee schedule,2152,12840.36,4935.59"
"Outpatient Medical Services,HOSPITAL,29999,ARTHROSCOPY OF JOINT,360,537.25,2500,pays based on per day rate,222.57,100% of BCBS custom fee schedule,221.11,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,331.66,pays based on APC rate,243.21,pays based on APC rate,320.6,pays based on APC rate,N/A,Not separately reimbursable,221.11,pays based on APC rate,322.35,60% of total billed charges,431.16,pays based on APC rate,286.95,100% of UHC custom fee schedule,221.11,pays based on APC rate ,N/A,not separately reimbursable,221.11,2600,222.57"
"Outpatient Medical Services,HOSPITAL,33999,CARDIAC SURGERY,360,1531.43,2500,pays based on per day rate,634.44,100% of BCBS custom fee schedule,569.88,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,854.83,pays based on APC rate,626.87,pays based on APC rate,826.33,pays based on APC rate,N/A,Not separately reimbursable,569.88,pays based on APC rate,918.86,60% of total billed charges,1111.27,pays based on APC rate,817.95,100% of UHC custom fee schedule,569.88,pays based on APC rate ,N/A,not separately reimbursable,569.88,2600,634.44"
"Outpatient Medical Services,HOSPITAL,35045,DIR RPR ARYSM&GRF INSJ RDL/UR ART,360,10662.4,2500,pays based on per day rate,4417.22,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4798.08,45% Of total billed charges,6397.44,60% of total billed charges,2125.02,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,6397.44,60% of total billed charges,8529.92,80% of total billed charges,5694.85,100% of UHC custom fee schedule,N/A,not separately reimbursable,1737,100% of WORK COMP custom fee schedule,1737,8529.92,4417.22"
"Outpatient Medical Services,HOSPITAL,35201,REP BLOOD VESS DIRECT NECK,360,10662.4,2500,pays based on per day rate,4417.22,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4798.08,45% Of total billed charges,6397.44,60% of total billed charges,2125.02,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,6397.44,60% of total billed charges,8529.92,80% of total billed charges,5694.85,100% of UHC custom fee schedule,N/A,not separately reimbursable,1480,100% of WORK COMP custom fee schedule,1480,8529.92,4417.22"
"Outpatient Medical Services,HOSPITAL,35206,REPAIR BLOOD VESSEL DIRECT UPPER EXTREMI,360,6231.85,2500,pays based on per day rate,2581.73,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2804.33,45% Of total billed charges,3739.11,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3739.11,60% of total billed charges,4985.48,80% of total billed charges,3328.47,100% of UHC custom fee schedule,N/A,not separately reimbursable,1463,100% of WORK COMP custom fee schedule,1463,4985.48,2581.73"
"Outpatient Medical Services,HOSPITAL,35221,REPAIR OF BLOOD VESSEL,360,6231.85,2500,pays based on per day rate,N/A,not separately reimbursable,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,3739.11,60% of total billed charges,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,6231.85,pays at line item charges due to status indicator C on the cms APC fee schedule,2010,100% of WORK COMP custom fee schedule,2010,6231.85,N/A"
"Outpatient Medical Services,HOSPITAL,35226,RPR BLOOD VESSEL DIRECT LOWER EXTREMITY,360,1432.13,2500,pays based on per day rate,593.3,100% of BCBS custom fee schedule,648.54,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,972.8,pays based on APC rate,713.38,pays based on APC rate,940.37,pays based on APC rate,285.42,100% LA Medicaid OP CCR which is 19.93 percent of charges,648.54,pays based on APC rate,859.28,60% of total billed charges,1264.65,pays based on APC rate,764.9,100% of UHC custom fee schedule,648.54,pays based on APC rate ,1444,100% of WORK COMP custom fee schedule,593.3,2600,593.3"
"Outpatient Medical Services,HOSPITAL,36415,VENIPUNCTURE,300,9.28,5.1,55% of total billed charges,3.11,100% of BCBS custom fee schedule,9.09,100% of cms custom fee schedule,4.18,45% of total billed charges,13.63,150% of cms custom fee schedule,9.99,110% of GILSBAR custom fee schedule,13.18,145% of cms custom fee schedule,2.99,100% LA Medicaid fee schedule,9.09,100% of cms custom fee schedule,5.57,60% of total billed charges,17.72,195% of cms custom fee schedule,N/A,not separately reimbursable,9.09,100% of cms custom fee schedule,N/A,not separately reimbursable,3.11,17.72,3.11"
"Outpatient Medical Services,HOSPITAL,36430,""TRANSFUSION,BLOOD OR BLOOD COMPONENTS"",391,937.68,515.72,55% of total billed charges,388.46,100% of BCBS custom fee schedule,402.97,pays based on per APC rate,421.96,45% of total billed charges,604.46,pays based on APC rate,443.26,pays based on APC rate,584.3,pays based on APC rate,186.88,100% LA Medicaid OP CCR which is 19.93 percent of charges,402.97,pays based on APC rate,562.61,60% of total billed charges,785.8,pays based on APC rate,500.82,100% of UHC custom fee schedule,402.97,pays based on APC rate ,73,100% of WORK COMP custom fee schedule,73,785.8,388.46"
"Outpatient Medical Services,HOSPITAL,36569,PICC LINE PLACEMENT,360,2457.43,2500,pays based on per day rate,1018.06,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1105.84,45% Of total billed charges,1474.46,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1474.46,60% of total billed charges,1965.94,80% of total billed charges,1312.52,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1018.06,2500,1018.06"
"Outpatient Medical Services,HOSPITAL,36569,MID LINE PLACEMENT,360,2457.43,2500,pays based on per day rate,1018.06,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1105.84,45% Of total billed charges,1474.46,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1474.46,60% of total billed charges,1965.94,80% of total billed charges,1312.52,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1018.06,2500,1018.06"
"Outpatient Medical Services,HOSPITAL,36583,RPLCMT COMPL TIN CTR VAD W/SUBW PMP,360,10662.4,2500,pays based on per day rate,4417.22,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4798.08,45% Of total billed charges,6397.44,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,6397.44,60% of total billed charges,8529.92,80% of total billed charges,5694.85,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,2500,8529.92,4417.22"
"Outpatient Medical Services,HOSPITAL,36584,""REPLACEMENT, CMPLT, OF PICC DEVICE"",360,2457.43,2500,pays based on per day rate,1018.06,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1105.84,45% Of total billed charges,1474.46,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1474.46,60% of total billed charges,1965.94,80% of total billed charges,1312.52,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1018.06,2500,1018.06"
"Outpatient Medical Services,HOSPITAL,36593,PICC LINE DECLOTTING,360,743.93,2500,pays based on per day rate,308.19,100% of BCBS custom fee schedule,305.73,pays based on per APC rate,150,100% of ASC TIER GROUPINGS rate,458.6,pays based on APC rate,336.3,pays based on APC rate,443.32,pays based on APC rate,148.27,100% LA Medicaid OP CCR which is 19.93 percent of charges,305.73,pays based on APC rate,446.36,60% of total billed charges,596.17,pays based on APC rate,397.33,100% of UHC custom fee schedule,305.73,pays based on APC rate ,61,100% of WORK COMP custom fee schedule,61,2500,308.19"
"Outpatient Medical Services,HOSPITAL,37609,LIG/BX TEMPORAL ART,360,3370.08,2500,pays based on per day rate,1396.15,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1516.54,45% Of total billed charges,2022.05,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2022.05,60% of total billed charges,2696.06,80% of total billed charges,1799.98,100% of UHC custom fee schedule,N/A,not separately reimbursable,345,100% of WORK COMP custom fee schedule,345,2696.06,1396.15"
"Outpatient Medical Services,HOSPITAL,37618,LIG MAJOR ART XTR,360,9384.13,2500,pays based on per day rate,N/A,not separately reimbursable,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,5630.48,60% of total billed charges,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,9384.13,pays at line item charges due to status indicator C on the cms APC fee schedule,704,100% of WORK COMP custom fee schedule,704,9384.13,N/A"
"Outpatient Medical Services,HOSPITAL,37799,VASCULAR SURGERY PROCEDURE,360,1531.43,2500,pays based on per day rate,634.44,100% of BCBS custom fee schedule,569.88,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,854.83,pays based on APC rate,626.87,pays based on APC rate,826.33,pays based on APC rate,N/A,Not separately reimbursable,569.88,pays based on APC rate,918.86,60% of total billed charges,1111.27,pays based on APC rate,817.95,100% of UHC custom fee schedule,569.88,pays based on APC rate ,N/A,not separately reimbursable,569.88,2600,634.44"
"Outpatient Medical Services,HOSPITAL,38220,BONE MARROW ASPIRATION ONLY,360,2561.25,2500,pays based on per day rate,1061.07,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1152.56,45% Of total billed charges,1536.75,60% of total billed charges,510.46,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1536.75,60% of total billed charges,2049,80% of total billed charges,1799.98,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1061.07,2500,1061.07"
"Outpatient Medical Services,HOSPITAL,38500,BX/EXC LYMPH NODE OPN SUPFC,360,5796.65,2500,pays based on per day rate,2401.44,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2608.49,45% Of total billed charges,3477.99,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3477.99,60% of total billed charges,4637.32,80% of total billed charges,3642.4,100% of UHC custom fee schedule,N/A,not separately reimbursable,335,100% of WORK COMP custom fee schedule,335,4637.32,2401.44"
"Outpatient Medical Services,HOSPITAL,41250,REPAIR LACERATION 2.5 CM OR LESS MOUTH,360,262.6,2500,pays based on per day rate,108.79,100% of BCBS custom fee schedule,367.81,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,551.72,pays based on APC rate,404.6,pays based on APC rate,533.33,pays based on APC rate,481.27,100% LA Medicaid fee schedule,367.81,pays based on APC rate,157.56,60% of total billed charges,717.24,pays based on APC rate,140.26,100% of UHC custom fee schedule,367.81,pays based on APC rate ,215,100% of WORK COMP custom fee schedule,108.79,2500,108.79"
"Outpatient Medical Services,HOSPITAL,49000,EXPL LAPT EXPL CELIOTOMY +-BX SPX,360,5832.3,2500,pays based on per day rate,N/A,not separately reimbursable,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,1162.38,100% LA Medicaid OP CCR which is 19.93 percent of charges,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,3499.38,60% of total billed charges,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,5832.3,pays at line item charges due to status indicator C on the cms APC fee schedule,1217,100% of WORK COMP custom fee schedule,1217,5832.3,N/A"
"Outpatient Medical Services,HOSPITAL,49402,REMOVAL PERITONEAL FOREIGN BODY FROM CAV,360,7277.9,2500,pays based on per day rate,3015.09,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,3275.06,45% Of total billed charges,4366.74,60% of total billed charges,1450.49,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,4366.74,60% of total billed charges,5822.32,80% of total billed charges,3887.17,100% of UHC custom fee schedule,N/A,not separately reimbursable,1772,100% of WORK COMP custom fee schedule,1772,5822.32,3015.09"
"Outpatient Medical Services,HOSPITAL,49560,REPAIR INITIAL INCISIONAL/VENTRAL HERNIA,360,6841.23,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,3078.55,45% Of total billed charges,4104.74,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,4104.74,60% of total billed charges,5472.98,80% of total billed charges,3887.17,100% of UHC custom fee schedule,N/A,not separately reimbursable,1170,100% of WORK COMP custom fee schedule,1170,5472.98,N/A"
"Outpatient Medical Services,HOSPITAL,49999,UNLIS PX ADB PRTM&OMENTUM,360,1858.73,2500,pays based on per day rate,770.03,100% of BCBS custom fee schedule,864.2,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,1296.3,pays based on APC rate,950.62,pays based on APC rate,1253.08,pays based on APC rate,N/A,Not separately reimbursable,864.2,pays based on APC rate,1115.24,60% of total billed charges,1685.19,pays based on APC rate,992.75,100% of UHC custom fee schedule,864.2,pays based on APC rate ,N/A,not separately reimbursable,770.03,2600,770.03"
"Outpatient Medical Services,HOSPITAL,51798,ULTRASOUND OF BLADDER - BLADDER SCAN,360,139.9,2500,pays based on per day rate,57.96,100% of BCBS custom fee schedule,54.75,pays based on per APC rate,150,100% of ASC TIER GROUPINGS rate,82.12,pays based on APC rate,60.22,pays based on APC rate,79.39,pays based on APC rate,27.88,100% LA Medicaid OP CCR which is 19.93 percent of charges,54.75,pays based on APC rate,83.94,60% of total billed charges,106.76,pays based on APC rate,74.72,100% of UHC custom fee schedule,54.75,pays based on APC rate ,N/A,not separately reimbursable,54.75,2500,57.96"
"Outpatient Medical Services,HOSPITAL,52000,CYSTOURETHROSCOPY,360,1414,2500,pays based on per day rate,585.79,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,636.3,45% Of total billed charges,848.4,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,848.4,60% of total billed charges,1131.2,80% of total billed charges,755.22,100% of UHC custom fee schedule,N/A,not separately reimbursable,246,100% of WORK COMP custom fee schedule,246,2500,585.79"
"Outpatient Medical Services,HOSPITAL,61888,REVISE/REMOVE NEURORECEIVER,360,14230.68,2500,pays based on per day rate,5895.48,100% of BCBS custom fee schedule,11494.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,17241.93,pays based on APC rate,12644.09,pays based on APC rate,16667.2,pays based on APC rate,359.35,100% LA Medicaid fee schedule,11494.63,pays based on APC rate,8538.41,60% of total billed charges,22414.53,pays based on APC rate,8085.85,100% of UHC custom fee schedule,11494.63,pays based on APC rate ,409,100% of WORK COMP custom fee schedule,409,22414.53,5895.48"
"Outpatient Medical Services,HOSPITAL,62140,CRANIOPLASTY SKULL DEFECT TO 5CM,360,7314.2,2500,pays based on per day rate,N/A,not separately reimbursable,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,4388.52,60% of total billed charges,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,7314.2,pays at line item charges due to status indicator C on the cms APC fee schedule,2014,100% of WORK COMP custom fee schedule,2014,7314.2,N/A"
"Outpatient Medical Services,HOSPITAL,62141,CRANIOPLASTY SKULL DEFECT LARGER THAN 5,360,5497.65,2500,pays based on per day rate,N/A,not separately reimbursable,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,3298.59,60% of total billed charges,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,5497.65,pays at line item charges due to status indicator C on the cms APC fee schedule,2471,100% of WORK COMP custom fee schedule,2471,5497.65,N/A"
"Outpatient Medical Services,HOSPITAL,62223,CRTJ SHUNT VENTRICULO-PRTL-PLEURAL OTH,360,4026.25,2500,pays based on per day rate,N/A,not separately reimbursable,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,2415.75,60% of total billed charges,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,4026.25,pays at line item charges due to status indicator C on the cms APC fee schedule,2281,100% of WORK COMP custom fee schedule,2281,4026.25,N/A"
"Outpatient Medical Services,HOSPITAL,62230,RPLCMNT/REVJ CSF SHUNT VALVE/CATH SHUNT,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1512,100% of WORK COMP custom fee schedule,1512,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,62267,PERCUTANEOUS ASPIRATION WITHIN NUCLEUS,360,1432.13,2500,pays based on per day rate,593.3,100% of BCBS custom fee schedule,648.54,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,972.8,pays based on APC rate,713.38,pays based on APC rate,940.37,pays based on APC rate,285.42,100% LA Medicaid OP CCR which is 19.93 percent of charges,648.54,pays based on APC rate,859.28,60% of total billed charges,1264.65,pays based on APC rate,764.9,100% of UHC custom fee schedule,648.54,pays based on APC rate ,322,100% of WORK COMP custom fee schedule,322,2500,593.3"
"Outpatient Medical Services,HOSPITAL,62268,PRQ ASPIR SPI CORD CST/SYRINX,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,510,100% of WORK COMP custom fee schedule,510,2500,696.18"
"Outpatient Medical Services,HOSPITAL,62270,SPI PNXR LMBR DX,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,135,100% of WORK COMP custom fee schedule,135,2500,562.78"
"Outpatient Medical Services,HOSPITAL,62272,SPINAL PUNCT THER DARAIN CEREB FLUID,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,176,100% of WORK COMP custom fee schedule,176,2500,562.78"
"Outpatient Medical Services,HOSPITAL,62273,INJECTION EPIDURAL OF BLOOD/CLOT PATCH,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,251,100% of WORK COMP custom fee schedule,251,2500,562.78"
"Outpatient Medical Services,HOSPITAL,62281,TREAT SPINAL CORD LESION,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,266,100% of WORK COMP custom fee schedule,266,2500,696.18"
"Outpatient Medical Services,HOSPITAL,62282,TREAT SPINAL CANAL LESION,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,352,100% of WORK COMP custom fee schedule,352,2500,696.18"
"Outpatient Medical Services,HOSPITAL,62290,INJECT FOR SPINE DISK X-RAY,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,402,100% of WORK COMP custom fee schedule,402,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,62291,INJECT FOR SPINE DISK X-RAY,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,393,100% of WORK COMP custom fee schedule,393,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,62310,INJECT SPINE C/T,360,2196.08,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,988.24,45% Of total billed charges,1317.65,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,1317.65,60% of total billed charges,1756.86,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,988.24,2500,N/A"
"Outpatient Medical Services,HOSPITAL,62311,INJECT SPINE L/S (CD),360,2196.08,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,988.24,45% Of total billed charges,1317.65,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,1317.65,60% of total billed charges,1756.86,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,988.24,2500,N/A"
"Outpatient Medical Services,HOSPITAL,62320,NJX INTERLAMINAR CRV/THRC,360,1345.1,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,807.06,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,N/A,not separately reimbursable,562.78,2600,562.78"
"Outpatient Medical Services,HOSPITAL,62321,NJX INTERLAMINAR CRV/THRC,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,N/A,not separately reimbursable,562.78,2600,562.78"
"Outpatient Medical Services,HOSPITAL,62322,NJX INTERLAMINAR LMBR/SAC,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,815.07,60% of total billed charges,1600.23,pays based on APC rate,725.56,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,562.78,2600,562.78"
"Outpatient Medical Services,HOSPITAL,62323,NJX INTERLAMINAR LMBR/SAC,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,N/A,not separately reimbursable,562.78,2600,562.78"
"Outpatient Medical Services,HOSPITAL,62350,IMPLANT SPINAL CANAL CATH,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,800,100% of WORK COMP custom fee schedule,800,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,62355,REMOVE SPINAL CANAL CATHETER,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,1799.98,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,2699.97,pays based on APC rate,1979.98,pays based on APC rate,2609.97,pays based on APC rate,481.27,100% LA Medicaid fee schedule,1799.98,pays based on APC rate,2415.75,60% of total billed charges,3509.97,pays based on APC rate,2150.45,100% of UHC custom fee schedule,1799.98,pays based on APC rate ,659,100% of WORK COMP custom fee schedule,659,3509.97,1667.99"
"Outpatient Medical Services,HOSPITAL,62360,IMPLTJ/RPL ITHCL/EDRL DRUG NFS SUBQ RSVR,360,41102,2500,pays based on per day rate,17027.74,100% of BCBS custom fee schedule,16291.29,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,24436.94,pays based on APC rate,17920.41,pays based on APC rate,23622.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,16291.29,pays based on APC rate,24661.2,60% of total billed charges,31768.02,pays based on APC rate,21952.84,100% of UHC custom fee schedule,16291.29,pays based on APC rate ,305,100% of WORK COMP custom fee schedule,305,31768.02,17027.74"
"Outpatient Medical Services,HOSPITAL,62361,IMPLANT SPINE INFUSION PUMP,360,34936.7,2500,pays based on per day rate,14473.58,100% of BCBS custom fee schedule,16291.29,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,24436.94,pays based on APC rate,17920.41,pays based on APC rate,23622.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,16291.29,pays based on APC rate,20962.02,60% of total billed charges,31768.02,pays based on APC rate,21952.84,100% of UHC custom fee schedule,16291.29,pays based on APC rate ,630,100% of WORK COMP custom fee schedule,630,31768.02,14473.58"
"Outpatient Medical Services,HOSPITAL,62362,IMPLANT OR REPLACE OF DEVICE FOR INTRATH,360,38635.88,2500,pays based on per day rate,16006.07,100% of BCBS custom fee schedule,16291.29,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,24436.94,pays based on APC rate,17920.41,pays based on APC rate,23622.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,16291.29,pays based on APC rate,23181.53,60% of total billed charges,31768.02,pays based on APC rate,21952.84,100% of UHC custom fee schedule,16291.29,pays based on APC rate ,823,100% of WORK COMP custom fee schedule,823,31768.02,16006.07"
"Outpatient Medical Services,HOSPITAL,62365,REMOVE SPINE INFUSION DEVICE,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,8854.52,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.88,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,667,100% of WORK COMP custom fee schedule,667,11510.88,4792.79"
"Outpatient Medical Services,HOSPITAL,63001,REMOVAL OF SPINAL LAMINA,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2582,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63003,LAM W/O OFFD 1/2 VRT SEG THRG,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2534,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63005,REMOVAL OF SPINAL LAMINA,360,11913.65,2500,pays based on per day rate,4935.59,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2374.39,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,7148.19,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2403,100% of WORK COMP custom fee schedule,2403,12840.36,4935.59"
"Outpatient Medical Services,HOSPITAL,63012,LAMINECTOMY WITH REMOVAL OF ABNORMAL FAC,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2508,100% of WORK COMP custom fee schedule,2500,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63017,REMOVAL OF SPINAL LAMINA,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2900,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63020,NECK SPINE DISK SURGERY,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2331,100% of WORK COMP custom fee schedule,2331,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63030,LOW BACK DISK SURGERY,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,1906,100% of WORK COMP custom fee schedule,1906,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63035,SPINAL DISK SURGERY ADD-ON,360,9704.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4366.85,45% Of total billed charges,5822.46,60% of total billed charges,1934.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,5822.46,60% of total billed charges,7763.28,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,498,100% of WORK COMP custom fee schedule,498,7763.28,N/A"
"Outpatient Medical Services,HOSPITAL,63040,LAMIN W/ DECOMP SINGLE CERVICAL,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,3139,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63042,LAMINOTOMY W/DECOM OF NERVE ROOT,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,3140,100% of WORK COMP custom fee schedule,2500,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63044,LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC E,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,6307.22,45% Of total billed charges,8409.63,60% of total billed charges,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,8409.63,60% of total billed charges,11212.84,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,0.01,11212.84,N/A"
"Outpatient Medical Services,HOSPITAL,63045,LAMINECTOMY FACETECTOMY AND FORAMINOTOMY,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2949,100% of WORK COMP custom fee schedule,2500,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63046,LAMINECTOMY FACETECTOMY FORAMINOTOMY,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2939,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63047,REMOVAL OF SPINAL LAMINA,360,13735.73,2500,pays based on per day rate,5690.44,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2737.53,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8241.44,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2819,100% of WORK COMP custom fee schedule,2500,12840.36,5690.44"
"Outpatient Medical Services,HOSPITAL,63048,REMOVE SPINAL LAMINA ADD-ON,360,9704.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4366.85,45% Of total billed charges,5822.46,60% of total billed charges,1934.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,5822.46,60% of total billed charges,7763.28,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,530,100% of WORK COMP custom fee schedule,530,7763.28,N/A"
"Outpatient Medical Services,HOSPITAL,63050,LAMOP CRV W/DCMPRN SPI CORD 2/MORE VRT,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3231,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63051,LAMINOPLASTY CERVICAL WITH DECOMPRESSION,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3577,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63055,TRANSPEDICULAR APP DECOM SPINAL CORD EQU,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,3439,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63056,TRANSPEDICULAR APP DECOM SPINAL CORD EQU,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,3114,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63057,TRANSPEDICULAR APP DECOM SPINAL CORD EQU,360,9704.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,3700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4366.85,45% Of total billed charges,5822.46,60% of total billed charges,1934.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,5822.46,60% of total billed charges,7763.28,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,691,100% of WORK COMP custom fee schedule,691,7763.28,N/A"
"Outpatient Medical Services,HOSPITAL,63075,NECK SPINE DISK SURGERY,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,7486.07,100% of UHC custom fee schedule,6584.8,pays based on APC rate ,2871,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63076,NECK SPINE DISK SURGERY,360,9868.58,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4440.86,45% Of total billed charges,5921.15,60% of total billed charges,1966.81,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,5921.15,60% of total billed charges,7894.86,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,640,100% of WORK COMP custom fee schedule,640,7894.86,N/A"
"Outpatient Medical Services,HOSPITAL,63081,VERTEBRAL CORPECTOMY PARTIAL OR COMPLETE,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3741,100% of WORK COMP custom fee schedule,2500,14016.05,5806.57"
"Outpatient Medical Services,HOSPITAL,63082,VCRPEC ANT DCMPRN CRV EA SGM,360,9868.58,2500,pays based on per day rate,N/A,not separately reimbursable,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,5921.15,60% of total billed charges,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,9868.58,pays at line item charges due to status indicator C on the cms APC fee schedule,699,100% of WORK COMP custom fee schedule,699,9868.58,N/A"
"Outpatient Medical Services,HOSPITAL,63090,VCRPEC TRANSPLANT/RPR DCMPRN THRC LMBR,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,4270,100% of WORK COMP custom fee schedule,2500,14016.05,5806.57"
"Outpatient Medical Services,HOSPITAL,63091,ANTERIOR CERVICAL ARTHRODESIS,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,428,100% of WORK COMP custom fee schedule,428,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63265,EXCISE INTRASPINL LESION CRV,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,N/A,not separately reimbursable,6584.8,pays based on APC rate ,3252,100% of WORK COMP custom fee schedule,2500,12840.36,N/A"
"Outpatient Medical Services,HOSPITAL,63266,Excise Intrspinl Lesion Thrc,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,N/A,not separately reimbursable,6584.8,pays based on APC rate ,3528,100% of WORK COMP custom fee schedule,2500,12840.36,N/A"
"Outpatient Medical Services,HOSPITAL,63267,EXCISE INTRASPINAL LESION,360,14016.05,2500,pays based on per day rate,5806.57,100% of BCBS custom fee schedule,6584.8,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,9877.2,pays based on APC rate,7243.28,pays based on APC rate,9547.95,pays based on APC rate,2793.4,100% LA Medicaid OP CCR which is 19.93 percent of charges,6584.8,pays based on APC rate,8409.63,60% of total billed charges,12840.36,pays based on APC rate,N/A,not separately reimbursable,6584.8,pays based on APC rate ,3020,100% of WORK COMP custom fee schedule,2500,12840.36,5806.57"
"Outpatient Medical Services,HOSPITAL,63271,excision laminectory other herniated dis,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3989,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63272,LAM EXC ISPI LES OT/TH NEO IDRL LMBR,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3617,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63281,LAM BX/EXC ISPI NEO IDRL XMED THRC,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,4180,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63282,LAM BX/EXC ISPI NEO IDRL XMED LMBR,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,3788,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63290,BX/EXC XDRL/IDRL LSN ANY LVL,360,14016.05,2500,pays based on per day rate,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,8409.63,60% of total billed charges,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,14016.05,pays at line item charges due to status indicator C on the cms APC fee schedule,4732,100% of WORK COMP custom fee schedule,2500,14016.05,N/A"
"Outpatient Medical Services,HOSPITAL,63650,IMPLANT NEUROELECTRODES,360,10143.15,2500,pays based on per day rate,4202.1,100% of BCBS custom fee schedule,6049.41,pays based on per APC rate,3700,100% of ASC TIER GROUPINGS rate,9074.12,pays based on APC rate,6654.36,pays based on APC rate,8771.65,pays based on APC rate,481.27,100% LA Medicaid fee schedule,6049.41,pays based on APC rate,6085.89,60% of total billed charges,11796.36,pays based on APC rate,8085.85,100% of UHC custom fee schedule,6049.41,pays based on APC rate ,1059,100% of WORK COMP custom fee schedule,1059,11796.36,4202.1"
"Outpatient Medical Services,HOSPITAL,63655,LAMINECTOMY FOR IMPLANTATION OF NEUROSTI,360,30767.9,2500,pays based on per day rate,12746.53,100% of BCBS custom fee schedule,19766.58,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,29649.86,pays based on APC rate,21743.23,pays based on APC rate,28661.53,pays based on APC rate,6132.04,100% LA Medicaid OP CCR which is 19.93 percent of charges,19766.58,pays based on APC rate,18460.74,60% of total billed charges,38544.83,pays based on APC rate,24527.36,100% of UHC custom fee schedule,19766.58,pays based on APC rate ,1704,100% of WORK COMP custom fee schedule,1704,38544.83,12746.53"
"Outpatient Medical Services,HOSPITAL,63661,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTR,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,1799.98,pays based on per APC rate,3400,100% of ASC TIER GROUPINGS rate,2699.97,pays based on APC rate,1979.98,pays based on APC rate,2609.97,pays based on APC rate,359.35,100% LA Medicaid fee schedule,1799.98,pays based on APC rate,2415.75,60% of total billed charges,3509.97,pays based on APC rate,2150.45,100% of UHC custom fee schedule,1799.98,pays based on APC rate ,667,100% of WORK COMP custom fee schedule,667,3509.97,1667.99"
"Outpatient Medical Services,HOSPITAL,63662,RMVL SPINAL NSTIM ELTRD PLATE PADDLE FLO,360,7198.45,2500,pays based on per day rate,2982.17,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3400,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,3239.3,45% Of total billed charges,4319.07,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,4319.07,60% of total billed charges,5758.76,80% of total billed charges,3844.73,100% of UHC custom fee schedule,N/A,not separately reimbursable,1626,100% of WORK COMP custom fee schedule,1626,5758.76,2982.17"
"Outpatient Medical Services,HOSPITAL,63663,REVJ INCL RPLCMT NSTIM ELTRD PRQ RA FLOU,360,15139.03,2500,pays based on per day rate,6271.8,100% of BCBS custom fee schedule,6049.41,pays based on per APC rate,3400,100% of ASC TIER GROUPINGS rate,9074.12,pays based on APC rate,6654.36,pays based on APC rate,8771.65,pays based on APC rate,359.35,100% LA Medicaid fee schedule,6049.41,pays based on APC rate,9083.42,60% of total billed charges,11796.36,pays based on APC rate,8085.85,100% of UHC custom fee schedule,6049.41,pays based on APC rate ,973,100% of WORK COMP custom fee schedule,973,11796.36,6271.8"
"Outpatient Medical Services,HOSPITAL,63685,INSRT/REDO SPINE N GENERATOR,360,59270.05,2500,pays based on per day rate,24554.4,100% of BCBS custom fee schedule,28089.33,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,42134,pays based on APC rate,30898.26,pays based on APC rate,40729.53,pays based on APC rate,481.27,100% LA Medicaid fee schedule,28089.33,pays based on APC rate,35562.03,60% of total billed charges,54774.2,pays based on APC rate,37242.96,100% of UHC custom fee schedule,28089.33,pays based on APC rate ,1073,100% of WORK COMP custom fee schedule,1073,54774.2,24554.4"
"Outpatient Medical Services,HOSPITAL,63688,REVISE REMOVE NEURORECEIVER,360,7198.45,2500,pays based on per day rate,2982.17,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,3239.3,45% Of total billed charges,4319.07,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,4319.07,60% of total billed charges,5758.76,80% of total billed charges,3844.73,100% of UHC custom fee schedule,N/A,not separately reimbursable,871,100% of WORK COMP custom fee schedule,871,5758.76,2982.17"
"Outpatient Medical Services,HOSPITAL,63707,REPAIR OF DURAL CEREBROSPINAL FLUID LEAK,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,6941.39,60% of total billed charges,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,1867,100% of WORK COMP custom fee schedule,1867,11568.98,4792.79"
"Outpatient Medical Services,HOSPITAL,63709,REPAIR OF DURAL CEREBROSPINAL FLUID LEAK,360,7198.45,2500,pays based on per day rate,N/A,not separately reimbursable,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,4319.07,60% of total billed charges,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,7198.45,pays at line item charges due to status indicator C on the cms APC fee schedule,2375,100% of WORK COMP custom fee schedule,2375,7198.45,N/A"
"Outpatient Medical Services,HOSPITAL,63710,GRAFT REPAIR OF SPINE DEFECT,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,2600,100% of ASC TIER GROUPINGS rate,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,Not separately reimbursable,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,6941.39,60% of total billed charges,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,N/A,not separately reimbursable,11568.98,pays at line item charges due to status indicator C on the cms APC fee schedule,1723,100% of WORK COMP custom fee schedule,1723,11568.98,4792.79"
"Outpatient Medical Services,HOSPITAL,63741,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,2305.7,100% LA Medicaid OP CCR which is 19.93 percent of charges,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1475,100% of WORK COMP custom fee schedule,1475,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,63744,RPL IRRIGATION/REVJ LUBOS SHUNT,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,550.32,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1180,100% of WORK COMP custom fee schedule,1180,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,64400,N BLOCK INJ TRIGEMINAL,360,611.75,2500,pays based on per day rate,253.44,100% of BCBS custom fee schedule,272.08,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,408.13,pays based on APC rate,299.29,pays based on APC rate,394.53,pays based on APC rate,121.92,100% LA Medicaid OP CCR which is 19.93 percent of charges,272.08,pays based on APC rate,367.05,60% of total billed charges,530.58,pays based on APC rate,326.74,100% of UHC custom fee schedule,272.08,pays based on APC rate ,117,100% of WORK COMP custom fee schedule,117,2500,253.44"
"Outpatient Medical Services,HOSPITAL,64405,""NBLOCK INJ, OCCIPITAL"",360,611.75,2500,pays based on per day rate,253.44,100% of BCBS custom fee schedule,272.08,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,408.13,pays based on APC rate,299.29,pays based on APC rate,394.53,pays based on APC rate,121.92,100% LA Medicaid OP CCR which is 19.93 percent of charges,272.08,pays based on APC rate,367.05,60% of total billed charges,530.58,pays based on APC rate,326.74,100% of UHC custom fee schedule,272.08,pays based on APC rate ,144,100% of WORK COMP custom fee schedule,144,2500,253.44"
"Outpatient Medical Services,HOSPITAL,64413,NJX ANES CRV PLEXUS,360,1358.45,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,611.3,45% Of total billed charges,815.07,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,815.07,60% of total billed charges,1086.76,80% of total billed charges,725.56,100% of UHC custom fee schedule,N/A,not separately reimbursable,158,100% of WORK COMP custom fee schedule,158,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64417,INJECTION ANESTHETIC AGENT AXILLARY NERV,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,158,100% of WORK COMP custom fee schedule,158,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64420,NJX ANES INTERCOSTAL NERVE,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,134,100% of WORK COMP custom fee schedule,134,2500,562.78"
"Outpatient Medical Services,HOSPITAL,64421,NBLOCK INJECTION INTERCOST MLT,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,190,100% of WORK COMP custom fee schedule,190,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64425,""NBLOCK INJ, ILIO-ING/HYPOGI"",360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,270.74,100% LA Medicaid OP CCR which is 19.93 percent of charges,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,172,100% of WORK COMP custom fee schedule,172,2500,562.78"
"Outpatient Medical Services,HOSPITAL,64445,INJECTION ANESTHETIC AGENT SCIATIC NERVE,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,270.74,100% LA Medicaid OP CCR which is 19.93 percent of charges,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,145,100% of WORK COMP custom fee schedule,145,2500,562.78"
"Outpatient Medical Services,HOSPITAL,64447,NJX ANES FEM NERVE 1,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,270.74,100% LA Medicaid OP CCR which is 19.93 percent of charges,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,138,100% of WORK COMP custom fee schedule,138,2500,562.78"
"Outpatient Medical Services,HOSPITAL,64449,INJECT ANES LUBAR PLEXUS POST ONT NFS CA,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,176,100% of WORK COMP custom fee schedule,176,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64450,""NBLOCK, OTHER PERIPHERAL"",360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,131,100% of WORK COMP custom fee schedule,131,2500,562.78"
"Outpatient Medical Services,HOSPITAL,64455,NJX ANES AND STEROID PLANTAR COMMON DIGI,360,611.75,2500,pays based on per day rate,253.44,100% of BCBS custom fee schedule,272.08,pays based on per APC rate,150,100% of ASC TIER GROUPINGS rate,408.13,pays based on APC rate,299.29,pays based on APC rate,394.53,pays based on APC rate,121.92,100% LA Medicaid OP CCR which is 19.93 percent of charges,272.08,pays based on APC rate,367.05,60% of total billed charges,530.58,pays based on APC rate,326.74,100% of UHC custom fee schedule,272.08,pays based on APC rate ,73,100% of WORK COMP custom fee schedule,73,2500,253.44"
"Outpatient Medical Services,HOSPITAL,64461,Pvb thoracic single inj site,360,1358.45,2500,pays based on per day rate,562.78,100% of BCBS custom fee schedule,638.33,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,957.5,pays based on APC rate,702.16,pays based on APC rate,925.58,pays based on APC rate,359.35,100% LA Medicaid fee schedule,638.33,pays based on APC rate,815.07,60% of total billed charges,1244.75,pays based on APC rate,725.56,100% of UHC custom fee schedule,638.33,pays based on APC rate ,N/A,not separately reimbursable,562.78,2600,562.78"
"Outpatient Medical Services,HOSPITAL,64462,Pvb thoracic 2nd+ inj site,360,693.74,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,312.18,45% Of total billed charges,416.24,60% of total billed charges,138.26,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,416.24,60% of total billed charges,554.99,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,312.18,2600,N/A"
"Outpatient Medical Services,HOSPITAL,64479,INJ FORAMEN EPIDURAL C/T,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,N/A,Not separately reimbursable,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64479,INJ FORAMEN EPIDURAL C/T,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,N/A,Not separately reimbursable,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64479,INJ FORAMEN EPIDURAL C/T,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,N/A,Not separately reimbursable,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64479,INJ FORAMEN EPIDURAL C/T,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,N/A,Not separately reimbursable,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64480,INJ FORAMEN EPIDURAL ADD-ON,360,418.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,188.15,45% Of total billed charges,250.86,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,250.86,60% of total billed charges,334.48,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,188.15,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64480,INJ FORAMEN EPIDURAL ADD-ON,360,418.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,188.15,45% Of total billed charges,250.86,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,250.86,60% of total billed charges,334.48,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,188.15,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64480,INJ FORAMEN EPIDURAL ADD-ON,360,418.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,188.15,45% Of total billed charges,250.86,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,250.86,60% of total billed charges,334.48,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,188.15,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64480,INJ FORAMEN EPIDURAL ADD-ON,360,418.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,188.15,45% Of total billed charges,250.86,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,250.86,60% of total billed charges,334.48,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,188.15,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64483,INJ FORAMEN EPIDURAL L/S,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64483,INJ FORAMEN EPIDURAL L/S,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64483,INJ FORAMEN EPIDURAL L/S,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64483,INJ FORAMEN EPIDURAL L/S,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64484,INJ FORAMEN EPIDURAL ADD-ON,360,1345.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,605.3,45% Of total billed charges,807.06,60% of total billed charges,268.08,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,807.06,60% of total billed charges,1076.08,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,605.3,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64484,INJ FORAMEN EPIDURAL ADD-ON,360,1345.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,605.3,45% Of total billed charges,807.06,60% of total billed charges,268.08,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,807.06,60% of total billed charges,1076.08,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,605.3,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64484,INJ FORAMEN EPIDURAL ADD-ON,360,1345.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,605.3,45% Of total billed charges,807.06,60% of total billed charges,268.08,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,807.06,60% of total billed charges,1076.08,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,605.3,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64484,INJ FORAMEN EPIDURAL ADD-ON,360,1345.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,605.3,45% Of total billed charges,807.06,60% of total billed charges,268.08,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,807.06,60% of total billed charges,1076.08,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,605.3,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64490,INJ DX OR THERAPEUTIC FACET CERV OR THOR,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64490,INJ DX OR THERAPEUTIC FACET CERV OR THOR,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64490,INJ DX OR THERAPEUTIC FACET CERV OR THOR,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64490,INJ DX OR THERAPEUTIC FACET CERV OR THOR,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64491,INJ DX OR THERA FACET CERV OR THOR 2ND L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64491,INJ DX OR THERA FACET CERV OR THOR 2ND L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64491,INJ DX OR THERA FACET CERV OR THOR 2ND L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64491,INJ DX OR THERA FACET CERV OR THOR 2ND L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64492,INJ DX OR THERA FACET CERV OR THOR 3RD L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64492,INJ DX OR THERA FACET CERV OR THOR 3RD L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64492,INJ DX OR THERA FACET CERV OR THOR 3RD L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64492,INJ DX OR THERA FACET CERV OR THOR 3RD L,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64493,NJX DX OR THER PVRT FACET JT LMBR SAC 1,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64493,NJX DX OR THER PVRT FACET JT LMBR SAC 1,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64493,NJX DX OR THER PVRT FACET JT LMBR SAC 1,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64493,NJX DX OR THER PVRT FACET JT LMBR SAC 1,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,334.91,100% LA Medicaid OP CCR which is 19.93 percent of charges,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,N/A,not separately reimbursable,696.18,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64494,NJX DX OR THER PVRT FACET JT LMBR SAC 2,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64494,NJX DX OR THER PVRT FACET JT LMBR SAC 2,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64494,NJX DX OR THER PVRT FACET JT LMBR SAC 2,360,1725.71,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,776.57,45% Of total billed charges,1035.43,60% of total billed charges,343.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1035.43,60% of total billed charges,1380.57,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,776.57,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64494,NJX DX OR THER PVRT FACET JT LMBR SAC 2,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64494,NJX DX OR THER PVRT FACET JT LMBR SAC 2,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64495,NJX DX OR THER PVRT FACET JT LMBR SAC 3,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64495,NJX DX OR THER PVRT FACET JT LMBR SAC 3,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64495,NJX DX OR THER PVRT FACET JT LMBR SAC 3,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64495,NJX DX OR THER PVRT FACET JT LMBR SAC 3,360,1208,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,543.6,45% Of total billed charges,724.8,60% of total billed charges,240.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,724.8,60% of total billed charges,966.4,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,543.6,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64510,""NBLOCK, STELLATE GANGLION"",360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,150,100% of WORK COMP custom fee schedule,150,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64510,""NBLOCK, STELLATE GANGLION"",360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,150,100% of WORK COMP custom fee schedule,150,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64510,""NBLOCK, STELLATE GANGLION"",360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,150,100% of WORK COMP custom fee schedule,150,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64510,""NBLOCK, STELLATE GANGLION"",360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,150,100% of WORK COMP custom fee schedule,150,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64517,NJX ANES SUPRIOR HYPOSGSTR PLEXUS,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,481.27,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,266,100% of WORK COMP custom fee schedule,266,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64520,NJX ANES LMBR THRC PVRT SYMPATHETIC,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,159,100% of WORK COMP custom fee schedule,159,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64530,NJX ANES CELIAC ;E +- RAD MNTR,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,215,100% of WORK COMP custom fee schedule,215,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64550,PHYSICAL THERAPY TNS EVALUATION,424,57.72,31.75,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,25.97,45% Of total billed charges,34.63,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,34.63,60% of total billed charges,46.18,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,47,100% of WORK COMP custom fee schedule,25.97,85,N/A"
"Outpatient Medical Services,HOSPITAL,64620,DSTRJ NULYT INTERC NRV,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,301,100% of WORK COMP custom fee schedule,301,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64633,DESTR PARAVERTEBRL NERVE L/S,360,3686.8,2500,pays based on per day rate,1634.63,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1659.06,45% Of total billed charges,2212.08,60% of total billed charges,734.78,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2212.08,60% of total billed charges,2949.44,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,2949.44,1634.63"
"Outpatient Medical Services,HOSPITAL,64633,DST NROLYTC AGNT PARVERTEB FCT,360,3945.73,2500,pays based on per day rate,1634.63,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1775.58,45% Of total billed charges,2367.44,60% of total billed charges,786.38,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2367.44,60% of total billed charges,3156.58,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,3156.58,1634.63"
"Outpatient Medical Services,HOSPITAL,64634,DESTR PARAVERTEBRAL N ADD-ON,360,2196.08,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,988.24,45% Of total billed charges,1317.65,60% of total billed charges,437.68,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1317.65,60% of total billed charges,1756.86,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,988.24,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64634,DST NROLYTC AGNT PRV FCT ADDL,360,685.62,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,308.53,45% Of total billed charges,411.37,60% of total billed charges,136.64,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,411.37,60% of total billed charges,548.5,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,308.53,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64635,DESTR PARAVERTEBRL NERVE C/T,360,3368.12,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1515.65,45% Of total billed charges,2020.87,60% of total billed charges,671.27,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2020.87,60% of total billed charges,2694.5,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1515.65,3050,1667.99"
"Outpatient Medical Services,HOSPITAL,64635,DST NROLYTC AGNT PARVERTEB IM/SAC,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1667.99,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64635,DST NROLYTC AGNT PARVERTEB IM/SAC,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1667.99,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64635,DST NROLYTC AGNT PARVERTEB IM/SAC,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1667.99,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64635,DST NROLYTC AGNT PARVERTEB IM/SAC,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,3050,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,802.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,1667.99,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64636,DESTR PARAVERTEBRAL N ADD-ON,360,1961.37,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,882.62,45% Of total billed charges,1176.82,60% of total billed charges,390.9,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1176.82,60% of total billed charges,1569.1,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,882.62,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64636,DST NROLYTC ADDL IM/SA,360,2801.96,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1260.88,45% Of total billed charges,1681.18,60% of total billed charges,558.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1681.18,60% of total billed charges,2241.57,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64636,DST NROLYTC ADDL IM/SA,360,2801.96,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1260.88,45% Of total billed charges,1681.18,60% of total billed charges,558.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1681.18,60% of total billed charges,2241.57,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64636,DST NROLYTC ADDL IM/SA,360,2801.96,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1260.88,45% Of total billed charges,1681.18,60% of total billed charges,558.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1681.18,60% of total billed charges,2241.57,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64636,DST NROLYTC ADDL IM/SA,360,2801.96,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1260.88,45% Of total billed charges,1681.18,60% of total billed charges,558.43,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1681.18,60% of total billed charges,2241.57,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,2500,N/A"
"Outpatient Medical Services,HOSPITAL,64640,DSTRJ NULTYOTH PRPH NRV/BRANCH,360,1680.45,2500,pays based on per day rate,696.18,100% of BCBS custom fee schedule,820.63,pays based on per APC rate,1250,100% of ASC TIER GROUPINGS rate,1230.94,pays based on APC rate,902.68,pays based on APC rate,1189.91,pays based on APC rate,359.35,100% LA Medicaid fee schedule,820.63,pays based on APC rate,1008.27,60% of total billed charges,1600.23,pays based on APC rate,897.54,100% of UHC custom fee schedule,820.63,pays based on APC rate ,248,100% of WORK COMP custom fee schedule,248,2500,696.18"
"Outpatient Medical Services,HOSPITAL,64702,NEURP DGTAL 1/BTH SM DGT,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,633,100% of WORK COMP custom fee schedule,633,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64704,REVISE HAND/FOOT NERVE,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,748,100% of WORK COMP custom fee schedule,748,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64708,REVISE ARM/LEG NERVE,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1011,100% of WORK COMP custom fee schedule,1011,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64708,REVISE ARM/LEG NERVE,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1011,100% of WORK COMP custom fee schedule,1011,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64708,REVISE ARM/LEG NERVE,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1011,100% of WORK COMP custom fee schedule,1011,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64708,REVISE ARM/LEG NERVE,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1011,100% of WORK COMP custom fee schedule,1011,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64718,REVISE ULNAR NERVE AT ELBOW,360,3059.95,2500,pays based on per day rate,1267.68,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1376.98,45% Of total billed charges,1835.97,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1835.97,60% of total billed charges,2447.96,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,943,100% of WORK COMP custom fee schedule,943,2500,1267.68"
"Outpatient Medical Services,HOSPITAL,64718,REVISE ULNAR NERVE AT ELBOW,360,3059.95,2500,pays based on per day rate,1267.68,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1376.98,45% Of total billed charges,1835.97,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1835.97,60% of total billed charges,2447.96,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,943,100% of WORK COMP custom fee schedule,943,2500,1267.68"
"Outpatient Medical Services,HOSPITAL,64718,REVISE ULNAR NERVE AT ELBOW,360,3059.95,2500,pays based on per day rate,1267.68,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1376.98,45% Of total billed charges,1835.97,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1835.97,60% of total billed charges,2447.96,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,943,100% of WORK COMP custom fee schedule,943,2500,1267.68"
"Outpatient Medical Services,HOSPITAL,64718,REVISE ULNAR NERVE AT ELBOW,360,3059.95,2500,pays based on per day rate,1267.68,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1376.98,45% Of total billed charges,1835.97,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1835.97,60% of total billed charges,2447.96,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,943,100% of WORK COMP custom fee schedule,943,2500,1267.68"
"Outpatient Medical Services,HOSPITAL,64719,REVISE ULNAR NERVE AT WRIST,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,745,100% of WORK COMP custom fee schedule,745,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64721,CARPAL TUNNEL SURGERY,360,3784.68,2500,pays based on per day rate,1567.92,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1703.11,45% Of total billed charges,2270.81,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2270.81,60% of total billed charges,3027.74,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,688,100% of WORK COMP custom fee schedule,688,3027.74,1567.92"
"Outpatient Medical Services,HOSPITAL,64722,RELIEVE PRESSURE ON NERVE OR NERVES,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,829,100% of WORK COMP custom fee schedule,829,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64727,INTERNAL NERVE REVISION,360,3952.93,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1778.82,45% Of total billed charges,2371.76,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2371.76,60% of total billed charges,3162.34,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,488,100% of WORK COMP custom fee schedule,488,3162.34,N/A"
"Outpatient Medical Services,HOSPITAL,64772,TRANSXJ/ALVSN OTH SPI NRV XDRL,360,3784.68,2500,pays based on per day rate,1567.92,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1703.11,45% Of total billed charges,2270.81,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2270.81,60% of total billed charges,3027.74,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1053,100% of WORK COMP custom fee schedule,1053,3027.74,1567.92"
"Outpatient Medical Services,HOSPITAL,64776,REMOVE DIGIT NERVE LESION,360,3952.93,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1778.82,45% Of total billed charges,2371.76,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2371.76,60% of total billed charges,3162.34,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,570,100% of WORK COMP custom fee schedule,570,3162.34,1667.99"
"Outpatient Medical Services,HOSPITAL,64778,EXCISION OF NEUROMA DIGITAL NERVE EACH,360,3952.93,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1778.82,45% Of total billed charges,2371.76,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2371.76,60% of total billed charges,3162.34,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,427,100% of WORK COMP custom fee schedule,427,3162.34,N/A"
"Outpatient Medical Services,HOSPITAL,64782,REMOVE LIMB NERVE LESION,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,777,100% of WORK COMP custom fee schedule,777,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64783,EXC NEUROMA HD/FT EA NRV XCP SM DGT,360,5534.1,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,2490.35,45% Of total billed charges,3320.46,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,3320.46,60% of total billed charges,4427.28,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,510,100% of WORK COMP custom fee schedule,510,4427.28,N/A"
"Outpatient Medical Services,HOSPITAL,64784,EXC NEUROMA M PR NRV XCP SCIATIC,360,3059.95,2500,pays based on per day rate,1267.68,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1376.98,45% Of total billed charges,1835.97,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,1835.97,60% of total billed charges,2447.96,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1137,100% of WORK COMP custom fee schedule,1137,2700,1267.68"
"Outpatient Medical Services,HOSPITAL,64787,IMPLANT NERVE END,360,3952.93,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1778.82,45% Of total billed charges,2371.76,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2371.76,60% of total billed charges,3162.34,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,593,100% of WORK COMP custom fee schedule,593,3162.34,N/A"
"Outpatient Medical Services,HOSPITAL,64788,EXC NEUROFIBROMA NEUROLEMMOMA CUTAN NRV,360,3422.33,2500,pays based on per day rate,1417.8,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1540.05,45% Of total billed charges,2053.4,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2053.4,60% of total billed charges,2737.86,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,598,100% of WORK COMP custom fee schedule,598,2737.86,1417.8"
"Outpatient Medical Services,HOSPITAL,64790,EXC NEROFIBROMA/LEMMOMA MAJOR PERIPH NRV,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2700,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,550.32,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1365,100% of WORK COMP custom fee schedule,1365,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64795,BIOPSY OF NERVE,360,4026.25,2500,pays based on per day rate,1667.99,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2200,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,1811.81,45% Of total billed charges,2415.75,60% of total billed charges,481.27,100% LA Medicaid fee schedule,N/A,not separately reimbursable,2415.75,60% of total billed charges,3221,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,409,100% of WORK COMP custom fee schedule,409,3221,1667.99"
"Outpatient Medical Services,HOSPITAL,64820,SYMPTH DGTAL ARTS EA DGT,360,1811.83,2500,pays based on per day rate,750.6,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2600,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,815.32,45% Of total billed charges,1087.1,60% of total billed charges,361.1,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,1087.1,60% of total billed charges,1449.46,80% of total billed charges,2150.45,100% of UHC custom fee schedule,N/A,not separately reimbursable,1191,100% of WORK COMP custom fee schedule,750.6,2600,750.6"
"Outpatient Medical Services,HOSPITAL,64831,REPAIR OF DIGIT NERVE,360,9833.63,2500,pays based on per day rate,4073.87,100% of BCBS custom fee schedule,N/A,not separately reimbursable,2900,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4425.13,45% Of total billed charges,5900.18,60% of total billed charges,679.83,100% LA Medicaid fee schedule,N/A,not separately reimbursable,5900.18,60% of total billed charges,7866.9,80% of total billed charges,6179.07,100% of UHC custom fee schedule,N/A,not separately reimbursable,906,100% of WORK COMP custom fee schedule,906,7866.9,4073.87"
"Outpatient Medical Services,HOSPITAL,64832,SUTR DGTAL NRV HD/FT E DGTL NRV,360,7087.18,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,3189.23,45% Of total billed charges,4252.31,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,4252.31,60% of total billed charges,5669.74,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,548,100% of WORK COMP custom fee schedule,548,5669.74,N/A"
"Outpatient Medical Services,HOSPITAL,64834,SUT 1 NV HN/FT CM SENS NV,360,8792.43,2500,pays based on per day rate,3642.53,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,5275.46,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,980,100% of WORK COMP custom fee schedule,980,11510.87,3642.53"
"Outpatient Medical Services,HOSPITAL,64835,SUTURE 1 NERVE MED MOTOR THENAR,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,550.32,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1237,100% of WORK COMP custom fee schedule,1237,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,64836,SUTURE 1 NERVE ULNAR MOTOR,360,7751.23,2500,pays based on per day rate,3211.18,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,550.32,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,4650.74,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1302,100% of WORK COMP custom fee schedule,1302,11510.87,3211.18"
"Outpatient Medical Services,HOSPITAL,64837,SUTR EAC NRV HAND FOOT,360,9922.05,2500,pays based on per day rate,N/A,not separately reimbursable,N/A,not separately reimbursable,1250,100% of ASC TIER GROUPINGS rate,N/A,not separately reimbursable,4464.92,45% Of total billed charges,5953.23,60% of total billed charges,359.35,100% LA Medicaid fee schedule,N/A,not separately reimbursable,5953.23,60% of total billed charges,7937.64,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,802,100% of WORK COMP custom fee schedule,802,7937.64,N/A"
"Outpatient Medical Services,HOSPITAL,64857,SUTURE OF MAJOR PERIPHERAL NERVE ARM/LEG,360,8792.43,2500,pays based on per day rate,3642.53,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2200,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,481.27,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,5275.46,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1735,100% of WORK COMP custom fee schedule,1735,11510.87,3642.53"
"Outpatient Medical Services,HOSPITAL,64896,NERVE GRAFT HAND/FOOT >4 CM,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,2700,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,550.32,100% LA Medicaid fee schedule,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,2748,100% of WORK COMP custom fee schedule,2500,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,64910,NERVE REPAIR W/CONDUIT EA NERVE,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,3050,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,2305.7,100% LA Medicaid OP CCR which is 19.93 percent of charges,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,1740,100% of WORK COMP custom fee schedule,1740,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,64911,NERVE REPAIR WITH AUTOGENOUS VEIN GRAFT,360,11568.98,2500,pays based on per day rate,4792.79,100% of BCBS custom fee schedule,5903.01,pays based on per APC rate,3050,100% of ASC TIER GROUPINGS rate,8854.51,pays based on APC rate,6493.31,pays based on APC rate,8559.37,pays based on APC rate,2305.7,100% LA Medicaid OP CCR which is 19.93 percent of charges,5903.01,pays based on APC rate,6941.39,60% of total billed charges,11510.87,pays based on APC rate,6179.07,100% of UHC custom fee schedule,5903.01,pays based on APC rate ,2185,100% of WORK COMP custom fee schedule,2185,11510.87,4792.79"
"Outpatient Medical Services,HOSPITAL,64999,NERVOUS SYSTEM SURGERY,360,611.75,2500,pays based on per day rate,253.44,100% of BCBS custom fee schedule,272.08,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,408.13,pays based on APC rate,299.29,pays based on APC rate,394.53,pays based on APC rate,N/A,Not separately reimbursable,272.08,pays based on APC rate,367.05,60% of total billed charges,530.58,pays based on APC rate,326.74,100% of UHC custom fee schedule,272.08,pays based on APC rate ,N/A,not separately reimbursable,253.44,2600,253.44"
"Outpatient Medical Services,RADIOLOGY,73000,XRAY DX CLAVICLE,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,55,100% of WORK COMP custom fee schedule,55,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73010,XRAY DX RT SCAPULA,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,56,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,73010,XRAY DX LT SCAPULA,320,90.45,49.75,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,40.7,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,18.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,54.27,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,40.7,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,73020,XRAY DX RT SHOULDER,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,51,100% of WORK COMP custom fee schedule,51,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73020,XRAY DX LT SHOULDER,320,90.45,49.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,40.7,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,18.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,54.27,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,51,100% of WORK COMP custom fee schedule,40.7,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73030,XRAY DX RT SHOULDER 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,61,100% of WORK COMP custom fee schedule,61,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73030,XRAY DX LT SHOULDER 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,61,100% of WORK COMP custom fee schedule,61,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73040,RADEX SHO ARTHG RS&I,320,1140.93,627.51,55% of total billed charges,472.66,100% of BCBS custom fee schedule,329.18,pays based on per APC rate,513.42,45% of total billed charges,493.78,pays based on APC rate,362.1,pays based on APC rate,477.32,pays based on APC rate,227.39,100% LA Medicaid OP CCR which is 19.93 percent of charges,329.18,pays based on APC rate,684.56,60% of total billed charges,641.91,pays based on APC rate,609.38,100% of UHC custom fee schedule,329.18,pays based on APC rate ,210,100% of WORK COMP custom fee schedule,210,684.56,472.66"
"Outpatient Medical Services,RADIOLOGY,73050,XRAY DX ACROMIOCLAVICULAR,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,70,100% of WORK COMP custom fee schedule,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73060,XRAY DX RT HUMERUS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,60,100% of WORK COMP custom fee schedule,60,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73060,XRAY DX LT HUMERUS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,60,100% of WORK COMP custom fee schedule,60,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73070,XRAY DX RT ELBOW AP&LAT,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,54,100% of WORK COMP custom fee schedule,54,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73070,XRAY DX LT ELBOW AP&LAT,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,54,100% of WORK COMP custom fee schedule,54,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73080,XRAY DX RT ELBOW 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,60,100% of WORK COMP custom fee schedule,60,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73080,XRAY DX LT ELBOW 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,60,100% of WORK COMP custom fee schedule,60,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73090,XRAY DX RT FOREARM AP&LA,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,55,100% of WORK COMP custom fee schedule,55,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73090,XRAY DX LT FOREARM AP&LA,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,55,100% of WORK COMP custom fee schedule,55,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73100,XRAY DX RT WRIST AP&LAT,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73100,XRAY DX LT WRIST AP&LAT,320,90.45,49.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,40.7,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,18.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,54.27,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,40.7,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73110,XRAY DX WRIST RT 3 VIEW,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73110,XRAY DX WRIST LT 3 VIEW,320,90.45,49.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,40.7,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,18.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,54.27,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,40.7,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73120,XRAY DX RT HAND 2 VIEWS,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,73120,XRAY DX LT HAND 2 VIEWS,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,73130,XRAY DX RT HAND 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73130,XRAY DX LT HAND 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73140,XRAY DX RT FINGERS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,45,100% of WORK COMP custom fee schedule,45,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73140,XRAY DX LT FINGERS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,45,100% of WORK COMP custom fee schedule,45,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73200,CT RIGHT UPPER EXTREMITY W/O CONTRAST,352,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,472,100% of WORK COMP custom fee schedule,98.02,472,118.55"
"Outpatient Medical Services,RADIOLOGY,73200,CT LEFT UPPER EXTREMITY W/O CONTRAST,352,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,472,100% of WORK COMP custom fee schedule,98.02,472,118.55"
"Outpatient Medical Services,RADIOLOGY,73201,CT LEFT UPPER EXTREMITY W/O CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,329.18,pays based on per APC rate,284.33,45% of total billed charges,493.77,pays based on APC rate,362.1,pays based on APC rate,477.31,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,329.18,pays based on APC rate,379.11,60% of total billed charges,641.91,pays based on APC rate,337.47,100% of UHC custom fee schedule,329.18,pays based on APC rate ,548,100% of WORK COMP custom fee schedule,261.76,641.91,261.76"
"Outpatient Medical Services,RADIOLOGY,73201,CT RIGHT UPPER EXTREMITY W/O CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,329.18,pays based on per APC rate,284.33,45% of total billed charges,493.77,pays based on APC rate,362.1,pays based on APC rate,477.31,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,329.18,pays based on APC rate,379.11,60% of total billed charges,641.91,pays based on APC rate,337.47,100% of UHC custom fee schedule,329.18,pays based on APC rate ,548,100% of WORK COMP custom fee schedule,261.76,641.91,261.76"
"Outpatient Medical Services,RADIOLOGY,73202,CT RIGHT UPPER EXTREMITY W/O & W/CONTRAS,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,663,100% of WORK COMP custom fee schedule,164.09,663,261.76"
"Outpatient Medical Services,RADIOLOGY,73202,CT LEFT UPPER EXTREMITY W/O & W/CONTRAS,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,663,100% of WORK COMP custom fee schedule,164.09,663,261.76"
"Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER JOINT EXTREMITY,619,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,906,100% of WORK COMP custom fee schedule,222.8,906,240.6"
"Outpatient Medical Services,RADIOLOGY,73501,X-RAY EXAM LT HIP UNI 1 VIEW,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73501,XRAY DX RT HIP 1 VIEW,320,205,112.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,92.25,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,40.86,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,123,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73501,XRAY DX LT HIP 1 VIEW,320,205,112.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,92.25,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,40.86,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,123,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73501,X-RAY EXAM RT HIP UNI 1 VIEW,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73502,XRAY DX RT HIP COMPLETE,320,265,145.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,119.25,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,52.81,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,159,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,159,64.34"
"Outpatient Medical Services,RADIOLOGY,73502,XRAY DX LT HIP COMPLETE,320,265,145.75,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,119.25,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,52.81,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,159,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,159,64.34"
"Outpatient Medical Services,RADIOLOGY,73502,X-RAY DX HIP 2 VIEW - RIGHT,320,67.6,37.18,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,30.42,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,13.47,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,40.56,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,30.42,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73502,X-RAY DX HIP 2 VIEW - LEFT,320,67.6,37.18,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,30.42,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,13.47,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,40.56,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,30.42,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73520,XRAY DX RT HIP BILATERAL W,320,220,121,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,99,45% of total billed charges,N/A,not separately reimbursable,99,45% Of total billed charges,132,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,132,60% of total billed charges,176,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,77,100% of WORK COMP custom fee schedule,77,176,N/A"
"Outpatient Medical Services,RADIOLOGY,73520,XRAY DX LT HIP BILATERAL W,320,220,121,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,99,45% of total billed charges,N/A,not separately reimbursable,99,45% Of total billed charges,132,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,132,60% of total billed charges,176,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,77,100% of WORK COMP custom fee schedule,77,176,N/A"
"Outpatient Medical Services,RADIOLOGY,73530,XRAY DX RT HIP OPERTVE OVR,320,530,291.5,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,238.5,45% of total billed charges,N/A,not separately reimbursable,238.5,45% Of total billed charges,318,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,318,60% of total billed charges,424,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,69,100% of WORK COMP custom fee schedule,69,424,N/A"
"Outpatient Medical Services,RADIOLOGY,73530,XRAY DX RT HIP OPRTVE UPTO,320,235,129.25,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,105.75,45% of total billed charges,N/A,not separately reimbursable,105.75,45% Of total billed charges,141,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,141,60% of total billed charges,188,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,69,100% of WORK COMP custom fee schedule,69,188,N/A"
"Outpatient Medical Services,RADIOLOGY,73530,XRAY DX LT HIP OPERTVE OVR,320,530,291.5,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,238.5,45% of total billed charges,N/A,not separately reimbursable,238.5,45% Of total billed charges,318,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,318,60% of total billed charges,424,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,69,100% of WORK COMP custom fee schedule,69,424,N/A"
"Outpatient Medical Services,RADIOLOGY,73530,XRAY DX LT HIP OPRTVE UPTO,320,235,129.25,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,105.75,45% of total billed charges,N/A,not separately reimbursable,105.75,45% Of total billed charges,141,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,141,60% of total billed charges,188,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,69,100% of WORK COMP custom fee schedule,69,188,N/A"
"Outpatient Medical Services,RADIOLOGY,73552,XRAY DX RT FEMUR,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73552,XRAY DX LT FEMUR,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73560,XRAY DX RT KNEE 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,56,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73560,XRAY DX LT KNEE 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,56,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73590,XRAY DX RT TIBIA & FIBULA,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,56,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73590,XRAY DX LT TIBIA & FIBULA,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,56,100% of WORK COMP custom fee schedule,56,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73600,XRAY DX RT ANKLE 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73600,XRAY DX LT ANKLE 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73610,XRAY DX RT ANKLE COMPLETE,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73610,XRAY DX LT ANKLE COMPLETE,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73620,XRAY DX RT FOOT 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73620,XRAY DX LT FOOT 2 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,53,100% of WORK COMP custom fee schedule,53,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73630,XRAY DX RT FOOT 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73630,XRAY DX LT FOOT 3 VIEWS,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,57,100% of WORK COMP custom fee schedule,57,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73650,XRAY DX RT CALCANEUS(HEEL),320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,52,100% of WORK COMP custom fee schedule,52,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73650,XRAY DX LT CALCANEUS(HEEL),320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,52,100% of WORK COMP custom fee schedule,52,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73660,XRAY DX RT TOES,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,45,100% of WORK COMP custom fee schedule,45,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73660,XRAY DX LT TOES,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,45,100% of WORK COMP custom fee schedule,45,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,73700,CT RIGHT LOWER EXTREMITY W/O CONTRAST,352,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,472,100% of WORK COMP custom fee schedule,98.02,472,118.55"
"Outpatient Medical Services,RADIOLOGY,73700,CT LEFT LOWER EXTREMITY W/O CONTRAST,352,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,472,100% of WORK COMP custom fee schedule,98.02,472,118.55"
"Outpatient Medical Services,RADIOLOGY,73701,CT RIGHT LOWER EXTREMITY W/CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,548,100% of WORK COMP custom fee schedule,164.09,548,261.76"
"Outpatient Medical Services,RADIOLOGY,73701,CT LEFT LOWER EXTREMITY W/CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,548,100% of WORK COMP custom fee schedule,164.09,548,261.76"
"Outpatient Medical Services,RADIOLOGY,73702,CT OF KNEE W/O CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,663,100% of WORK COMP custom fee schedule,164.09,663,261.76"
"Outpatient Medical Services,RADIOLOGY,73702,CT LEFT LOWER EXT W/O AND W/ CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,663,100% of WORK COMP custom fee schedule,164.09,663,261.76"
"Outpatient Medical Services,RADIOLOGY,73702,CT RIGHT LOWER EXT W/O AND W/ CONTRAST,352,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,164.09,pays based on per APC rate,284.33,45% of total billed charges,246.13,pays based on APC rate,180.49,pays based on APC rate,237.92,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,164.09,pays based on APC rate,379.11,60% of total billed charges,319.97,pays based on APC rate,337.47,100% of UHC custom fee schedule,164.09,pays based on APC rate ,663,100% of WORK COMP custom fee schedule,164.09,663,261.76"
"Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER JOINT EXTREMITY,619,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,906,100% of WORK COMP custom fee schedule,222.8,906,240.6"
"Outpatient Medical Services,RADIOLOGY,74000,XRAY ABDOMEN AP - PROFESSIONAL,972,145,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,Not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,N/A,N/A"
"Outpatient Medical Services,RADIOLOGY,74000,XRAY DX ABDOMEN 2 VIEW,320,235,129.25,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,105.75,45% of total billed charges,N/A,not separately reimbursable,105.75,45% Of total billed charges,141,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,141,60% of total billed charges,188,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,57,100% of WORK COMP custom fee schedule,57,188,N/A"
"Outpatient Medical Services,RADIOLOGY,74018,XRAY DX ABDOMEN AP,320,235,129.25,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,105.75,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,46.84,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,141,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,74019,XRAY DX ABDOMEN 2 VIEWS,320,145,79.75,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,65.25,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,28.9,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,87,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,N/A,not separately reimbursable,65.25,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,74020,""XRAY ABDOMEN, COMP. - PROFESSIONAL"",972,145,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,Not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,N/A,N/A"
"Outpatient Medical Services,RADIOLOGY,74021,XRAY DX ABDOMEN 3 OR MORE VIEWS,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,N/A,not separately reimbursable,98.01,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,74022,XRAY ABDOMEN COMP. ACUTE ABD SER. - PRO,972,286.15,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,N/A,N/A"
"Outpatient Medical Services,RADIOLOGY,74150,CT OF ABDOMEN WITHOUT CONTRAST,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,533,100% of WORK COMP custom fee schedule,98.02,533,118.55"
"Outpatient Medical Services,RADIOLOGY,74150,CT OF ABDOMEN W/ CONTRAST,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,533,100% of WORK COMP custom fee schedule,98.02,533,118.55"
"Outpatient Medical Services,RADIOLOGY,74176,CT ABD & PELV W/O CONTRAST,320,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,467,100% of WORK COMP custom fee schedule,222.8,467,240.6"
"Outpatient Medical Services,RADIOLOGY,74177,CT ABD & PELV W CONTRAST,320,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,329.18,pays based on per APC rate,284.33,45% of total billed charges,493.77,pays based on APC rate,362.1,pays based on APC rate,477.31,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,329.18,pays based on APC rate,379.11,60% of total billed charges,641.91,pays based on APC rate,337.47,100% of UHC custom fee schedule,329.18,pays based on APC rate ,736,100% of WORK COMP custom fee schedule,261.76,736,261.76"
"Outpatient Medical Services,RADIOLOGY,74178,CT ABD & PELV W & W/O CONTRAST,320,631.85,347.52,55% of total billed charges,261.76,100% of BCBS custom fee schedule,329.18,pays based on per APC rate,284.33,45% of total billed charges,493.77,pays based on APC rate,362.1,pays based on APC rate,477.31,pays based on APC rate,125.93,100% LA Medicaid OP CCR which is 19.93 percent of charges,329.18,pays based on APC rate,379.11,60% of total billed charges,641.91,pays based on APC rate,337.47,100% of UHC custom fee schedule,329.18,pays based on APC rate ,935,100% of WORK COMP custom fee schedule,261.76,935,261.76"
"Outpatient Medical Services,RADIOLOGY,75820,VENOGRAM,320,1531.43,842.29,55% of total billed charges,634.44,100% of BCBS custom fee schedule,1431.89,pays based on per APC rate,689.14,45% of total billed charges,2147.84,pays based on APC rate,1575.08,pays based on APC rate,2076.25,pays based on APC rate,305.21,100% LA Medicaid OP CCR which is 19.93 percent of charges,1431.89,pays based on APC rate,918.86,60% of total billed charges,2792.2,pays based on APC rate,817.95,100% of UHC custom fee schedule,1431.89,pays based on APC rate ,144,100% of WORK COMP custom fee schedule,144,2792.2,634.44"
"Outpatient Medical Services,RADIOLOGY,76000,C-ARM OR 1-5 MINUTES,320,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,115,100% of WORK COMP custom fee schedule,115,434.47,240.6"
"Outpatient Medical Services,RADIOLOGY,76000,C-ARM OR 5.01-10 MINUTES,320,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,115,100% of WORK COMP custom fee schedule,115,434.47,240.6"
"Outpatient Medical Services,RADIOLOGY,76000,C-ARM OR 10.01-15 MINUTES,320,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,115,100% of WORK COMP custom fee schedule,115,434.47,240.6"
"Outpatient Medical Services,RADIOLOGY,76000,C-ARM FLUORO OTHER PAIN INJECTION,320,580.78,319.43,55% of total billed charges,240.6,100% of BCBS custom fee schedule,222.8,pays based on per APC rate,261.35,45% of total billed charges,334.21,pays based on APC rate,245.08,pays based on APC rate,323.06,pays based on APC rate,115.75,100% LA Medicaid OP CCR which is 19.93 percent of charges,222.8,pays based on APC rate,348.47,60% of total billed charges,434.47,pays based on APC rate,310.2,100% of UHC custom fee schedule,222.8,pays based on APC rate ,115,100% of WORK COMP custom fee schedule,115,434.47,240.6"
"Outpatient Medical Services,RADIOLOGY,76496,XRAY DX FLOUROSCOPY OR,320,155.3,85.42,55% of total billed charges,64.34,100% of BCBS custom fee schedule,81.16,pays based on per APC rate,69.89,45% of total billed charges,121.74,pays based on APC rate,89.27,pays based on APC rate,117.68,pays based on APC rate,30.95,100% LA Medicaid OP CCR which is 19.93 percent of charges,81.16,pays based on APC rate,93.18,60% of total billed charges,158.26,pays based on APC rate,82.95,100% of UHC custom fee schedule,81.16,pays based on APC rate ,N/A,not separately reimbursable,64.34,158.26,64.34"
"Outpatient Medical Services,RADIOLOGY,76700,ULTRASOUND ABDOMEN COMPLETE,402,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,229,100% of WORK COMP custom fee schedule,98.02,229,118.55"
"Outpatient Medical Services,RADIOLOGY,76770,ULTRASOUND RENAL - COMPLETE,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,222,100% of WORK COMP custom fee schedule,98.02,222,118.55"
"Outpatient Medical Services,RADIOLOGY,76815,ULTRASOUND FETAL MONITORING,402,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,175,100% of WORK COMP custom fee schedule,98.01,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,76857,US EXAM PELVIC LIMITED,360,286.15,2500,pays based on per day rate,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,117,100% of WORK COMP custom fee schedule,98.02,2600,118.55"
"Outpatient Medical Services,RADIOLOGY,76881,US XTR NON-VASC COMPLETE,360,286.15,2500,pays based on per day rate,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,254,100% of WORK COMP custom fee schedule,98.02,2600,118.55"
"Outpatient Medical Services,RADIOLOGY,76881,US EXTREMITY NON-VASC REAL-TIME IMG COMP,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.02,pays based on per APC rate,128.77,45% of total billed charges,147.03,pays based on APC rate,107.81,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.02,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.02,pays based on APC rate ,254,100% of WORK COMP custom fee schedule,98.02,254,118.55"
"Outpatient Medical Services,RADIOLOGY,76882,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,320,286.15,157.38,55% of total billed charges,118.55,100% of BCBS custom fee schedule,98.01,pays based on per APC rate,128.77,45% of total billed charges,147.02,pays based on APC rate,107.82,pays based on APC rate,142.12,pays based on APC rate,57.03,100% LA Medicaid OP CCR which is 19.93 percent of charges,98.01,pays based on APC rate,171.69,60% of total billed charges,191.13,pays based on APC rate,152.84,100% of UHC custom fee schedule,98.01,pays based on APC rate ,72,100% of WORK COMP custom fee schedule,72,191.13,118.55"
"Outpatient Medical Services,RADIOLOGY,77001,XRAY DX FLUOROSCPY MORE,320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,248,100% of WORK COMP custom fee schedule,0.73,248,N/A"
"Outpatient Medical Services,RADIOLOGY,77002,""C-ARM  JNT INJ, TRIG PNT, PIRF, ASP, COC"",320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,163,100% of WORK COMP custom fee schedule,0.73,163,N/A"
"Outpatient Medical Services,RADIOLOGY,77003,XRAY DX FLOURO GUIDANCE,320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,136,100% of WORK COMP custom fee schedule,0.73,136,N/A"
"Outpatient Medical Services,RADIOLOGY,77003,C-ARM 10.01-15 MINUTES PAIN INJECTION,320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,136,100% of WORK COMP custom fee schedule,0.73,136,N/A"
"Outpatient Medical Services,RADIOLOGY,77003,""C-ARM PAIN INJ. 1-5 MIN, SI , RHIZO"",320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,136,100% of WORK COMP custom fee schedule,0.73,136,N/A"
"Outpatient Medical Services,RADIOLOGY,77003,C-ARM PAIN INJ. 5-10,320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,136,100% of WORK COMP custom fee schedule,0.73,136,N/A"
"Outpatient Medical Services,RADIOLOGY,77003,C-ARM  SPINE PAIN INJECTION,320,1.63,0.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,0.73,45% of total billed charges,N/A,not separately reimbursable,0.73,45% Of total billed charges,0.98,60% of total billed charges,0.32,100% LA Medicaid OP CCR which is 19.93 percent of charges,N/A,not separately reimbursable,0.98,60% of total billed charges,1.3,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,136,100% of WORK COMP custom fee schedule,0.73,136,N/A"
"Outpatient Medical Services,THERAPY,97001,PHYSICAL THERAPY EVALUATION NEW PATIENT,424,140,77,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,63,45% Of total billed charges,84,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,84,60% of total billed charges,112,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,117,100% of WORK COMP custom fee schedule,63,117,N/A"
"Outpatient Medical Services,THERAPY,97001,PT PT 15 MIN EVALUATI,424,175,96.25,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,78.75,45% Of total billed charges,105,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,105,60% of total billed charges,140,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,117,100% of WORK COMP custom fee schedule,78.75,140,N/A"
"Outpatient Medical Services,THERAPY,97001,PT PT EVALUATION,424,612.5,336.88,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,275.63,45% Of total billed charges,367.5,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,367.5,60% of total billed charges,490,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,117,100% of WORK COMP custom fee schedule,85,490,N/A"
"Outpatient Medical Services,THERAPY,97002,PHYSICAL THERAPY RE-EVALUATION,424,45,24.75,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,20.25,45% Of total billed charges,27,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,27,60% of total billed charges,36,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,49,100% of WORK COMP custom fee schedule,20.25,85,N/A"
"Outpatient Medical Services,THERAPY,97002,PT PT RE-EVALUATION,424,175,96.25,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,78.75,45% Of total billed charges,105,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,105,60% of total billed charges,140,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,49,100% of WORK COMP custom fee schedule,49,140,N/A"
"Outpatient Medical Services,THERAPY,97010,PT HOT/COLD PACKS,421,4.09,5.76,100% of AETNA custom fee schedule,N/A,not separately reimbursable,4.09,100% of cms physician fee schedule,85,pays based on per visit rate,6.14,150% of cms physician fee schedule,4.5,110% of GILSBAR physician fee schedule,5.93,145% of cms physician fee schedule,N/A,Not separately reimbursable,4.09,100% of cms physician fee schedule,2.45,60% of total billed charges,7.98,195% of cms physician fee schedule,N/A,not separately reimbursable,4.09,100% of cms physician fee schedule,19,100% of WORK COMP custom fee schedule,2.45,85,N/A"
"Outpatient Medical Services,THERAPY,97012,TRACTION MECHANICAL,421,37.55,15.42,100% of AETNA custom fee schedule,15.56,100% of BCBS custom fee schedule,13.53,100% of cms physician fee schedule,85,pays based on per visit rate,20.3,150% of cms physician fee schedule,14.88,110% of GILSBAR physician fee schedule,19.62,145% of cms physician fee schedule,N/A,Not separately reimbursable,13.53,100% of cms physician fee schedule,22.53,60% of total billed charges,26.38,195% of cms physician fee schedule,N/A,not separately reimbursable,13.53,100% of cms physician fee schedule,30,100% of WORK COMP custom fee schedule,13.53,85,15.56"
"Outpatient Medical Services,THERAPY,97012,PT MECHANICAL TRACTION,421,N/A,N/A,not separately reimbursable,N/A,not separately reimbursable,13.53,100% of cms physician fee schedule,85,pays based on per visit rate,20.3,150% of cms physician fee schedule,14.88,110% of GILSBAR physician fee schedule,19.62,145% of cms physician fee schedule,N/A,Not separately reimbursable,13.53,100% of cms physician fee schedule,N/A,not separately reimbursable,26.38,195% of cms physician fee schedule,N/A,not separately reimbursable,13.53,100% of cms physician fee schedule,N/A,not separately reimbursable,13.53,85,N/A"
"Outpatient Medical Services,THERAPY,97014,PT ELECTRICAL STIMULATION UNATTENDED,421,37.23,15.13,100% of AETNA custom fee schedule,15.42,100% of BCBS custom fee schedule,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,16.75,45% Of total billed charges,22.34,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,22.34,60% of total billed charges,29.78,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,30,100% of WORK COMP custom fee schedule,15.13,85,15.42"
"Outpatient Medical Services,THERAPY,97014,PT ELECTRICAL STIMULATION (UNATTENDED),421,37.23,15.13,100% of AETNA custom fee schedule,15.42,100% of BCBS custom fee schedule,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,16.75,45% Of total billed charges,22.34,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,22.34,60% of total billed charges,29.78,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,30,100% of WORK COMP custom fee schedule,15.13,85,15.42"
"Outpatient Medical Services,THERAPY,97016,PT VASOPNEUMATIC,421,39.95,17.99,100% of AETNA custom fee schedule,16.55,100% of BCBS custom fee schedule,10.98,100% of cms physician fee schedule,85,pays based on per visit rate,16.47,150% of cms physician fee schedule,12.08,110% of GILSBAR physician fee schedule,15.92,145% of cms physician fee schedule,N/A,Not separately reimbursable,10.98,100% of cms physician fee schedule,23.97,60% of total billed charges,21.41,195% of cms physician fee schedule,N/A,not separately reimbursable,10.98,100% of cms physician fee schedule,35,100% of WORK COMP custom fee schedule,10.98,85,16.55"
"Outpatient Medical Services,THERAPY,97016,PT VASOPNEUMATIC DEVICES,421,49.95,17.99,100% of AETNA custom fee schedule,16.55,100% of BCBS custom fee schedule,10.98,100% of cms physician fee schedule,85,pays based on per visit rate,16.47,150% of cms physician fee schedule,12.08,110% of GILSBAR physician fee schedule,15.92,145% of cms physician fee schedule,N/A,Not separately reimbursable,10.98,100% of cms physician fee schedule,29.97,60% of total billed charges,21.41,195% of cms physician fee schedule,N/A,not separately reimbursable,10.98,100% of cms physician fee schedule,35,100% of WORK COMP custom fee schedule,10.98,85,16.55"
"Outpatient Medical Services,THERAPY,97018,PT PARAFFIN BATH,421,22.2,10.2,100% of AETNA custom fee schedule,9.2,100% of BCBS custom fee schedule,5.67,100% of cms physician fee schedule,85,pays based on per visit rate,8.51,150% of cms physician fee schedule,6.24,110% of GILSBAR physician fee schedule,8.22,145% of cms physician fee schedule,N/A,Not separately reimbursable,5.67,100% of cms physician fee schedule,13.32,60% of total billed charges,11.06,195% of cms physician fee schedule,N/A,not separately reimbursable,5.67,100% of cms physician fee schedule,36,100% of WORK COMP custom fee schedule,5.67,85,9.2"
"Outpatient Medical Services,THERAPY,97018,PT PARAFFIN BATH,421,22.61,10.2,100% of AETNA custom fee schedule,9.2,100% of BCBS custom fee schedule,5.67,100% of cms physician fee schedule,85,pays based on per visit rate,8.51,150% of cms physician fee schedule,6.24,110% of GILSBAR physician fee schedule,8.22,145% of cms physician fee schedule,N/A,Not separately reimbursable,5.67,100% of cms physician fee schedule,13.57,60% of total billed charges,11.06,195% of cms physician fee schedule,N/A,not separately reimbursable,5.67,100% of cms physician fee schedule,36,100% of WORK COMP custom fee schedule,5.67,85,9.2"
"Outpatient Medical Services,THERAPY,97022,PT STERILE WHIRLPOOL,421,47.75,21.76,100% of AETNA custom fee schedule,19.78,100% of BCBS custom fee schedule,14.36,100% of cms physician fee schedule,85,pays based on per visit rate,21.54,150% of cms physician fee schedule,15.8,110% of GILSBAR physician fee schedule,20.82,145% of cms physician fee schedule,N/A,Not separately reimbursable,14.36,100% of cms physician fee schedule,28.65,60% of total billed charges,28,195% of cms physician fee schedule,N/A,not separately reimbursable,14.36,100% of cms physician fee schedule,29,100% of WORK COMP custom fee schedule,14.36,85,19.78"
"Outpatient Medical Services,THERAPY,97022,APPL MODALITY 1+ AREAS WP,421,52.22,21.76,100% of AETNA custom fee schedule,19.78,100% of BCBS custom fee schedule,14.36,100% of cms physician fee schedule,85,pays based on per visit rate,21.54,150% of cms physician fee schedule,15.8,110% of GILSBAR physician fee schedule,20.82,145% of cms physician fee schedule,N/A,Not separately reimbursable,14.36,100% of cms physician fee schedule,31.33,60% of total billed charges,28,195% of cms physician fee schedule,N/A,not separately reimbursable,14.36,100% of cms physician fee schedule,29,100% of WORK COMP custom fee schedule,14.36,85,19.78"
"Outpatient Medical Services,THERAPY,97022,PT WHIRLPOOL,421,15.22,21.76,100% of AETNA custom fee schedule,19.78,100% of BCBS custom fee schedule,14.36,100% of cms physician fee schedule,85,pays based on per visit rate,21.54,150% of cms physician fee schedule,15.8,110% of GILSBAR physician fee schedule,20.82,145% of cms physician fee schedule,N/A,Not separately reimbursable,14.36,100% of cms physician fee schedule,9.13,60% of total billed charges,28,195% of cms physician fee schedule,N/A,not separately reimbursable,14.36,100% of cms physician fee schedule,29,100% of WORK COMP custom fee schedule,9.13,85,19.78"
"Outpatient Medical Services,THERAPY,97032,ELECTRICAL STIMULATION MANUAL,421,39.3,18.27,100% of AETNA custom fee schedule,16.28,100% of BCBS custom fee schedule,13.53,100% of cms physician fee schedule,85,pays based on per visit rate,20.3,150% of cms physician fee schedule,14.88,110% of GILSBAR physician fee schedule,19.62,145% of cms physician fee schedule,N/A,Not separately reimbursable,13.53,100% of cms physician fee schedule,23.58,60% of total billed charges,26.38,195% of cms physician fee schedule,N/A,not separately reimbursable,13.53,100% of cms physician fee schedule,28,100% of WORK COMP custom fee schedule,13.53,85,16.28"
"Outpatient Medical Services,THERAPY,97033,PT IONTOPHORESIS,421,52.38,24.67,100% of AETNA custom fee schedule,21.7,100% of BCBS custom fee schedule,17.56,100% of cms physician fee schedule,85,pays based on per visit rate,26.34,150% of cms physician fee schedule,19.32,110% of GILSBAR physician fee schedule,25.46,145% of cms physician fee schedule,N/A,Not separately reimbursable,17.56,100% of cms physician fee schedule,31.43,60% of total billed charges,34.24,195% of cms physician fee schedule,N/A,not separately reimbursable,17.56,100% of cms physician fee schedule,29,100% of WORK COMP custom fee schedule,17.56,85,21.7"
"Outpatient Medical Services,THERAPY,97033,PT IONTOPHORESIS EA 15 MINUTES,421,72.73,24.67,100% of AETNA custom fee schedule,21.7,100% of BCBS custom fee schedule,17.56,100% of cms physician fee schedule,85,pays based on per visit rate,26.34,150% of cms physician fee schedule,19.32,110% of GILSBAR physician fee schedule,25.46,145% of cms physician fee schedule,N/A,Not separately reimbursable,17.56,100% of cms physician fee schedule,43.64,60% of total billed charges,34.24,195% of cms physician fee schedule,N/A,not separately reimbursable,17.56,100% of cms physician fee schedule,29,100% of WORK COMP custom fee schedule,17.56,85,21.7"
"Outpatient Medical Services,THERAPY,97035,PT ULTRASOUND,421,33.95,12.4,100% of AETNA custom fee schedule,14.06,100% of BCBS custom fee schedule,13.09,100% of cms physician fee schedule,85,pays based on per visit rate,19.64,150% of cms physician fee schedule,14.4,110% of GILSBAR physician fee schedule,18.98,145% of cms physician fee schedule,N/A,Not separately reimbursable,13.09,100% of cms physician fee schedule,20.37,60% of total billed charges,25.53,195% of cms physician fee schedule,N/A,not separately reimbursable,13.09,100% of cms physician fee schedule,23,100% of WORK COMP custom fee schedule,12.4,85,14.06"
"Outpatient Medical Services,THERAPY,97035,PT ULTRASOUND EA 15 MINUTES,421,44.45,12.4,100% of AETNA custom fee schedule,14.06,100% of BCBS custom fee schedule,13.09,100% of cms physician fee schedule,85,pays based on per visit rate,19.64,150% of cms physician fee schedule,14.4,110% of GILSBAR physician fee schedule,18.98,145% of cms physician fee schedule,N/A,Not separately reimbursable,13.09,100% of cms physician fee schedule,26.67,60% of total billed charges,25.53,195% of cms physician fee schedule,N/A,not separately reimbursable,13.09,100% of cms physician fee schedule,23,100% of WORK COMP custom fee schedule,12.4,85,14.06"
"Outpatient Medical Services,THERAPY,97039,PT PHONOPHORESIS,421,45.26,24.89,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,20.37,45% Of total billed charges,27.16,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,27.16,60% of total billed charges,36.21,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,31,100% of WORK COMP custom fee schedule,20.37,85,N/A"
"Outpatient Medical Services,THERAPY,97039,PT UNLISTED MODALITY,421,45.26,24.89,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,20.37,45% Of total billed charges,27.16,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,27.16,60% of total billed charges,36.21,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,31,100% of WORK COMP custom fee schedule,20.37,85,N/A"
"Outpatient Medical Services,THERAPY,97039,PT UNLISTED MODALITY,421,45.26,24.89,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,20.37,45% Of total billed charges,27.16,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,27.16,60% of total billed charges,36.21,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,31,100% of WORK COMP custom fee schedule,20.37,85,N/A"
"Outpatient Medical Services,THERAPY,97110,PT THERAPEUTIC EXERCISE,421,77.58,30.95,100% of AETNA custom fee schedule,32.14,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,16.21,100% LA Medicaid fee schedule,27.12,100% of cms physician fee schedule,46.55,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,43,100% of WORK COMP custom fee schedule,27.12,85,32.14"
"Outpatient Medical Services,THERAPY,97110,PT EXERCISES TO DEVELOP STRENGTH,421,101.96,30.95,100% of AETNA custom fee schedule,32.14,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,16.21,100% LA Medicaid fee schedule,27.12,100% of cms physician fee schedule,61.18,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,43,100% of WORK COMP custom fee schedule,27.12,85,32.14"
"Outpatient Medical Services,THERAPY,97110,PT PT 15 MIN EXERCISE,421,29.86,30.95,100% of AETNA custom fee schedule,32.14,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,16.21,100% LA Medicaid fee schedule,27.12,100% of cms physician fee schedule,17.92,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,43,100% of WORK COMP custom fee schedule,17.92,85,32.14"
"Outpatient Medical Services,THERAPY,97110,PT THERAPEAUTIC ACTIVITY,424,29.86,30.95,100% of AETNA custom fee schedule,32.14,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,16.21,100% LA Medicaid fee schedule,27.12,100% of cms physician fee schedule,17.92,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,43,100% of WORK COMP custom fee schedule,17.92,85,32.14"
"Outpatient Medical Services,THERAPY,97112,PT NEUROMUSCULAR RE-EDUCATION,421,88.15,32.22,100% of AETNA custom fee schedule,36.52,100% of BCBS custom fee schedule,30.16,100% of cms physician fee schedule,85,pays based on per visit rate,45.24,150% of cms physician fee schedule,33.18,110% of GILSBAR physician fee schedule,43.73,145% of cms physician fee schedule,N/A,Not separately reimbursable,30.16,100% of cms physician fee schedule,52.89,60% of total billed charges,58.81,195% of cms physician fee schedule,N/A,not separately reimbursable,30.16,100% of cms physician fee schedule,42,100% of WORK COMP custom fee schedule,30.16,85,36.52"
"Outpatient Medical Services,THERAPY,97112,PT NEUROMUSCULAR REEDUCATION OF MOVEMENT,421,30.85,32.22,100% of AETNA custom fee schedule,36.52,100% of BCBS custom fee schedule,30.16,100% of cms physician fee schedule,85,pays based on per visit rate,45.24,150% of cms physician fee schedule,33.18,110% of GILSBAR physician fee schedule,43.73,145% of cms physician fee schedule,N/A,Not separately reimbursable,30.16,100% of cms physician fee schedule,18.51,60% of total billed charges,58.81,195% of cms physician fee schedule,N/A,not separately reimbursable,30.16,100% of cms physician fee schedule,42,100% of WORK COMP custom fee schedule,18.51,85,36.52"
"Outpatient Medical Services,THERAPY,97113,AQUATIC THERAPEUTIC EXERCISES,421,98.53,40.32,100% of AETNA custom fee schedule,40.82,100% of BCBS custom fee schedule,34.08,100% of cms physician fee schedule,85,pays based on per visit rate,51.12,150% of cms physician fee schedule,37.49,110% of GILSBAR physician fee schedule,49.42,145% of cms physician fee schedule,N/A,Not separately reimbursable,34.08,100% of cms physician fee schedule,59.12,60% of total billed charges,66.46,195% of cms physician fee schedule,N/A,not separately reimbursable,34.08,100% of cms physician fee schedule,46,100% of WORK COMP custom fee schedule,34.08,85,40.82"
"Outpatient Medical Services,THERAPY,97113,JOINT CAMP PREHAB,421,25,40.32,100% of AETNA custom fee schedule,40.82,100% of BCBS custom fee schedule,34.08,100% of cms physician fee schedule,85,pays based on per visit rate,51.12,150% of cms physician fee schedule,37.49,110% of GILSBAR physician fee schedule,49.42,145% of cms physician fee schedule,N/A,Not separately reimbursable,34.08,100% of cms physician fee schedule,15,60% of total billed charges,66.46,195% of cms physician fee schedule,N/A,not separately reimbursable,34.08,100% of cms physician fee schedule,46,100% of WORK COMP custom fee schedule,15,85,40.82"
"Outpatient Medical Services,THERAPY,97116,PT GAIT TRAINING,421,76.7,27.14,100% of AETNA custom fee schedule,31.78,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.12,100% of cms physician fee schedule,46.02,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,38,100% of WORK COMP custom fee schedule,27.12,85,31.78"
"Outpatient Medical Services,THERAPY,97116,PT GAIT TRAINING,421,26.19,27.14,100% of AETNA custom fee schedule,31.78,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.12,100% of cms physician fee schedule,15.71,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,38,100% of WORK COMP custom fee schedule,15.71,85,31.78"
"Outpatient Medical Services,THERAPY,97116,PT PT 15 MIN GAIT MIN,421,175,27.14,100% of AETNA custom fee schedule,31.78,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.12,100% of cms physician fee schedule,105,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,38,100% of WORK COMP custom fee schedule,27.12,105,31.78"
"Outpatient Medical Services,THERAPY,97116,PT PT PATIENT EDUCATION,421,26.19,27.14,100% of AETNA custom fee schedule,31.78,100% of BCBS custom fee schedule,27.12,100% of cms physician fee schedule,85,pays based on per visit rate,40.68,150% of cms physician fee schedule,29.83,110% of GILSBAR physician fee schedule,39.32,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.12,100% of cms physician fee schedule,15.71,60% of total billed charges,52.88,195% of cms physician fee schedule,N/A,not separately reimbursable,27.12,100% of cms physician fee schedule,38,100% of WORK COMP custom fee schedule,15.71,85,31.78"
"Outpatient Medical Services,THERAPY,97124,PT MASSAGE,421,76.98,25.03,100% of AETNA custom fee schedule,31.89,100% of BCBS custom fee schedule,27.59,100% of cms physician fee schedule,85,pays based on per visit rate,41.39,150% of cms physician fee schedule,30.35,110% of GILSBAR physician fee schedule,40.01,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.59,100% of cms physician fee schedule,46.19,60% of total billed charges,53.8,195% of cms physician fee schedule,N/A,not separately reimbursable,27.59,100% of cms physician fee schedule,34,100% of WORK COMP custom fee schedule,25.03,85,31.89"
"Outpatient Medical Services,THERAPY,97124,PT MASSAGE,421,23.7,25.03,100% of AETNA custom fee schedule,31.89,100% of BCBS custom fee schedule,27.59,100% of cms physician fee schedule,85,pays based on per visit rate,41.39,150% of cms physician fee schedule,30.35,110% of GILSBAR physician fee schedule,40.01,145% of cms physician fee schedule,N/A,Not separately reimbursable,27.59,100% of cms physician fee schedule,14.22,60% of total billed charges,53.8,195% of cms physician fee schedule,N/A,not separately reimbursable,27.59,100% of cms physician fee schedule,34,100% of WORK COMP custom fee schedule,14.22,85,31.89"
"Outpatient Medical Services,THERAPY,97139,PT UNLISTED PROCEDURE,421,59.82,32.9,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,26.92,45% Of total billed charges,35.89,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,35.89,60% of total billed charges,47.86,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,27,100% of WORK COMP custom fee schedule,26.92,85,N/A"
"Outpatient Medical Services,THERAPY,97139,PT UNLISTED THERAPEUTIC PROCEDURE,421,17.52,9.64,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,7.88,45% Of total billed charges,10.51,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,10.51,60% of total billed charges,14.02,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,27,100% of WORK COMP custom fee schedule,7.88,85,N/A"
"Outpatient Medical Services,THERAPY,97140,PT MANUAL THERAPY TECHNIQUE,421,70.28,28.53,100% of AETNA custom fee schedule,29.11,100% of BCBS custom fee schedule,25.62,100% of cms physician fee schedule,85,pays based on per visit rate,38.43,150% of cms physician fee schedule,28.18,110% of GILSBAR physician fee schedule,37.15,145% of cms physician fee schedule,N/A,Not separately reimbursable,25.62,100% of cms physician fee schedule,42.17,60% of total billed charges,49.96,195% of cms physician fee schedule,N/A,not separately reimbursable,25.62,100% of cms physician fee schedule,44,100% of WORK COMP custom fee schedule,25.62,85,29.11"
"Outpatient Medical Services,THERAPY,97140,PT MANUAL THERAPY,421,27.83,28.53,100% of AETNA custom fee schedule,29.11,100% of BCBS custom fee schedule,25.62,100% of cms physician fee schedule,85,pays based on per visit rate,38.43,150% of cms physician fee schedule,28.18,110% of GILSBAR physician fee schedule,37.15,145% of cms physician fee schedule,N/A,Not separately reimbursable,25.62,100% of cms physician fee schedule,16.7,60% of total billed charges,49.96,195% of cms physician fee schedule,N/A,not separately reimbursable,25.62,100% of cms physician fee schedule,44,100% of WORK COMP custom fee schedule,16.7,85,29.11"
"Outpatient Medical Services,THERAPY,97150,PT GROUP THERAPEUTIC EXERCISE,421,46.38,16.85,100% of AETNA custom fee schedule,19.21,100% of BCBS custom fee schedule,16.53,100% of cms physician fee schedule,85,pays based on per visit rate,24.8,150% of cms physician fee schedule,18.18,110% of GILSBAR physician fee schedule,23.97,145% of cms physician fee schedule,N/A,Not separately reimbursable,16.53,100% of cms physician fee schedule,27.83,60% of total billed charges,32.23,195% of cms physician fee schedule,N/A,not separately reimbursable,16.53,100% of cms physician fee schedule,34,100% of WORK COMP custom fee schedule,16.53,85,19.21"
"Outpatient Medical Services,THERAPY,97161,PT EVAL LOW COMPLEX 20 MIN,424,211.98,79.21,100% of AETNA custom fee schedule,87.82,100% of BCBS custom fee schedule,92.4,100% of cms physician fee schedule,85,pays based on per visit rate,138.6,150% of cms physician fee schedule,101.64,110% of GILSBAR physician fee schedule,133.98,145% of cms physician fee schedule,74.48,100% LA Medicaid fee schedule,92.4,100% of cms physician fee schedule,127.19,60% of total billed charges,180.18,195% of cms physician fee schedule,N/A,not separately reimbursable,92.4,100% of cms physician fee schedule,N/A,not separately reimbursable,79.21,180.18,87.82"
"Outpatient Medical Services,THERAPY,97162,PT EVAL MOD COMPLEX 30 MIN,424,211.98,79.21,100% of AETNA custom fee schedule,87.82,100% of BCBS custom fee schedule,92.4,100% of cms physician fee schedule,85,pays based on per visit rate,138.6,150% of cms physician fee schedule,101.64,110% of GILSBAR physician fee schedule,133.98,145% of cms physician fee schedule,74.48,100% LA Medicaid fee schedule,92.4,100% of cms physician fee schedule,127.19,60% of total billed charges,180.18,195% of cms physician fee schedule,N/A,not separately reimbursable,92.4,100% of cms physician fee schedule,N/A,not separately reimbursable,79.21,180.18,87.82"
"Outpatient Medical Services,THERAPY,97163,PT EVAL HI COMPLEX 45 MIN,424,211.98,79.21,100% of AETNA custom fee schedule,87.82,100% of BCBS custom fee schedule,92.4,100% of cms physician fee schedule,85,pays based on per visit rate,138.6,150% of cms physician fee schedule,101.64,110% of GILSBAR physician fee schedule,133.98,145% of cms physician fee schedule,74.48,100% LA Medicaid fee schedule,92.4,100% of cms physician fee schedule,127.19,60% of total billed charges,180.18,195% of cms physician fee schedule,N/A,not separately reimbursable,92.4,100% of cms physician fee schedule,N/A,not separately reimbursable,79.21,180.18,87.82"
"Outpatient Medical Services,THERAPY,97164,PT RE-EVAL EST PLAN CARE,424,143.1,53.17,100% of AETNA custom fee schedule,59.28,100% of BCBS custom fee schedule,63.31,100% of cms physician fee schedule,85,pays based on per visit rate,94.97,150% of cms physician fee schedule,69.64,110% of GILSBAR physician fee schedule,91.8,145% of cms physician fee schedule,50.38,100% LA Medicaid fee schedule,63.31,100% of cms physician fee schedule,85.86,60% of total billed charges,123.45,195% of cms physician fee schedule,N/A,not separately reimbursable,63.31,100% of cms physician fee schedule,N/A,not separately reimbursable,53.17,123.45,59.28"
"Outpatient Medical Services,THERAPY,97530,PT THERAPEUTIC ACTIVITIES,421,101.88,33.02,100% of AETNA custom fee schedule,42.2,100% of BCBS custom fee schedule,32.21,100% of cms physician fee schedule,85,pays based on per visit rate,48.32,150% of cms physician fee schedule,35.43,110% of GILSBAR physician fee schedule,46.7,145% of cms physician fee schedule,13.35,100% LA Medicaid fee schedule,32.21,100% of cms physician fee schedule,61.13,60% of total billed charges,62.81,195% of cms physician fee schedule,N/A,not separately reimbursable,32.21,100% of cms physician fee schedule,44,100% of WORK COMP custom fee schedule,32.21,85,42.2"
"Outpatient Medical Services,THERAPY,97530,PT THERAPEUTIC ACTIVITIES,421,30.79,33.02,100% of AETNA custom fee schedule,42.2,100% of BCBS custom fee schedule,32.21,100% of cms physician fee schedule,85,pays based on per visit rate,48.32,150% of cms physician fee schedule,35.43,110% of GILSBAR physician fee schedule,46.7,145% of cms physician fee schedule,13.35,100% LA Medicaid fee schedule,32.21,100% of cms physician fee schedule,18.47,60% of total billed charges,62.81,195% of cms physician fee schedule,N/A,not separately reimbursable,32.21,100% of cms physician fee schedule,44,100% of WORK COMP custom fee schedule,18.47,85,42.2"
"Outpatient Medical Services,THERAPY,97533,PT SENSORY INTEGRATIVE TECHNIQUES,421,86.35,27.94,100% of AETNA custom fee schedule,35.77,100% of BCBS custom fee schedule,55.17,100% of cms physician fee schedule,85,pays based on per visit rate,82.76,150% of cms physician fee schedule,60.69,110% of GILSBAR physician fee schedule,80,145% of cms physician fee schedule,N/A,Not separately reimbursable,55.17,100% of cms physician fee schedule,51.81,60% of total billed charges,107.58,195% of cms physician fee schedule,N/A,not separately reimbursable,55.17,100% of cms physician fee schedule,59,100% of WORK COMP custom fee schedule,27.94,107.58,35.77"
"Outpatient Medical Services,THERAPY,97535,PT SELF CARE HOME MANAGEMENT,421,87.13,33.49,100% of AETNA custom fee schedule,36.09,100% of BCBS custom fee schedule,29.97,100% of cms physician fee schedule,85,pays based on per visit rate,44.96,150% of cms physician fee schedule,32.97,110% of GILSBAR physician fee schedule,43.46,145% of cms physician fee schedule,N/A,Not separately reimbursable,29.97,100% of cms physician fee schedule,52.28,60% of total billed charges,58.44,195% of cms physician fee schedule,N/A,not separately reimbursable,29.97,100% of cms physician fee schedule,45,100% of WORK COMP custom fee schedule,29.97,85,36.09"
"Outpatient Medical Services,THERAPY,97535,PT SELF-CARE/HOME MANAGEMENT TRAINING,421,31.57,33.49,100% of AETNA custom fee schedule,36.09,100% of BCBS custom fee schedule,29.97,100% of cms physician fee schedule,85,pays based on per visit rate,44.96,150% of cms physician fee schedule,32.97,110% of GILSBAR physician fee schedule,43.46,145% of cms physician fee schedule,N/A,Not separately reimbursable,29.97,100% of cms physician fee schedule,18.94,60% of total billed charges,58.44,195% of cms physician fee schedule,N/A,not separately reimbursable,29.97,100% of cms physician fee schedule,45,100% of WORK COMP custom fee schedule,18.94,85,36.09"
"Outpatient Medical Services,THERAPY,97537,PT COMMUNITY TRAINING,421,83.75,29.04,100% of AETNA custom fee schedule,34.7,100% of BCBS custom fee schedule,29.8,100% of cms physician fee schedule,85,pays based on per visit rate,44.7,150% of cms physician fee schedule,32.78,110% of GILSBAR physician fee schedule,43.21,145% of cms physician fee schedule,N/A,Not separately reimbursable,29.8,100% of cms physician fee schedule,50.25,60% of total billed charges,58.11,195% of cms physician fee schedule,N/A,not separately reimbursable,29.8,100% of cms physician fee schedule,45,100% of WORK COMP custom fee schedule,29.04,85,34.7"
"Outpatient Medical Services,THERAPY,97545,PT WORK CONDITIONING INITIAL 2 HOURS,421,403.62,126.21,100% of AETNA custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,181.63,45% Of total billed charges,242.17,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,242.17,60% of total billed charges,322.9,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,88,100% of WORK COMP custom fee schedule,85,322.9,N/A"
"Outpatient Medical Services,THERAPY,97546,PT WORK CONDITIONING EACH ADDITIONAL HR,421,161.11,50.54,100% of AETNA custom fee schedule,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,72.5,45% Of total billed charges,96.67,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,96.67,60% of total billed charges,128.89,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,44,100% of WORK COMP custom fee schedule,44,128.89,N/A"
"Outpatient Medical Services,THERAPY,97597,DEBRIDEMENT OPEN WOUND 20 SQ CM<,360,422.38,2500,pays based on per day rate,174.98,100% of BCBS custom fee schedule,183.15,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,274.73,pays based on APC rate,201.46,pays based on APC rate,265.56,pays based on APC rate,N/A,Not separately reimbursable,183.15,pays based on APC rate,253.43,60% of total billed charges,357.14,pays based on APC rate,225.59,100% of UHC custom fee schedule,183.15,pays based on APC rate ,155,100% of WORK COMP custom fee schedule,155,2600,174.98"
"Outpatient Medical Services,THERAPY,97597,PT SHARPS DEBRIDEMENT,421,422.38,232.31,55% of total billed charges,174.98,100% of BCBS custom fee schedule,183.15,pays based on per APC rate,85,pays based on per visit rate,274.73,pays based on APC rate,201.46,pays based on APC rate,265.56,pays based on APC rate,N/A,Not separately reimbursable,183.15,pays based on APC rate,253.43,60% of total billed charges,357.14,pays based on APC rate,225.59,100% of UHC custom fee schedule,183.15,pays based on APC rate ,155,100% of WORK COMP custom fee schedule,85,357.14,174.98"
"Outpatient Medical Services,THERAPY,97597,PT EQUAL TO 20 SQUARE CENTIMETERS,421,422.38,232.31,55% of total billed charges,174.98,100% of BCBS custom fee schedule,183.15,pays based on per APC rate,85,pays based on per visit rate,274.73,pays based on APC rate,201.46,pays based on APC rate,265.56,pays based on APC rate,N/A,Not separately reimbursable,183.15,pays based on APC rate,253.43,60% of total billed charges,357.14,pays based on APC rate,225.59,100% of UHC custom fee schedule,183.15,pays based on APC rate ,155,100% of WORK COMP custom fee schedule,85,357.14,174.98"
"Outpatient Medical Services,THERAPY,97598,PT SQUARE CENTIMETERS,421,272.76,150.02,55% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,122.74,45% Of total billed charges,163.66,60% of total billed charges,N/A,Not separately reimbursable,N/A,not separately reimbursable,163.66,60% of total billed charges,218.21,80% of total billed charges,N/A,not separately reimbursable,N/A,not separately reimbursable,51,100% of WORK COMP custom fee schedule,51,218.21,N/A"
"Outpatient Medical Services,THERAPY,97605,WOUND VAC PLACEMENT  - LESS THAN 50CM,360,422.38,2500,pays based on per day rate,174.98,100% of BCBS custom fee schedule,183.15,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,274.73,pays based on APC rate,201.46,pays based on APC rate,265.57,pays based on APC rate,N/A,Not separately reimbursable,183.15,pays based on APC rate,253.43,60% of total billed charges,357.14,pays based on APC rate,225.59,100% of UHC custom fee schedule,183.15,pays based on APC rate ,86,100% of WORK COMP custom fee schedule,86,2600,174.98"
"Outpatient Medical Services,THERAPY,97606,WOUND VAC PLACEMENT  - GREATER THAN 50CM,360,777,2500,pays based on per day rate,321.9,100% of BCBS custom fee schedule,368.27,pays based on per APC rate,2600,100% of ASC TIER GROUPINGS rate,552.4,pays based on APC rate,405.09,pays based on APC rate,533.99,pays based on APC rate,N/A,Not separately reimbursable,368.27,pays based on APC rate,466.2,60% of total billed charges,718.12,pays based on APC rate,415,100% of UHC custom fee schedule,368.27,pays based on APC rate ,92,100% of WORK COMP custom fee schedule,92,2600,321.9"
"Outpatient Medical Services,THERAPY,97750,PHYSICAL THERAPY PERFORMANCE TEST,421,94.95,52.22,55% of total billed charges,39.34,100% of BCBS custom fee schedule,31.11,100% of cms physician fee schedule,85,pays based on per visit rate,46.67,150% of cms physician fee schedule,34.22,110% of GILSBAR physician fee schedule,45.11,145% of cms physician fee schedule,N/A,Not separately reimbursable,31.11,100% of cms physician fee schedule,56.97,60% of total billed charges,60.66,195% of cms physician fee schedule,N/A,not separately reimbursable,31.11,100% of cms physician fee schedule,50,100% of WORK COMP custom fee schedule,31.11,85,39.34"
"Outpatient Medical Services,THERAPY,97750,PT PHYSICAL PERFORMANCE TEST OR MEASUREM,421,202.74,111.51,55% of total billed charges,39.34,100% of BCBS custom fee schedule,31.11,100% of cms physician fee schedule,85,pays based on per visit rate,46.67,150% of cms physician fee schedule,34.22,110% of GILSBAR physician fee schedule,45.11,145% of cms physician fee schedule,N/A,Not separately reimbursable,31.11,100% of cms physician fee schedule,121.64,60% of total billed charges,60.66,195% of cms physician fee schedule,N/A,not separately reimbursable,31.11,100% of cms physician fee schedule,50,100% of WORK COMP custom fee schedule,31.11,121.64,39.34"
"Outpatient Medical Services,THERAPY,97752,PT MUSCLE TESTING WITH TORGUE CURVES,421,N/A,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,85,pays based on per visit rate,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,Not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,N/A,not separately reimbursable,85,85,N/A"
"Outpatient Medical Services,THERAPY,97760,PT ORTHOTIC TRAINING,421,117.7,64.74,55% of total billed charges,48.76,100% of BCBS custom fee schedule,42.42,100% of cms physician fee schedule,85,pays based on per visit rate,63.63,150% of cms physician fee schedule,46.66,110% of GILSBAR physician fee schedule,61.51,145% of cms physician fee schedule,22.34,100% LA Medicaid fee schedule,42.42,100% of cms physician fee schedule,70.62,60% of total billed charges,82.72,195% of cms physician fee schedule,N/A,not separately reimbursable,42.42,100% of cms physician fee schedule,39,100% of WORK COMP custom fee schedule,39,85,48.76"
"Outpatient Medical Services,THERAPY,97760,PT ORTHOTICS FITTING AND TRAINING,421,N/A,N/A,not separately reimbursable,N/A,not separately reimbursable,42.42,100% of cms physician fee schedule,85,pays based on per visit rate,63.63,150% of cms physician fee schedule,46.66,110% of GILSBAR physician fee schedule,61.51,145% of cms physician fee schedule,22.34,100% LA Medicaid fee schedule,42.42,100% of cms physician fee schedule,N/A,not separately reimbursable,82.72,195% of cms physician fee schedule,N/A,not separately reimbursable,42.42,100% of cms physician fee schedule,N/A,not separately reimbursable,42.42,85,N/A"
"Outpatient Medical Services,BEHAVIORAL,90832,""Psychotherapy, 30 minute"",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,BEHAVIORAL,90834,""Psychotherapy, 45 minutes"",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,BEHAVIORAL,90837,""Psychotherapy, 60 minutes"",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,BEHAVIORAL,90846,""Family psychotherapy, not including patient, 50 minutes"",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,BEHAVIORAL,90847,""Family psychotherapy, including patient, 50 min"",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99203,""New patient office or other outpatient visit, typically 30 min"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99204,""New patient office of other outpatient visit, typically 45 min"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99205,""New patient office of other outpatient visit, typically 60 min"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99243,""Patient office consultation, typically 40 min"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99244,""Patient office consultation, typically 60 min"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99385,""Initial new patient preventive medicine evaluation, for those ages 18 to 39"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OFFICE VISIT,99386,""Initial new patient preventive medicine evaluation, for those ages 40 to 64"",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80048,Basic metabolic panel,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80053,""Blood test, comprehensive group of blood chemicals"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80061,""Blood test, lipids"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80069,Kidney function panel tes,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,80076,Liver function blood test panel,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,81003,Prostate specific antigen,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,84443,""Blood test, thyroid stimulating hormone"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,85025,""Complete blood cell count, with differential white blood cells, automated"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,85027,""Complete blood count, automated"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,85610,""Blood test, clotting time"",300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,LAB,85730,Coagulation assessment blood test,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,70450,""CT scan, head or brain, without contrast"",350,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,610,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,72110,""X-Ray, lower back, minimum four views"",320,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal ,610,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,72193,""CT scan, pelvis, with contrast"",350,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,76805,""Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus"",402,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,76830,Ultrasound pelvis through vagina,402,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,403,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,77067,""Mammography, screening, bilateral"",403,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,RADIOLOGY,19120,""Removal of 1 or more breast growth, open procedure"",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,43235,""Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop"",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,43239,""Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,59400,""Routine obstetric care for vaginal delivery, including pre-and post-delivery care"",720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,59510,""Routine obstetric care for cesarean delivery, including pre-and post-delivery care"",720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,ECCG,93000,""Electrocardiogram, routine, with interpretation and report"",730,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Outpatient Medical Services,SLEEP STUDY,95810,Sleep study,920,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"
"Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED"