HOSPITAL_NAME,LAST_UPDATED_ON,VERSION,HOSPITAL_LOCATION,HOSPITAL_ADDRESS,LICENSE_NUMBER|CO,"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.",,,,,,,,,,,,,,
DELTA COUNTY MEMORIAL HOSPITAL, 2024-07-01,2.0.0,DELTA COUNTY MEMORIAL HOSPITAL,"1501 E 3RD STREET, DELTA, CO  81416",11145,TRUE,,,,,,,,,,,,,,
DESCRIPTION,CODE|1,CODE|1|TYPE,CODE|2,CODE|2|TYPE,MODIFIERS,SETTING,DRUG_UNIT_OF_MEASUREMENT,DRUG_TYPE_OF_MEASUREMENT,STANDARD_CHARGE|GROSS,STANDARD_CHARGE|DISCOUNTED_CASH,PAYER_NAME,PLAN_NAME,STANDARD_CHARGE|NEGOTIATED_DOLLAR,STANDARD_CHARGE|NEGOTIATED_PERCENTAGE,STANDARD_CHARGE|NEGOTIATED_ALGORITHM,ESTIMATED_AMOUNT,STANDARD_CHARGE|METHODOLOGY,STANDARD_CHARGE|MIN,STANDARD_CHARGE|MAX,ADDITIONAL_GENERIC_NOTES
MED/SURG LEVEL I,1100001,CDM,,,,INPATIENT,,,1891.5,756.6,BLUE CROSS ANTHEM,COMMERCIAL,1721.265,,,,OTHER,1418.63,1853.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MED/SURG LEVEL I,1100001,CDM,,,,INPATIENT,,,1891.5,756.6,MONUMENT,COMMERCIAL,,,,1513.2,,1418.63,1853.67,CODE COMINATION NOT COVERED BY THIS PLAN
MED/SURG LEVEL I,1100001,CDM,,,,INPATIENT,,,1891.5,756.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3300,PER DIEM,1418.63,1853.67,
MED/SURG LEVEL II,1100002,CDM,,,,INPATIENT,,,2626.5,1050.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2390.12,OTHER,1969.88,2573.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MED/SURG LEVEL II,1100002,CDM,,,,INPATIENT,,,2626.5,1050.6,MONUMENT,COMMERCIAL,,,,2101.2,,1969.88,2573.97,
MED/SURG LEVEL II,1100002,CDM,,,,INPATIENT,,,2626.5,1050.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3300,PER DIEM,1969.88,2573.97,
MED/SURG LEVEL III,1100003,CDM,,,,INPATIENT,,,3571.5,1428.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3250.07,OTHER,2678.63,3500.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MED/SURG LEVEL III,1100003,CDM,,,,INPATIENT,,,3571.5,1428.6,MONUMENT,COMMERCIAL,,,,2857.2,,2678.63,3500.07,
MED/SURG LEVEL III,1100003,CDM,,,,INPATIENT,,,3571.5,1428.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3300,PER DIEM,2678.63,3500.07,
MED/SURG W/TELEMETRY,1100005,CDM,,,,INPATIENT,,,4096.5,1638.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3727.82,OTHER,3072.38,4014.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MED/SURG W/TELEMETRY,1100005,CDM,,,,INPATIENT,,,4096.5,1638.6,MONUMENT,COMMERCIAL,,,,3277.2,,3072.38,4014.57,
MED/SURG W/TELEMETRY,1100005,CDM,,,,INPATIENT,,,4096.5,1638.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3300,PER DIEM,3072.38,4014.57,
ICU LEVEL I,1100010,CDM,,,,INPATIENT,,,4306.5,1722.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3918.92,OTHER,3229.88,4220.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ICU LEVEL I,1100010,CDM,,,,INPATIENT,,,4306.5,1722.6,MONUMENT,COMMERCIAL,,,,3445.2,,3229.88,4220.37,
ICU LEVEL I,1100010,CDM,,,,INPATIENT,,,4306.5,1722.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER DIEM,3229.88,4220.37,
ICU LEVEL II,1100011,CDM,,,,INPATIENT,,,4831.5,1932.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,4396.67,OTHER,3623.63,4734.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ICU LEVEL II,1100011,CDM,,,,INPATIENT,,,4831.5,1932.6,MONUMENT,COMMERCIAL,,,,3865.2,,3623.63,4734.87,
ICU LEVEL II,1100011,CDM,,,,INPATIENT,,,4831.5,1932.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER DIEM,3623.63,4734.87,
ICU TRANSITIONAL,1100015,CDM,,,,INPATIENT,,,4096.5,1638.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3727.82,OTHER,3072.38,4014.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ICU TRANSITIONAL,1100015,CDM,,,,INPATIENT,,,4096.5,1638.6,MONUMENT,COMMERCIAL,,,,3277.2,,3072.38,4014.57,
ICU TRANSITIONAL,1100015,CDM,,,,INPATIENT,,,4096.5,1638.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER DIEM,3072.38,4014.57,
ICU MED SURG,1100020,CDM,,,,INPATIENT,,,946.25,378.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,861.09,OTHER,709.69,927.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ICU MED SURG,1100020,CDM,,,,INPATIENT,,,946.25,378.5,MONUMENT,COMMERCIAL,,,,757,,709.69,927.33,
ICU MED SURG,1100020,CDM,,,,INPATIENT,,,946.25,378.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER DIEM,709.69,927.33,
TPAC ROOM RATE,1100030,CDM,,,,INPATIENT,,,400,160,BLUE CROSS ANTHEM,COMMERCIAL,,,,364,OTHER,300,392,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TPAC ROOM RATE,1100030,CDM,,,,INPATIENT,,,400,160,MONUMENT,COMMERCIAL,,,,320,,300,392,
TPAC ROOM RATE,1100030,CDM,,,,INPATIENT,,,400,160,UNITED HEALTH,UNITED COMMERCIAL,,,,300,PER DIEM,300,392,
CARDIOVERSION ELECTIVE (ICU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1348.17,OTHER,1111.13,1451.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARDIOVERSION ELECTIVE (ICU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,MONUMENT,COMMERCIAL,,,,1185.2,,1111.13,1451.87,
CARDIOVERSION ELECTIVE (ICU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER DIEM,1111.13,1451.87,
SEMI-PRIVATE ROOM & BOARD,1200001,CDM,,,,INPATIENT,,,946.25,378.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,861.09,OTHER,709.69,927.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEMI-PRIVATE ROOM & BOARD,1200001,CDM,,,,INPATIENT,,,946.25,378.5,MONUMENT,COMMERCIAL,,,,757,,709.69,927.33,
SEMI-PRIVATE ROOM & BOARD,1200001,CDM,,,,INPATIENT,,,946.25,378.5,UNITED HEALTH,UNITED COMMERCIAL,,,,3300,PER DIEM,709.69,927.33,
NEWBORN CARE,1200002,CDM,,,,INPATIENT,,,729.5,291.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,663.85,OTHER,547.13,714.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEWBORN CARE,1200002,CDM,,,,INPATIENT,,,729.5,291.8,MONUMENT,COMMERCIAL,,,,583.6,,547.13,714.91,
NEWBORN CARE,1200002,CDM,,,,INPATIENT,,,729.5,291.8,UNITED HEALTH,UNITED COMMERCIAL,,,,513,PER DIEM,547.13,714.91,
SEMI-PRIVATE ROOM OB,1200004,CDM,,,,INPATIENT,,,946.25,378.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,861.09,OTHER,709.69,927.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEMI-PRIVATE ROOM OB,1200004,CDM,,,,INPATIENT,,,946.25,378.5,MONUMENT,COMMERCIAL,,,,757,,709.69,927.33,
SEMI-PRIVATE ROOM OB,1200004,CDM,,,,INPATIENT,,,946.25,378.5,UNITED HEALTH,UNITED COMMERCIAL,,,,3400,PER CASE,709.69,927.33,
TRAY CEN VENOUS CATH 5.0 FR,1600000,CDM,,,,INPATIENT,,,500.5,200.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,455.46,OTHER,375.38,490.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY CEN VENOUS CATH 5.0 FR,1600000,CDM,,,,INPATIENT,,,500.5,200.2,MONUMENT,COMMERCIAL,,,,400.4,,375.38,490.49,
TRAY CEN VENOUS CATH 5.0 FR,1600000,CDM,,,,INPATIENT,,,500.5,200.2,UNITED HEALTH,UNITED COMMERCIAL,,,,375.38,,375.38,490.49,
MRI HIP WO,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP WO,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
US THYROID FNA,10005,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1385.81,1810.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PRESSURE TRANSDUCER,1600162,CDM,,,,INPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.72,OTHER,33.56,43.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PRESSURE TRANSDUCER,1600162,CDM,,,,INPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
PRESSURE TRANSDUCER,1600162,CDM,,,,INPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,,33.56,,33.56,43.86,
PORT ACCESS TRAY,1600166,CDM,,,,INPATIENT,,,38,15.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.58,OTHER,28.5,37.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PORT ACCESS TRAY,1600166,CDM,,,,INPATIENT,,,38,15.2,MONUMENT,COMMERCIAL,,,,30.4,,28.5,37.24,
PORT ACCESS TRAY,1600166,CDM,,,,INPATIENT,,,38,15.2,UNITED HEALTH,UNITED COMMERCIAL,,,,28.5,,28.5,37.24,
PUMP VSCD ANTIEMBIOLIC,1610200,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PUMP VSCD ANTIEMBIOLIC,1610200,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
PUMP VSCD ANTIEMBIOLIC,1610200,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
KUGEL HERNIA PATCH,1610201,CDM,,,,INPATIENT,,,724.5,289.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,659.3,OTHER,543.38,710.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KUGEL HERNIA PATCH,1610201,CDM,,,,INPATIENT,,,724.5,289.8,MONUMENT,COMMERCIAL,,,,579.6,,543.38,710.01,
KUGEL HERNIA PATCH,1610201,CDM,,,,INPATIENT,,,724.5,289.8,UNITED HEALTH,UNITED COMMERCIAL,,,,543.38,,543.38,710.01,
SPINAL LUMBAR PUNCTURE,1610210,CDM,,,,INPATIENT,,,249.25,99.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,226.82,OTHER,186.94,244.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPINAL LUMBAR PUNCTURE,1610210,CDM,,,,INPATIENT,,,249.25,99.7,MONUMENT,COMMERCIAL,,,,199.4,,186.94,244.27,
SPINAL LUMBAR PUNCTURE,1610210,CDM,,,,INPATIENT,,,249.25,99.7,UNITED HEALTH,UNITED COMMERCIAL,,,,186.94,,186.94,244.27,
PUMP IV,1610212,CDM,,,,INPATIENT,,,291.75,116.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,265.49,OTHER,218.81,285.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PUMP IV,1610212,CDM,,,,INPATIENT,,,291.75,116.7,MONUMENT,COMMERCIAL,,,,233.4,,218.81,285.92,
PUMP IV,1610212,CDM,,,,INPATIENT,,,291.75,116.7,UNITED HEALTH,UNITED COMMERCIAL,,,,218.81,,218.81,285.92,
PUMP KENDALL,1610218,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PUMP KENDALL,1610218,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
PUMP KENDALL,1610218,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
PUMP FEEDING,1610220,CDM,,,,INPATIENT,,,144.25,57.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.27,OTHER,108.19,141.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PUMP FEEDING,1610220,CDM,,,,INPATIENT,,,144.25,57.7,MONUMENT,COMMERCIAL,,,,115.4,,108.19,141.37,
PUMP FEEDING,1610220,CDM,,,,INPATIENT,,,144.25,57.7,UNITED HEALTH,UNITED COMMERCIAL,,,,108.19,,108.19,141.37,
IV PUMP PER DAY,1610222,CDM,,,,INPATIENT,,,291.75,116.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,265.49,OTHER,218.81,285.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV PUMP PER DAY,1610222,CDM,,,,INPATIENT,,,291.75,116.7,MONUMENT,COMMERCIAL,,,,233.4,,218.81,285.92,
IV PUMP PER DAY,1610222,CDM,,,,INPATIENT,,,291.75,116.7,UNITED HEALTH,UNITED COMMERCIAL,,,,218.81,,218.81,285.92,
TRACTION BUCKS BOOT,1610242,CDM,,,,INPATIENT,,,175,70,BLUE CROSS ANTHEM,COMMERCIAL,,,,159.25,OTHER,131.25,171.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRACTION BUCKS BOOT,1610242,CDM,,,,INPATIENT,,,175,70,MONUMENT,COMMERCIAL,,,,140,,131.25,171.5,
TRACTION BUCKS BOOT,1610242,CDM,,,,INPATIENT,,,175,70,UNITED HEALTH,UNITED COMMERCIAL,,,,131.25,,131.25,171.5,
PROBE COVER KIT,1610244,CDM,,,,INPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.71,OTHER,25.31,33.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROBE COVER KIT,1610244,CDM,,,,INPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
PROBE COVER KIT,1610244,CDM,,,,INPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,,25.31,,25.31,33.08,
ENDOBUTTON CL 15MM,1611000,CDM,,,,INPATIENT,,,922.5,369,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.48,OTHER,691.88,904.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 15MM,1611000,CDM,,,,INPATIENT,,,922.5,369,MONUMENT,COMMERCIAL,,,,738,,691.88,904.05,
ENDOBUTTON CL 15MM,1611000,CDM,,,,INPATIENT,,,922.5,369,UNITED HEALTH,UNITED COMMERCIAL,,,,691.88,,691.88,904.05,
ENDOBUTTON CL 20MM,1611020,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 20MM,1611020,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 20MM,1611020,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 25MM,1611040,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 25MM,1611040,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 25MM,1611040,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 30MM,1611060,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 30MM,1611060,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 30MM,1611060,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 35MM,1611080,CDM,,,,INPATIENT,,,739.5,295.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,672.95,OTHER,554.63,724.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 35MM,1611080,CDM,,,,INPATIENT,,,739.5,295.8,MONUMENT,COMMERCIAL,,,,591.6,,554.63,724.71,
ENDOBUTTON CL 35MM,1611080,CDM,,,,INPATIENT,,,739.5,295.8,UNITED HEALTH,UNITED COMMERCIAL,,,,554.63,,554.63,724.71,
INSUFFLATOR  HEATED,1611900,CDM,,,,INPATIENT,,,199.5,79.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,181.55,OTHER,149.63,195.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INSUFFLATOR  HEATED,1611900,CDM,,,,INPATIENT,,,199.5,79.8,MONUMENT,COMMERCIAL,,,,159.6,,149.63,195.51,
INSUFFLATOR  HEATED,1611900,CDM,,,,INPATIENT,,,199.5,79.8,UNITED HEALTH,UNITED COMMERCIAL,,,,149.63,,149.63,195.51,
ENDOBUTTON CL 40MM,1612000,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 40MM,1612000,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 40MM,1612000,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 45MM,1612020,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 45MM,1612020,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 45MM,1612020,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 50MM,1612040,CDM,,,,INPATIENT,,,929,371.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.39,OTHER,696.75,910.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 50MM,1612040,CDM,,,,INPATIENT,,,929,371.6,MONUMENT,COMMERCIAL,,,,743.2,,696.75,910.42,
ENDOBUTTON CL 50MM,1612040,CDM,,,,INPATIENT,,,929,371.6,UNITED HEALTH,UNITED COMMERCIAL,,,,696.75,,696.75,910.42,
ENDOBUTTON CL 55MM,1612060,CDM,,,,INPATIENT,,,922.5,369,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.48,OTHER,691.88,904.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 55MM,1612060,CDM,,,,INPATIENT,,,922.5,369,MONUMENT,COMMERCIAL,,,,738,,691.88,904.05,
ENDOBUTTON CL 55MM,1612060,CDM,,,,INPATIENT,,,922.5,369,UNITED HEALTH,UNITED COMMERCIAL,,,,691.88,,691.88,904.05,
ENDOBUTTON CL 60MM,1612080,CDM,,,,INPATIENT,,,922.5,369,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.48,OTHER,691.88,904.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON CL 60MM,1612080,CDM,,,,INPATIENT,,,922.5,369,MONUMENT,COMMERCIAL,,,,738,,691.88,904.05,
ENDOBUTTON CL 60MM,1612080,CDM,,,,INPATIENT,,,922.5,369,UNITED HEALTH,UNITED COMMERCIAL,,,,691.88,,691.88,904.05,
ENDOBUTTON DRILL PIN 4.5MM,1613000,CDM,,,,INPATIENT,,,382,152.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,347.62,OTHER,286.5,374.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOBUTTON DRILL PIN 4.5MM,1613000,CDM,,,,INPATIENT,,,382,152.8,MONUMENT,COMMERCIAL,,,,305.6,,286.5,374.36,
ENDOBUTTON DRILL PIN 4.5MM,1613000,CDM,,,,INPATIENT,,,382,152.8,UNITED HEALTH,UNITED COMMERCIAL,,,,286.5,,286.5,374.36,
BAG BLOOD TRANSFER,1613030,CDM,,,,INPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.55,OTHER,39.19,51.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG BLOOD TRANSFER,1613030,CDM,,,,INPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
BAG BLOOD TRANSFER,1613030,CDM,,,,INPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,,39.19,,39.19,51.21,
BLANKET FULL BODY ADULT,1613050,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLANKET FULL BODY ADULT,1613050,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
BLANKET FULL BODY ADULT,1613050,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
BLANKET UPPER BODY,1613070,CDM,,,,INPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43,OTHER,35.44,46.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLANKET UPPER BODY,1613070,CDM,,,,INPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
BLANKET UPPER BODY,1613070,CDM,,,,INPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,,35.44,,35.44,46.31,
ENDOPATH EXCELL 5MM BLADELESS,1613100,CDM,,,,INPATIENT,,,261.5,104.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.97,OTHER,196.13,256.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPATH EXCELL 5MM BLADELESS,1613100,CDM,,,,INPATIENT,,,261.5,104.6,MONUMENT,COMMERCIAL,,,,209.2,,196.13,256.27,
ENDOPATH EXCELL 5MM BLADELESS,1613100,CDM,,,,INPATIENT,,,261.5,104.6,UNITED HEALTH,UNITED COMMERCIAL,,,,196.13,,196.13,256.27,
ENDOPATH EXCEL 5MM SLEEVE,1613105,CDM,,,,INPATIENT,,,153.25,61.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.46,OTHER,114.94,150.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPATH EXCEL 5MM SLEEVE,1613105,CDM,,,,INPATIENT,,,153.25,61.3,MONUMENT,COMMERCIAL,,,,122.6,,114.94,150.19,
ENDOPATH EXCEL 5MM SLEEVE,1613105,CDM,,,,INPATIENT,,,153.25,61.3,UNITED HEALTH,UNITED COMMERCIAL,,,,114.94,,114.94,150.19,
ENDOPATH 150MM PNEUMONEEDLE,1613110,CDM,,,,INPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.06,OTHER,84.94,110.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPATH 150MM PNEUMONEEDLE,1613110,CDM,,,,INPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ENDOPATH 150MM PNEUMONEEDLE,1613110,CDM,,,,INPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,,84.94,,84.94,110.99,
ENDOSTITCH,1613115,CDM,,,,INPATIENT,,,328.25,131.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,298.71,OTHER,246.19,321.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOSTITCH,1613115,CDM,,,,INPATIENT,,,328.25,131.3,MONUMENT,COMMERCIAL,,,,262.6,,246.19,321.69,
ENDOSTITCH,1613115,CDM,,,,INPATIENT,,,328.25,131.3,UNITED HEALTH,UNITED COMMERCIAL,,,,246.19,,246.19,321.69,
ENDOSCOPIC SPOT MARKER,1613117,CDM,,,,INPATIENT,,,102.25,40.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.05,OTHER,76.69,100.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOSCOPIC SPOT MARKER,1613117,CDM,,,,INPATIENT,,,102.25,40.9,MONUMENT,COMMERCIAL,,,,81.8,,76.69,100.21,
ENDOSCOPIC SPOT MARKER,1613117,CDM,,,,INPATIENT,,,102.25,40.9,UNITED HEALTH,UNITED COMMERCIAL,,,,76.69,,76.69,100.21,
ASPIRATING CURETTE 8MM,1613140,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ASPIRATING CURETTE 8MM,1613140,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
ASPIRATING CURETTE 8MM,1613140,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
ASPIRATING CURETTE 10MM,1613142,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ASPIRATING CURETTE 10MM,1613142,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
ASPIRATING CURETTE 10MM,1613142,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
ASPIRATING CURETTE 12MM,1613144,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ASPIRATING CURETTE 12MM,1613144,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
ASPIRATING CURETTE 12MM,1613144,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
BINDER ABD UNIV 9 INCH,1613154,CDM,,,,INPATIENT,,,168,67.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.88,OTHER,126,164.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BINDER ABD UNIV 9 INCH,1613154,CDM,,,,INPATIENT,,,168,67.2,MONUMENT,COMMERCIAL,,,,134.4,,126,164.64,
BINDER ABD UNIV 9 INCH,1613154,CDM,,,,INPATIENT,,,168,67.2,UNITED HEALTH,UNITED COMMERCIAL,,,,126,,126,164.64,
BINDER ABD UNIV X-LARGE,1613155,CDM,,,,INPATIENT,,,200.25,80.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,182.23,OTHER,150.19,196.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BINDER ABD UNIV X-LARGE,1613155,CDM,,,,INPATIENT,,,200.25,80.1,MONUMENT,COMMERCIAL,,,,160.2,,150.19,196.25,
BINDER ABD UNIV X-LARGE,1613155,CDM,,,,INPATIENT,,,200.25,80.1,UNITED HEALTH,UNITED COMMERCIAL,,,,150.19,,150.19,196.25,
BINDER ABD UNIV 12 INCH,1613156,CDM,,,,INPATIENT,,,139.25,55.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,126.72,OTHER,104.44,136.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BINDER ABD UNIV 12 INCH,1613156,CDM,,,,INPATIENT,,,139.25,55.7,MONUMENT,COMMERCIAL,,,,111.4,,104.44,136.47,
BINDER ABD UNIV 12 INCH,1613156,CDM,,,,INPATIENT,,,139.25,55.7,UNITED HEALTH,UNITED COMMERCIAL,,,,104.44,,104.44,136.47,
BINDER ABD UNIV XX-LARGE,1613157,CDM,,,,INPATIENT,,,200.25,80.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,182.23,OTHER,150.19,196.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BINDER ABD UNIV XX-LARGE,1613157,CDM,,,,INPATIENT,,,200.25,80.1,MONUMENT,COMMERCIAL,,,,160.2,,150.19,196.25,
BINDER ABD UNIV XX-LARGE,1613157,CDM,,,,INPATIENT,,,200.25,80.1,UNITED HEALTH,UNITED COMMERCIAL,,,,150.19,,150.19,196.25,
CANNULA SURETAC 7MM,1613202,CDM,,,,INPATIENT,,,125.75,50.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.43,OTHER,94.31,123.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANNULA SURETAC 7MM,1613202,CDM,,,,INPATIENT,,,125.75,50.3,MONUMENT,COMMERCIAL,,,,100.6,,94.31,123.24,
CANNULA SURETAC 7MM,1613202,CDM,,,,INPATIENT,,,125.75,50.3,UNITED HEALTH,UNITED COMMERCIAL,,,,94.31,,94.31,123.24,
CATH FEMALE KIT,1613227,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FEMALE KIT,1613227,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
CATH FEMALE KIT,1613227,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
TRAY CATH 14FR,1613228,CDM,,,,INPATIENT,,,29.75,11.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.07,OTHER,22.31,29.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY CATH 14FR,1613228,CDM,,,,INPATIENT,,,29.75,11.9,MONUMENT,COMMERCIAL,,,,23.8,,22.31,29.16,
TRAY CATH 14FR,1613228,CDM,,,,INPATIENT,,,29.75,11.9,UNITED HEALTH,UNITED COMMERCIAL,,,,22.31,,22.31,29.16,
CATH THERMO (SWANZ),1613229,CDM,,,,INPATIENT,,,631.75,252.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,574.89,OTHER,473.81,619.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH THERMO (SWANZ),1613229,CDM,,,,INPATIENT,,,631.75,252.7,MONUMENT,COMMERCIAL,,,,505.4,,473.81,619.12,
CATH THERMO (SWANZ),1613229,CDM,,,,INPATIENT,,,631.75,252.7,UNITED HEALTH,UNITED COMMERCIAL,,,,473.81,,473.81,619.12,
CATH TRIPLE LUMEN,1613232,CDM,,,,INPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,402.68,OTHER,331.88,433.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH TRIPLE LUMEN,1613232,CDM,,,,INPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
CATH TRIPLE LUMEN,1613232,CDM,,,,INPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,331.88,,331.88,433.65,
CATH FOLEY 08FR 3CC PED,1613240,CDM,,,,INPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.36,OTHER,67.88,88.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 08FR 3CC PED,1613240,CDM,,,,INPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
CATH FOLEY 08FR 3CC PED,1613240,CDM,,,,INPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,,67.88,,67.88,88.69,
CATH FOLEY 10FR 5CC PED,1613241,CDM,,,,INPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.36,OTHER,67.88,88.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 10FR 5CC PED,1613241,CDM,,,,INPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
CATH FOLEY 10FR 5CC PED,1613241,CDM,,,,INPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,,67.88,,67.88,88.69,
CATH FOLEY 12FR 5CC,1613242,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 12FR 5CC,1613242,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 12FR 5CC,1613242,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 14FR 5CC,1613243,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 14FR 5CC,1613243,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 14FR 5CC,1613243,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 16FR 5CC,1613244,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 16FR 5CC,1613244,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 16FR 5CC,1613244,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 18FR 5CC,1613245,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 18FR 5CC,1613245,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 18FR 5CC,1613245,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 20FR 5CC,1613246,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 20FR 5CC,1613246,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 20FR 5CC,1613246,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 22FR 5CC,1613247,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 22FR 5CC,1613247,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
CATH FOLEY 22FR 5CC,1613247,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
CATH FOLEY 24FR 5CC,1613248,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 24FR 5CC,1613248,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
CATH FOLEY 24FR 5CC,1613248,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CATH FOLEY 16FR W/UR,1613249,CDM,,,,INPATIENT,,,125.75,50.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.43,OTHER,94.31,123.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 16FR W/UR,1613249,CDM,,,,INPATIENT,,,125.75,50.3,MONUMENT,COMMERCIAL,,,,100.6,,94.31,123.24,
CATH FOLEY 16FR W/UR,1613249,CDM,,,,INPATIENT,,,125.75,50.3,UNITED HEALTH,UNITED COMMERCIAL,,,,94.31,,94.31,123.24,
CATH FOLEY 20FR 30CC,1613250,CDM,,,,INPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.61,OTHER,49.13,64.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 20FR 30CC,1613250,CDM,,,,INPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
CATH FOLEY 20FR 30CC,1613250,CDM,,,,INPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,49.13,,49.13,64.19,
CATH FOLEY 16FR 30CC,1613255,CDM,,,,INPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.48,OTHER,60.56,79.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 16FR 30CC,1613255,CDM,,,,INPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
CATH FOLEY 16FR 30CC,1613255,CDM,,,,INPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,,60.56,,60.56,79.14,
CATH FOLEY 18FR 30CC,1613256,CDM,,,,INPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.18,OTHER,33.94,44.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 18FR 30CC,1613256,CDM,,,,INPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
CATH FOLEY 18FR 30CC,1613256,CDM,,,,INPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,,33.94,,33.94,44.35,
CATH FOLEY 20FR 30CC 3-WAY,1613257,CDM,,,,INPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.51,OTHER,81.19,106.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 20FR 30CC 3-WAY,1613257,CDM,,,,INPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
CATH FOLEY 20FR 30CC 3-WAY,1613257,CDM,,,,INPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,,81.19,,81.19,106.09,
CATH FOLEY 22FR 30CC,1613258,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 22FR 30CC,1613258,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
CATH FOLEY 22FR 30CC,1613258,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
CATH FOLEY 24FR 30CC,1613259,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 24FR 30CC,1613259,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
CATH FOLEY 24FR 30CC,1613259,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
CATH FOLEY 24FR 30CC 3-WAY,1613260,CDM,,,,INPATIENT,,,87.75,35.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.85,OTHER,65.81,86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 24FR 30CC 3-WAY,1613260,CDM,,,,INPATIENT,,,87.75,35.1,MONUMENT,COMMERCIAL,,,,70.2,,65.81,86,
CATH FOLEY 24FR 30CC 3-WAY,1613260,CDM,,,,INPATIENT,,,87.75,35.1,UNITED HEALTH,UNITED COMMERCIAL,,,,65.81,,65.81,86,
CATH FOLEY 16FR 5CC COUNCIL,1613265,CDM,,,,INPATIENT,,,182.75,73.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,166.3,OTHER,137.06,179.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOLEY 16FR 5CC COUNCIL,1613265,CDM,,,,INPATIENT,,,182.75,73.1,MONUMENT,COMMERCIAL,,,,146.2,,137.06,179.1,
CATH FOLEY 16FR 5CC COUNCIL,1613265,CDM,,,,INPATIENT,,,182.75,73.1,UNITED HEALTH,UNITED COMMERCIAL,,,,137.06,,137.06,179.1,
POLYPECTOMY SNARE,1613295,CDM,,,,INPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.75,OTHER,93.75,122.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POLYPECTOMY SNARE,1613295,CDM,,,,INPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
POLYPECTOMY SNARE,1613295,CDM,,,,INPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,,93.75,,93.75,122.5,
V-CATH INSERTION,1613315,CDM,,,,INPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.53,OTHER,101.81,133.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH INSERTION,1613315,CDM,,,,INPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
V-CATH INSERTION,1613315,CDM,,,,INPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,,101.81,,101.81,133.04,
V-CATH MIDLINE 3FR,1613316,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH MIDLINE 3FR,1613316,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
V-CATH MIDLINE 3FR,1613316,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
V-CATH MIDLINE 4FR,1613317,CDM,,,,INPATIENT,,,339.25,135.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.72,OTHER,254.44,332.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH MIDLINE 4FR,1613317,CDM,,,,INPATIENT,,,339.25,135.7,MONUMENT,COMMERCIAL,,,,271.4,,254.44,332.47,
V-CATH MIDLINE 4FR,1613317,CDM,,,,INPATIENT,,,339.25,135.7,UNITED HEALTH,UNITED COMMERCIAL,,,,254.44,,254.44,332.47,
V-CATH KIT 2FR,1613318,CDM,,,,INPATIENT,,,384.5,153.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,349.9,OTHER,288.38,376.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH KIT 2FR,1613318,CDM,,,,INPATIENT,,,384.5,153.8,MONUMENT,COMMERCIAL,,,,307.6,,288.38,376.81,
V-CATH KIT 2FR,1613318,CDM,,,,INPATIENT,,,384.5,153.8,UNITED HEALTH,UNITED COMMERCIAL,,,,288.38,,288.38,376.81,
V-CATH PICC 3FR,1613319,CDM,,,,INPATIENT,,,439,175.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,399.49,OTHER,329.25,430.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH PICC 3FR,1613319,CDM,,,,INPATIENT,,,439,175.6,MONUMENT,COMMERCIAL,,,,351.2,,329.25,430.22,
V-CATH PICC 3FR,1613319,CDM,,,,INPATIENT,,,439,175.6,UNITED HEALTH,UNITED COMMERCIAL,,,,329.25,,329.25,430.22,
V-CATH PICC 4FR,1613320,CDM,,,,INPATIENT,,,350,140,BLUE CROSS ANTHEM,COMMERCIAL,,,,318.5,OTHER,262.5,343,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH PICC 4FR,1613320,CDM,,,,INPATIENT,,,350,140,MONUMENT,COMMERCIAL,,,,280,,262.5,343,
V-CATH PICC 4FR,1613320,CDM,,,,INPATIENT,,,350,140,UNITED HEALTH,UNITED COMMERCIAL,,,,262.5,,262.5,343,
V-CATH INTRODUCER 3.0FR,1613321,CDM,,,,INPATIENT,,,105.5,42.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.01,OTHER,79.13,103.39,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
V-CATH INTRODUCER 3.0FR,1613321,CDM,,,,INPATIENT,,,105.5,42.2,MONUMENT,COMMERCIAL,,,,84.4,,79.13,103.39,
V-CATH INTRODUCER 3.0FR,1613321,CDM,,,,INPATIENT,,,105.5,42.2,UNITED HEALTH,UNITED COMMERCIAL,,,,79.13,,79.13,103.39,
NEEDLE GRIPPER 22 X 25MM,1613322,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE GRIPPER 22 X 25MM,1613322,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
NEEDLE GRIPPER 22 X 25MM,1613322,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
NEEDLE GRIPPER HUBER  22 X 3/4,1613324,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE GRIPPER HUBER  22 X 3/4,1613324,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
NEEDLE GRIPPER HUBER  22 X 3/4,1613324,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
NEEDLE HUBER WINGED EXT.,1613327,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE HUBER WINGED EXT.,1613327,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
NEEDLE HUBER WINGED EXT.,1613327,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
NEEDLE GRIPPER 20G X 25MM,1613328,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE GRIPPER 20G X 25MM,1613328,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
NEEDLE GRIPPER 20G X 25MM,1613328,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
OXISENSOR MAX-P,1613330,CDM,,,,INPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.75,OTHER,54.19,70.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OXISENSOR MAX-P,1613330,CDM,,,,INPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
OXISENSOR MAX-P,1613330,CDM,,,,INPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,,54.19,,54.19,70.81,
CEMENT SIMPLEX,1613350,CDM,,,,INPATIENT,,,516.5,206.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,470.02,OTHER,387.38,506.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CEMENT SIMPLEX,1613350,CDM,,,,INPATIENT,,,516.5,206.6,MONUMENT,COMMERCIAL,,,,413.2,,387.38,506.17,
CEMENT SIMPLEX,1613350,CDM,,,,INPATIENT,,,516.5,206.6,UNITED HEALTH,UNITED COMMERCIAL,,,,387.38,,387.38,506.17,
CEMENT BONE PALACOS,1613352,CDM,,,,INPATIENT,,,433.5,173.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,394.49,OTHER,325.13,424.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CEMENT BONE PALACOS,1613352,CDM,,,,INPATIENT,,,433.5,173.4,MONUMENT,COMMERCIAL,,,,346.8,,325.13,424.83,
CEMENT BONE PALACOS,1613352,CDM,,,,INPATIENT,,,433.5,173.4,UNITED HEALTH,UNITED COMMERCIAL,,,,325.13,,325.13,424.83,
CHEMO - TAXAL SET TUBING,1613355,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CHEMO - TAXAL SET TUBING,1613355,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
CHEMO - TAXAL SET TUBING,1613355,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
DERMABOND SKIN ADHESIVE,1613358,CDM,,,,INPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.61,OTHER,49.13,64.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DERMABOND SKIN ADHESIVE,1613358,CDM,,,,INPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
DERMABOND SKIN ADHESIVE,1613358,CDM,,,,INPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,49.13,,49.13,64.19,
CIRCUITS VENT W/TRAPS,1613370,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCUITS VENT W/TRAPS,1613370,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
CIRCUITS VENT W/TRAPS,1613370,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
CIRCUIT VENTILATOR HEATED WR,1613371,CDM,,,,INPATIENT,,,120,48,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.2,OTHER,90,117.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCUIT VENTILATOR HEATED WR,1613371,CDM,,,,INPATIENT,,,120,48,MONUMENT,COMMERCIAL,,,,96,,90,117.6,
CIRCUIT VENTILATOR HEATED WR,1613371,CDM,,,,INPATIENT,,,120,48,UNITED HEALTH,UNITED COMMERCIAL,,,,90,,90,117.6,
CIRCUIT BILEVEL HEATED WIRE,1613372,CDM,,,,INPATIENT,,,230.5,92.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,209.76,OTHER,172.88,225.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCUIT BILEVEL HEATED WIRE,1613372,CDM,,,,INPATIENT,,,230.5,92.2,MONUMENT,COMMERCIAL,,,,184.4,,172.88,225.89,
CIRCUIT BILEVEL HEATED WIRE,1613372,CDM,,,,INPATIENT,,,230.5,92.2,UNITED HEALTH,UNITED COMMERCIAL,,,,172.88,,172.88,225.89,
EASY CAP II CO2 DETECTOR,1613374,CDM,,,,INPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.86,OTHER,109.5,143.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EASY CAP II CO2 DETECTOR,1613374,CDM,,,,INPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
EASY CAP II CO2 DETECTOR,1613374,CDM,,,,INPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,,109.5,,109.5,143.08,
FOG REDUCTION DEVICE,1613376,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FOG REDUCTION DEVICE,1613376,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
FOG REDUCTION DEVICE,1613376,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
COLLECTION SET  DISP TUBING,1613385,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COLLECTION SET  DISP TUBING,1613385,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
COLLECTION SET  DISP TUBING,1613385,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
DRAIN LARGE WOUND 5/8X15,1613450,CDM,,,,INPATIENT,,,184.75,73.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.12,OTHER,138.56,181.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN LARGE WOUND 5/8X15,1613450,CDM,,,,INPATIENT,,,184.75,73.9,MONUMENT,COMMERCIAL,,,,147.8,,138.56,181.06,
DRAIN LARGE WOUND 5/8X15,1613450,CDM,,,,INPATIENT,,,184.75,73.9,UNITED HEALTH,UNITED COMMERCIAL,,,,138.56,,138.56,181.06,
DRAIN PVC 1/4 CONSTAVAC,1613451,CDM,,,,INPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN PVC 1/4 CONSTAVAC,1613451,CDM,,,,INPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
DRAIN PVC 1/4 CONSTAVAC,1613451,CDM,,,,INPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
DRAIN PVC 1/8 SNYDER,1613452,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN PVC 1/8 SNYDER,1613452,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
DRAIN PVC 1/8 SNYDER,1613452,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
DRAIN BLAKE FLUTED 19FR,1613459,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN BLAKE FLUTED 19FR,1613459,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
DRAIN BLAKE FLUTED 19FR,1613459,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
DRAIN BLAKE FLUTED 15FR,1613460,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN BLAKE FLUTED 15FR,1613460,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
DRAIN BLAKE FLUTED 15FR,1613460,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
DRAPE SURG IOBAN 6650,1613480,CDM,,,,INPATIENT,,,525.75,210.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,478.43,OTHER,394.31,515.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAPE SURG IOBAN 6650,1613480,CDM,,,,INPATIENT,,,525.75,210.3,MONUMENT,COMMERCIAL,,,,420.6,,394.31,515.24,
DRAPE SURG IOBAN 6650,1613480,CDM,,,,INPATIENT,,,525.75,210.3,UNITED HEALTH,UNITED COMMERCIAL,,,,394.31,,394.31,515.24,
DRAPE CASSETTE,1613490,CDM,,,,INPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.85,OTHER,26.25,34.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAPE CASSETTE,1613490,CDM,,,,INPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
DRAPE CASSETTE,1613490,CDM,,,,INPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,,26.25,,26.25,34.3,
GERIGLOVE,1613692,CDM,,,,INPATIENT,,,152.25,60.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,138.55,OTHER,114.19,149.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GERIGLOVE,1613692,CDM,,,,INPATIENT,,,152.25,60.9,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
GERIGLOVE,1613692,CDM,,,,INPATIENT,,,152.25,60.9,UNITED HEALTH,UNITED COMMERCIAL,,,,114.19,,114.19,149.21,
ENDO CLIP 10MM M/L ER320,1613700,CDM,,,,INPATIENT,,,558,223.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,507.78,OTHER,418.5,546.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO CLIP 10MM M/L ER320,1613700,CDM,,,,INPATIENT,,,558,223.2,MONUMENT,COMMERCIAL,,,,446.4,,418.5,546.84,
ENDO CLIP 10MM M/L ER320,1613700,CDM,,,,INPATIENT,,,558,223.2,UNITED HEALTH,UNITED COMMERCIAL,,,,418.5,,418.5,546.84,
LEUKOCYTE FILTERS,1613710,CDM,,,,INPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.13,OTHER,103.13,134.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LEUKOCYTE FILTERS,1613710,CDM,,,,INPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
LEUKOCYTE FILTERS,1613710,CDM,,,,INPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,103.13,,103.13,134.75,
LEUKOCYTE DEPLETION FILTER,1613712,CDM,,,,INPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.7,OTHER,167.06,218.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LEUKOCYTE DEPLETION FILTER,1613712,CDM,,,,INPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
LEUKOCYTE DEPLETION FILTER,1613712,CDM,,,,INPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,167.06,,167.06,218.3,
ENDOPOUCH RETRIEVER,1613720,CDM,,,,INPATIENT,,,516.25,206.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,469.79,OTHER,387.19,505.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPOUCH RETRIEVER,1613720,CDM,,,,INPATIENT,,,516.25,206.5,MONUMENT,COMMERCIAL,,,,413,,387.19,505.93,
ENDOPOUCH RETRIEVER,1613720,CDM,,,,INPATIENT,,,516.25,206.5,UNITED HEALTH,UNITED COMMERCIAL,,,,387.19,,387.19,505.93,
ENDO DISSECTOR 5MM,1613730,CDM,,,,INPATIENT,,,545.75,218.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,496.63,OTHER,409.31,534.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO DISSECTOR 5MM,1613730,CDM,,,,INPATIENT,,,545.75,218.3,MONUMENT,COMMERCIAL,,,,436.6,,409.31,534.84,
ENDO DISSECTOR 5MM,1613730,CDM,,,,INPATIENT,,,545.75,218.3,UNITED HEALTH,UNITED COMMERCIAL,,,,409.31,,409.31,534.84,
ENDO RETRACTOR,1613740,CDM,,,,INPATIENT,,,635.75,254.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,578.53,OTHER,476.81,623.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO RETRACTOR,1613740,CDM,,,,INPATIENT,,,635.75,254.3,MONUMENT,COMMERCIAL,,,,508.6,,476.81,623.04,
ENDO RETRACTOR,1613740,CDM,,,,INPATIENT,,,635.75,254.3,UNITED HEALTH,UNITED COMMERCIAL,,,,476.81,,476.81,623.04,
END CUTTER 4.2,1613750,CDM,,,,INPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,402.68,OTHER,331.88,433.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
END CUTTER 4.2,1613750,CDM,,,,INPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
END CUTTER 4.2,1613750,CDM,,,,INPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,331.88,,331.88,433.65,
ENDOPATH MULTISEAL CAPS,1613760,CDM,,,,INPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.87,OTHER,38.63,50.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPATH MULTISEAL CAPS,1613760,CDM,,,,INPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
ENDOPATH MULTISEAL CAPS,1613760,CDM,,,,INPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,,38.63,,38.63,50.47,
IV BLOOD SET Y-TYPE,1613805,CDM,,,,INPATIENT,,,28.5,11.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.94,OTHER,21.38,27.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV BLOOD SET Y-TYPE,1613805,CDM,,,,INPATIENT,,,28.5,11.4,MONUMENT,COMMERCIAL,,,,22.8,,21.38,27.93,
IV BLOOD SET Y-TYPE,1613805,CDM,,,,INPATIENT,,,28.5,11.4,UNITED HEALTH,UNITED COMMERCIAL,,,,21.38,,21.38,27.93,
IV BUTTERFLY 19 GA,1613820,CDM,,,,INPATIENT,,,13.5,5.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.29,OTHER,10.13,13.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV BUTTERFLY 19 GA,1613820,CDM,,,,INPATIENT,,,13.5,5.4,MONUMENT,COMMERCIAL,,,,10.8,,10.13,13.23,
IV BUTTERFLY 19 GA,1613820,CDM,,,,INPATIENT,,,13.5,5.4,UNITED HEALTH,UNITED COMMERCIAL,,,,10.13,,10.13,13.23,
IV BUTTERFLY 21 GA,1613821,CDM,,,,INPATIENT,,,63.75,25.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.01,OTHER,47.81,62.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV BUTTERFLY 21 GA,1613821,CDM,,,,INPATIENT,,,63.75,25.5,MONUMENT,COMMERCIAL,,,,51,,47.81,62.48,
IV BUTTERFLY 21 GA,1613821,CDM,,,,INPATIENT,,,63.75,25.5,UNITED HEALTH,UNITED COMMERCIAL,,,,47.81,,47.81,62.48,
IV BUTTERFLY 23 GA,1613822,CDM,,,,INPATIENT,,,63.75,25.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.01,OTHER,47.81,62.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV BUTTERFLY 23 GA,1613822,CDM,,,,INPATIENT,,,63.75,25.5,MONUMENT,COMMERCIAL,,,,51,,47.81,62.48,
IV BUTTERFLY 23 GA,1613822,CDM,,,,INPATIENT,,,63.75,25.5,UNITED HEALTH,UNITED COMMERCIAL,,,,47.81,,47.81,62.48,
IV BUTTERFLY 25 GA,1613823,CDM,,,,INPATIENT,,,13.5,5.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.29,OTHER,10.13,13.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV BUTTERFLY 25 GA,1613823,CDM,,,,INPATIENT,,,13.5,5.4,MONUMENT,COMMERCIAL,,,,10.8,,10.13,13.23,
IV BUTTERFLY 25 GA,1613823,CDM,,,,INPATIENT,,,13.5,5.4,UNITED HEALTH,UNITED COMMERCIAL,,,,10.13,,10.13,13.23,
IV CONT EVACUATED 500 ML,1613840,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV CONT EVACUATED 500 ML,1613840,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
IV CONT EVACUATED 500 ML,1613840,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
IV CONT EVACUATED 1000 ML,1613841,CDM,,,,INPATIENT,,,32.25,12.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.35,OTHER,24.19,31.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV CONT EVACUATED 1000 ML,1613841,CDM,,,,INPATIENT,,,32.25,12.9,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
IV CONT EVACUATED 1000 ML,1613841,CDM,,,,INPATIENT,,,32.25,12.9,UNITED HEALTH,UNITED COMMERCIAL,,,,24.19,,24.19,31.61,
AGGRESS MENISCUS 4.0MM,1613875,CDM,,,,INPATIENT,,,524.5,209.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,477.3,OTHER,393.38,514.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AGGRESS MENISCUS 4.0MM,1613875,CDM,,,,INPATIENT,,,524.5,209.8,MONUMENT,COMMERCIAL,,,,419.6,,393.38,514.01,
AGGRESS MENISCUS 4.0MM,1613875,CDM,,,,INPATIENT,,,524.5,209.8,UNITED HEALTH,UNITED COMMERCIAL,,,,393.38,,393.38,514.01,
AGGRESS MENISCUS 5.0,1613880,CDM,,,,INPATIENT,,,573.25,229.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,521.66,OTHER,429.94,561.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AGGRESS MENISCUS 5.0,1613880,CDM,,,,INPATIENT,,,573.25,229.3,MONUMENT,COMMERCIAL,,,,458.6,,429.94,561.79,
AGGRESS MENISCUS 5.0,1613880,CDM,,,,INPATIENT,,,573.25,229.3,UNITED HEALTH,UNITED COMMERCIAL,,,,429.94,,429.94,561.79,
IV PRIMARY VEN/NONVEN SET,1613905,CDM,,,,INPATIENT,,,22,8.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.02,OTHER,16.5,21.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV PRIMARY VEN/NONVEN SET,1613905,CDM,,,,INPATIENT,,,22,8.8,MONUMENT,COMMERCIAL,,,,17.6,,16.5,21.56,
IV PRIMARY VEN/NONVEN SET,1613905,CDM,,,,INPATIENT,,,22,8.8,UNITED HEALTH,UNITED COMMERCIAL,,,,16.5,,16.5,21.56,
INTERLINK T-CON EXT,1613906,CDM,,,,INPATIENT,,,12,4.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,10.92,OTHER,9,11.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INTERLINK T-CON EXT,1613906,CDM,,,,INPATIENT,,,12,4.8,MONUMENT,COMMERCIAL,,,,9.6,,9,11.76,
INTERLINK T-CON EXT,1613906,CDM,,,,INPATIENT,,,12,4.8,UNITED HEALTH,UNITED COMMERCIAL,,,,9,,9,11.76,
INTERLINK SYSTEM,1613907,CDM,,,,INPATIENT,,,22,8.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.02,OTHER,16.5,21.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INTERLINK SYSTEM,1613907,CDM,,,,INPATIENT,,,22,8.8,MONUMENT,COMMERCIAL,,,,17.6,,16.5,21.56,
INTERLINK SYSTEM,1613907,CDM,,,,INPATIENT,,,22,8.8,UNITED HEALTH,UNITED COMMERCIAL,,,,16.5,,16.5,21.56,
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.8,OTHER,60,78.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,,60,,60,78.4,
IV SECONDARY SET,1613915,CDM,,,,INPATIENT,,,13.5,5.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.29,OTHER,10.13,13.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV SECONDARY SET,1613915,CDM,,,,INPATIENT,,,13.5,5.4,MONUMENT,COMMERCIAL,,,,10.8,,10.13,13.23,
IV SECONDARY SET,1613915,CDM,,,,INPATIENT,,,13.5,5.4,UNITED HEALTH,UNITED COMMERCIAL,,,,10.13,,10.13,13.23,
BEDSIDE KNEE (PEDS) IMMOBILIZ,1614100,CDM,,,,INPATIENT,,,117.25,46.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.7,OTHER,87.94,114.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BEDSIDE KNEE (PEDS) IMMOBILIZ,1614100,CDM,,,,INPATIENT,,,117.25,46.9,MONUMENT,COMMERCIAL,,,,93.8,,87.94,114.91,
BEDSIDE KNEE (PEDS) IMMOBILIZ,1614100,CDM,,,,INPATIENT,,,117.25,46.9,UNITED HEALTH,UNITED COMMERCIAL,,,,87.94,,87.94,114.91,
KIT FETAL PRESSURE,1614232,CDM,,,,INPATIENT,,,256.5,102.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,233.42,OTHER,192.38,251.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KIT FETAL PRESSURE,1614232,CDM,,,,INPATIENT,,,256.5,102.6,MONUMENT,COMMERCIAL,,,,205.2,,192.38,251.37,
KIT FETAL PRESSURE,1614232,CDM,,,,INPATIENT,,,256.5,102.6,UNITED HEALTH,UNITED COMMERCIAL,,,,192.38,,192.38,251.37,
KIT GASTRIC LAVAGE,1614234,CDM,,,,INPATIENT,,,144.25,57.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.27,OTHER,108.19,141.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KIT GASTRIC LAVAGE,1614234,CDM,,,,INPATIENT,,,144.25,57.7,MONUMENT,COMMERCIAL,,,,115.4,,108.19,141.37,
KIT GASTRIC LAVAGE,1614234,CDM,,,,INPATIENT,,,144.25,57.7,UNITED HEALTH,UNITED COMMERCIAL,,,,108.19,,108.19,141.37,
TRAY INTUBATION,1614238,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY INTUBATION,1614238,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY INTUBATION,1614238,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
LINEAR STAPLER 55MM STAND GIA,1614270,CDM,,,,INPATIENT,,,572.25,228.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,520.75,OTHER,429.19,560.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR STAPLER 55MM STAND GIA,1614270,CDM,,,,INPATIENT,,,572.25,228.9,MONUMENT,COMMERCIAL,,,,457.8,,429.19,560.81,
LINEAR STAPLER 55MM STAND GIA,1614270,CDM,,,,INPATIENT,,,572.25,228.9,UNITED HEALTH,UNITED COMMERCIAL,,,,429.19,,429.19,560.81,
LINEAR STAPLER 60MM BLUE,1614280,CDM,,,,INPATIENT,,,532.5,213,BLUE CROSS ANTHEM,COMMERCIAL,,,,484.58,OTHER,399.38,521.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR STAPLER 60MM BLUE,1614280,CDM,,,,INPATIENT,,,532.5,213,MONUMENT,COMMERCIAL,,,,426,,399.38,521.85,
LINEAR STAPLER 60MM BLUE,1614280,CDM,,,,INPATIENT,,,532.5,213,UNITED HEALTH,UNITED COMMERCIAL,,,,399.38,,399.38,521.85,
RELOAD 60MM STANDARD 3.5MM BLU,1614282,CDM,,,,INPATIENT,,,346,138.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,314.86,OTHER,259.5,339.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RELOAD 60MM STANDARD 3.5MM BLU,1614282,CDM,,,,INPATIENT,,,346,138.4,MONUMENT,COMMERCIAL,,,,276.8,,259.5,339.08,
RELOAD 60MM STANDARD 3.5MM BLU,1614282,CDM,,,,INPATIENT,,,346,138.4,UNITED HEALTH,UNITED COMMERCIAL,,,,259.5,,259.5,339.08,
LINEAR CUTTER 35MM VASCULAR,1614285,CDM,,,,INPATIENT,,,1089.75,435.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.67,OTHER,817.31,1067.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR CUTTER 35MM VASCULAR,1614285,CDM,,,,INPATIENT,,,1089.75,435.9,MONUMENT,COMMERCIAL,,,,871.8,,817.31,1067.96,
LINEAR CUTTER 35MM VASCULAR,1614285,CDM,,,,INPATIENT,,,1089.75,435.9,UNITED HEALTH,UNITED COMMERCIAL,,,,817.31,,817.31,1067.96,
35MM STANDARD/VAS. RELOADS,1614290,CDM,,,,INPATIENT,,,501.75,200.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,456.59,OTHER,376.31,491.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
35MM STANDARD/VAS. RELOADS,1614290,CDM,,,,INPATIENT,,,501.75,200.7,MONUMENT,COMMERCIAL,,,,401.4,,376.31,491.72,
35MM STANDARD/VAS. RELOADS,1614290,CDM,,,,INPATIENT,,,501.75,200.7,UNITED HEALTH,UNITED COMMERCIAL,,,,376.31,,376.31,491.72,
35MM VASCULAR RELOADS,1614295,CDM,,,,INPATIENT,,,501.75,200.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,456.59,OTHER,376.31,491.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
35MM VASCULAR RELOADS,1614295,CDM,,,,INPATIENT,,,501.75,200.7,MONUMENT,COMMERCIAL,,,,401.4,,376.31,491.72,
35MM VASCULAR RELOADS,1614295,CDM,,,,INPATIENT,,,501.75,200.7,UNITED HEALTH,UNITED COMMERCIAL,,,,376.31,,376.31,491.72,
LINENS DRAPE HIP W/C-ARM,1614300,CDM,,,,INPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,223.41,OTHER,184.13,240.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINENS DRAPE HIP W/C-ARM,1614300,CDM,,,,INPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
LINENS DRAPE HIP W/C-ARM,1614300,CDM,,,,INPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,184.13,,184.13,240.59,
MASK  AMBU LARYNGEAL SIZE 3,1614584,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MASK  AMBU LARYNGEAL SIZE 3,1614584,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
MASK  AMBU LARYNGEAL SIZE 3,1614584,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
MASK  AMBU LARYNGEAL SIZE 4,1614586,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MASK  AMBU LARYNGEAL SIZE 4,1614586,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
MASK  AMBU LARYNGEAL SIZE 4,1614586,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
MASK  AMBU LARYNGEAL SIZE 5,1614588,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MASK  AMBU LARYNGEAL SIZE 5,1614588,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
MASK  AMBU LARYNGEAL SIZE 5,1614588,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
NEEDLE WHITACRE 22GX3 1/2,1614609,CDM,,,,INPATIENT,,,59.5,23.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.15,OTHER,44.63,58.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE WHITACRE 22GX3 1/2,1614609,CDM,,,,INPATIENT,,,59.5,23.8,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
NEEDLE WHITACRE 22GX3 1/2,1614609,CDM,,,,INPATIENT,,,59.5,23.8,UNITED HEALTH,UNITED COMMERCIAL,,,,44.63,,44.63,58.31,
ORTHO BOOT CAST SMALL,1614706,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO BOOT CAST SMALL,1614706,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
ORTHO BOOT CAST SMALL,1614706,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
ORTHO BOOT CAST MEDIUM,1614707,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO BOOT CAST MEDIUM,1614707,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
ORTHO BOOT CAST MEDIUM,1614707,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
ORTHO BOOT CAST LARGE,1614708,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO BOOT CAST LARGE,1614708,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
ORTHO BOOT CAST LARGE,1614708,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
ORTHO BOOT CAST XLG,1614709,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO BOOT CAST XLG,1614709,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
ORTHO BOOT CAST XLG,1614709,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
ORTHO COLLAR CERV SMALL,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO COLLAR CERV SMALL,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ORTHO COLLAR CERV SMALL,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
ORTHO COLLAR CERV MEDIUM,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO COLLAR CERV MEDIUM,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ORTHO COLLAR CERV MEDIUM,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
ORTHO COLLAR CERV LARGE,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO COLLAR CERV LARGE,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ORTHO COLLAR CERV LARGE,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
ORTHO IM/SHOULDER FEMALE MED,1614736,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO IM/SHOULDER FEMALE MED,1614736,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
ORTHO IM/SHOULDER FEMALE MED,1614736,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
ORTHO IM/SHOULDER FEMALE LARGE,1614737,CDM,,,,INPATIENT,,,86,34.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.26,OTHER,64.5,84.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO IM/SHOULDER FEMALE LARGE,1614737,CDM,,,,INPATIENT,,,86,34.4,MONUMENT,COMMERCIAL,,,,68.8,,64.5,84.28,
ORTHO IM/SHOULDER FEMALE LARGE,1614737,CDM,,,,INPATIENT,,,86,34.4,UNITED HEALTH,UNITED COMMERCIAL,,,,64.5,,64.5,84.28,
ORTHO IM/SHOULDER FEMALE X-LGE,1614738,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO IM/SHOULDER FEMALE X-LGE,1614738,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
ORTHO IM/SHOULDER FEMALE X-LGE,1614738,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
ORTHO SPLINT CLAVICAL MEDIUM,1614833,CDM,,,,INPATIENT,,,142.75,57.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.9,OTHER,107.06,139.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SPLINT CLAVICAL MEDIUM,1614833,CDM,,,,INPATIENT,,,142.75,57.1,MONUMENT,COMMERCIAL,,,,114.2,,107.06,139.9,
ORTHO SPLINT CLAVICAL MEDIUM,1614833,CDM,,,,INPATIENT,,,142.75,57.1,UNITED HEALTH,UNITED COMMERCIAL,,,,107.06,,107.06,139.9,
ORTHO SPLINT CLAVICAL LARGE,1614834,CDM,,,,INPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.27,OTHER,112.31,146.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SPLINT CLAVICAL LARGE,1614834,CDM,,,,INPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
ORTHO SPLINT CLAVICAL LARGE,1614834,CDM,,,,INPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,,112.31,,112.31,146.76,
ORTHO SUPPORT KNEE MEDIUM,L1830,HCPCS,274,RC,,INPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.62,OTHER,96.94,126.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SUPPORT KNEE MEDIUM,L1830,HCPCS,274,RC,,INPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
ORTHO SUPPORT KNEE MEDIUM,L1830,HCPCS,274,RC,,INPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,,96.94,,96.94,126.67,
PAD HELL & ELBOW PROTECTOR,1614948,CDM,,,,INPATIENT,,,15,6,BLUE CROSS ANTHEM,COMMERCIAL,,,,13.65,OTHER,11.25,14.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PAD HELL & ELBOW PROTECTOR,1614948,CDM,,,,INPATIENT,,,15,6,MONUMENT,COMMERCIAL,,,,12,,11.25,14.7,
PAD HELL & ELBOW PROTECTOR,1614948,CDM,,,,INPATIENT,,,15,6,UNITED HEALTH,UNITED COMMERCIAL,,,,11.25,,11.25,14.7,
INFUSION SET INTERTIP,1614952,CDM,,,,INPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INFUSION SET INTERTIP,1614952,CDM,,,,INPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
INFUSION SET INTERTIP,1614952,CDM,,,,INPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
INFUSION SET POWER LOC SAFETY,1614954,CDM,,,,INPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.6,OTHER,45,58.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INFUSION SET POWER LOC SAFETY,1614954,CDM,,,,INPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
INFUSION SET POWER LOC SAFETY,1614954,CDM,,,,INPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,,45,,45,58.8,
PAD GROUNDING,1614965,CDM,,,,INPATIENT,,,57,22.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.87,OTHER,42.75,55.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PAD GROUNDING,1614965,CDM,,,,INPATIENT,,,57,22.8,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
PAD GROUNDING,1614965,CDM,,,,INPATIENT,,,57,22.8,UNITED HEALTH,UNITED COMMERCIAL,,,,42.75,,42.75,55.86,
DUO THEM PAD HYPO 24X60,1614972,CDM,,,,INPATIENT,,,155.75,62.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.73,OTHER,116.81,152.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DUO THEM PAD HYPO 24X60,1614972,CDM,,,,INPATIENT,,,155.75,62.3,MONUMENT,COMMERCIAL,,,,124.6,,116.81,152.64,
DUO THEM PAD HYPO 24X60,1614972,CDM,,,,INPATIENT,,,155.75,62.3,UNITED HEALTH,UNITED COMMERCIAL,,,,116.81,,116.81,152.64,
DUO THERM PAD 18X24,1614976,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DUO THERM PAD 18X24,1614976,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
DUO THERM PAD 18X24,1614976,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
PAIN BUSTER,1614980,CDM,,,,INPATIENT,,,724.5,289.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,659.3,OTHER,543.38,710.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PAIN BUSTER,1614980,CDM,,,,INPATIENT,,,724.5,289.8,MONUMENT,COMMERCIAL,,,,579.6,,543.38,710.01,
PAIN BUSTER,1614980,CDM,,,,INPATIENT,,,724.5,289.8,UNITED HEALTH,UNITED COMMERCIAL,,,,543.38,,543.38,710.01,
STAPLE SKIN EXTRACTOR,1615135,CDM,,,,INPATIENT,,,4,1.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3.64,OTHER,3,3.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STAPLE SKIN EXTRACTOR,1615135,CDM,,,,INPATIENT,,,4,1.6,MONUMENT,COMMERCIAL,,,,3.2,,3,3.92,
STAPLE SKIN EXTRACTOR,1615135,CDM,,,,INPATIENT,,,4,1.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3,,3,3.92,
TENDON SPACER SZ 4,1615141,CDM,,,,INPATIENT,,,1360.25,544.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1237.83,OTHER,1020.19,1333.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TENDON SPACER SZ 4,1615141,CDM,,,,INPATIENT,,,1360.25,544.1,MONUMENT,COMMERCIAL,,,,1088.2,,1020.19,1333.05,
TENDON SPACER SZ 4,1615141,CDM,,,,INPATIENT,,,1360.25,544.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1020.19,,1020.19,1333.05,
TENDON SPACER SZ 5,1615142,CDM,,,,INPATIENT,,,1360.25,544.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1237.83,OTHER,1020.19,1333.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TENDON SPACER SZ 5,1615142,CDM,,,,INPATIENT,,,1360.25,544.1,MONUMENT,COMMERCIAL,,,,1088.2,,1020.19,1333.05,
TENDON SPACER SZ 5,1615142,CDM,,,,INPATIENT,,,1360.25,544.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1020.19,,1020.19,1333.05,
STRYKERFLOW PUMP & HAND,1615308,CDM,,,,INPATIENT,,,292,116.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,265.72,OTHER,219,286.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STRYKERFLOW PUMP & HAND,1615308,CDM,,,,INPATIENT,,,292,116.8,MONUMENT,COMMERCIAL,,,,233.6,,219,286.16,
STRYKERFLOW PUMP & HAND,1615308,CDM,,,,INPATIENT,,,292,116.8,UNITED HEALTH,UNITED COMMERCIAL,,,,219,,219,286.16,
STERI CUFF 18 INCH,1615324,CDM,,,,INPATIENT,,,186.5,74.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.72,OTHER,139.88,182.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERI CUFF 18 INCH,1615324,CDM,,,,INPATIENT,,,186.5,74.6,MONUMENT,COMMERCIAL,,,,149.2,,139.88,182.77,
STERI CUFF 18 INCH,1615324,CDM,,,,INPATIENT,,,186.5,74.6,UNITED HEALTH,UNITED COMMERCIAL,,,,139.88,,139.88,182.77,
STERI CUFF 34 INCH,1615326,CDM,,,,INPATIENT,,,236,94.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.76,OTHER,177,231.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERI CUFF 34 INCH,1615326,CDM,,,,INPATIENT,,,236,94.4,MONUMENT,COMMERCIAL,,,,188.8,,177,231.28,
STERI CUFF 34 INCH,1615326,CDM,,,,INPATIENT,,,236,94.4,UNITED HEALTH,UNITED COMMERCIAL,,,,177,,177,231.28,
STOCKING EMB XLG,1615354,CDM,,,,INPATIENT,,,108.5,43.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.74,OTHER,81.38,106.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STOCKING EMB XLG,1615354,CDM,,,,INPATIENT,,,108.5,43.4,MONUMENT,COMMERCIAL,,,,86.8,,81.38,106.33,
STOCKING EMB XLG,1615354,CDM,,,,INPATIENT,,,108.5,43.4,UNITED HEALTH,UNITED COMMERCIAL,,,,81.38,,81.38,106.33,
SUCTION TIP KAMVAC MINI,1615421,CDM,,,,INPATIENT,,,150.75,60.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.18,OTHER,113.06,147.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUCTION TIP KAMVAC MINI,1615421,CDM,,,,INPATIENT,,,150.75,60.3,MONUMENT,COMMERCIAL,,,,120.6,,113.06,147.74,
SUCTION TIP KAMVAC MINI,1615421,CDM,,,,INPATIENT,,,150.75,60.3,UNITED HEALTH,UNITED COMMERCIAL,,,,113.06,,113.06,147.74,
SUCTION TIP POOLE,1615440,CDM,,,,INPATIENT,,,40.5,16.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.86,OTHER,30.38,39.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUCTION TIP POOLE,1615440,CDM,,,,INPATIENT,,,40.5,16.2,MONUMENT,COMMERCIAL,,,,32.4,,30.38,39.69,
SUCTION TIP POOLE,1615440,CDM,,,,INPATIENT,,,40.5,16.2,UNITED HEALTH,UNITED COMMERCIAL,,,,30.38,,30.38,39.69,
SUPPORTER MALE LARGE,1615467,CDM,,,,INPATIENT,,,101.25,40.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,92.14,OTHER,75.94,99.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUPPORTER MALE LARGE,1615467,CDM,,,,INPATIENT,,,101.25,40.5,MONUMENT,COMMERCIAL,,,,81,,75.94,99.23,
SUPPORTER MALE LARGE,1615467,CDM,,,,INPATIENT,,,101.25,40.5,UNITED HEALTH,UNITED COMMERCIAL,,,,75.94,,75.94,99.23,
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,234,93.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.94,OTHER,175.5,229.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,234,93.6,MONUMENT,COMMERCIAL,,,,187.2,,175.5,229.32,
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,234,93.6,UNITED HEALTH,UNITED COMMERCIAL,,,,175.5,,175.5,229.32,
TOMCAT SHAVER 5.5,1615510,CDM,,,,INPATIENT,,,265.5,106.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,241.61,OTHER,199.13,260.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TOMCAT SHAVER 5.5,1615510,CDM,,,,INPATIENT,,,265.5,106.2,MONUMENT,COMMERCIAL,,,,212.4,,199.13,260.19,
TOMCAT SHAVER 5.5,1615510,CDM,,,,INPATIENT,,,265.5,106.2,UNITED HEALTH,UNITED COMMERCIAL,,,,199.13,,199.13,260.19,
TUBE TRACHEOSTOMY #7,1615511,CDM,,,,INPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.71,OTHER,175.31,229.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TUBE TRACHEOSTOMY #7,1615511,CDM,,,,INPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
TUBE TRACHEOSTOMY #7,1615511,CDM,,,,INPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,175.31,,175.31,229.08,
TRAY EPIDURAL CONTINUOUS,1615520,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY EPIDURAL CONTINUOUS,1615520,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
TRAY EPIDURAL CONTINUOUS,1615520,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
TRAY LUMBAR PUNCTURE ADULT,1615525,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY LUMBAR PUNCTURE ADULT,1615525,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
TRAY LUMBAR PUNCTURE ADULT,1615525,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
TRAY LUMBAR PUNCTURE PEDS,1615526,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY LUMBAR PUNCTURE PEDS,1615526,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
TRAY LUMBAR PUNCTURE PEDS,1615526,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
TRAY LACERATION REPAIR,1615536,CDM,,,,INPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.87,OTHER,38.63,50.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY LACERATION REPAIR,1615536,CDM,,,,INPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
TRAY LACERATION REPAIR,1615536,CDM,,,,INPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,,38.63,,38.63,50.47,
TRAY SUBCLAVIAN #61248,1615539,CDM,,,,INPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.32,OTHER,39,50.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY SUBCLAVIAN #61248,1615539,CDM,,,,INPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
TRAY SUBCLAVIAN #61248,1615539,CDM,,,,INPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,,39,,39,50.96,
TRAY EYE,1615540,CDM,,,,INPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.47,OTHER,52.31,68.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY EYE,1615540,CDM,,,,INPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
TRAY EYE,1615540,CDM,,,,INPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,,52.31,,52.31,68.36,
TRAY BONE MARROW,1615542,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY BONE MARROW,1615542,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY BONE MARROW,1615542,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
TRAY CHEST TUBE,1615544,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY CHEST TUBE,1615544,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY CHEST TUBE,1615544,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
TRAY THORANCENTESIS,1615545,CDM,,,,INPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,207.03,OTHER,170.63,222.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY THORANCENTESIS,1615545,CDM,,,,INPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
TRAY THORANCENTESIS,1615545,CDM,,,,INPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,,170.63,,170.63,222.95,
TRAY I&D,1615546,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY I&D,1615546,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY I&D,1615546,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
TRAY SUTURING,1615548,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY SUTURING,1615548,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY SUTURING,1615548,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
CUSTOM RADIOLOGY TRAY,1615549,CDM,,,,INPATIENT,,,114,45.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.74,OTHER,85.5,111.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUSTOM RADIOLOGY TRAY,1615549,CDM,,,,INPATIENT,,,114,45.6,MONUMENT,COMMERCIAL,,,,91.2,,85.5,111.72,
CUSTOM RADIOLOGY TRAY,1615549,CDM,,,,INPATIENT,,,114,45.6,UNITED HEALTH,UNITED COMMERCIAL,,,,85.5,,85.5,111.72,
TRAY TRACH,1615550,CDM,,,,INPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.57,OTHER,55.69,72.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY TRACH,1615550,CDM,,,,INPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRAY TRACH,1615550,CDM,,,,INPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,,55.69,,55.69,72.77,
SPARC SLING SYSTEM W/TENSION,1615852,CDM,,,,INPATIENT,,,2108.75,843.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1918.96,OTHER,1581.56,2066.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPARC SLING SYSTEM W/TENSION,1615852,CDM,,,,INPATIENT,,,2108.75,843.5,MONUMENT,COMMERCIAL,,,,1687,,1581.56,2066.58,
SPARC SLING SYSTEM W/TENSION,1615852,CDM,,,,INPATIENT,,,2108.75,843.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1581.56,,1581.56,2066.58,
BIOPSY SYSTEM,1620000,CDM,,,,INPATIENT,,,292,116.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,265.72,OTHER,219,286.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOPSY SYSTEM,1620000,CDM,,,,INPATIENT,,,292,116.8,MONUMENT,COMMERCIAL,,,,233.6,,219,286.16,
BIOPSY SYSTEM,1620000,CDM,,,,INPATIENT,,,292,116.8,UNITED HEALTH,UNITED COMMERCIAL,,,,219,,219,286.16,
K-PAD PUMP PER DAY,1620100,CDM,,,,INPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.49,OTHER,100.13,130.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
K-PAD PUMP PER DAY,1620100,CDM,,,,INPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
K-PAD PUMP PER DAY,1620100,CDM,,,,INPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,,100.13,,100.13,130.83,
PACIFERS ORTHODONTIC,1621545,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PACIFERS ORTHODONTIC,1621545,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
PACIFERS ORTHODONTIC,1621545,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
WIRE GUIDE J 125CM,1621980,CDM,,,,INPATIENT,,,125.75,50.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.43,OTHER,94.31,123.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WIRE GUIDE J 125CM,1621980,CDM,,,,INPATIENT,,,125.75,50.3,MONUMENT,COMMERCIAL,,,,100.6,,94.31,123.24,
WIRE GUIDE J 125CM,1621980,CDM,,,,INPATIENT,,,125.75,50.3,UNITED HEALTH,UNITED COMMERCIAL,,,,94.31,,94.31,123.24,
PENEDRIL DRILL TIP,1622225,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PENEDRIL DRILL TIP,1622225,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
PENEDRIL DRILL TIP,1622225,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
LACTATION CONSULT,1622230,CDM,722,RC,,INPATIENT,,,170.25,68.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.93,OTHER,127.69,166.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LACTATION CONSULT,1622230,CDM,722,RC,,INPATIENT,,,170.25,68.1,MONUMENT,COMMERCIAL,,,,136.2,,127.69,166.85,
LACTATION CONSULT,1622230,CDM,722,RC,,INPATIENT,,,170.25,68.1,UNITED HEALTH,UNITED COMMERCIAL,,,,127.69,,127.69,166.85,
LACTATION CONSULT PAST 30 DAYS,99211,CPT,510,RC,,OUTPATIENT,,,170.25,68.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.2,OTHER,127.7,166.8,PERCENT OF CHARGES BASED ON HCPCS CODE
LACTATION CONSULT PAST 30 DAYS,99211,CPT,510,RC,,OUTPATIENT,,,170.25,68.1,MONUMENT,COMMERCIAL,,,,136.2,,127.7,166.8,
US RENAL FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1323,1728.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PUMP BREAST,1622240,CDM,,,,INPATIENT,,,129.75,51.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.07,OTHER,97.31,127.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PUMP BREAST,1622240,CDM,,,,INPATIENT,,,129.75,51.9,MONUMENT,COMMERCIAL,,,,103.8,,97.31,127.16,
PUMP BREAST,1622240,CDM,,,,INPATIENT,,,129.75,51.9,UNITED HEALTH,UNITED COMMERCIAL,,,,97.31,,97.31,127.16,
BREAST/NIPPLE SHIELD,1622242,CDM,,,,INPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43,OTHER,35.44,46.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BREAST/NIPPLE SHIELD,1622242,CDM,,,,INPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
BREAST/NIPPLE SHIELD,1622242,CDM,,,,INPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,,35.44,,35.44,46.31,
BREAST PUMP KIT,1622244,CDM,,,,INPATIENT,,,169.75,67.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.47,OTHER,127.31,166.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BREAST PUMP KIT,1622244,CDM,,,,INPATIENT,,,169.75,67.9,MONUMENT,COMMERCIAL,,,,135.8,,127.31,166.36,
BREAST PUMP KIT,1622244,CDM,,,,INPATIENT,,,169.75,67.9,UNITED HEALTH,UNITED COMMERCIAL,,,,127.31,,127.31,166.36,
TRAY TRIPLE LUMEN CATH,1622590,CDM,,,,INPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,402.68,OTHER,331.88,433.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY TRIPLE LUMEN CATH,1622590,CDM,,,,INPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
TRAY TRIPLE LUMEN CATH,1622590,CDM,,,,INPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,331.88,,331.88,433.65,
TRAY TUOHY NEEDLE CATH SET 18G,1622592,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY TUOHY NEEDLE CATH SET 18G,1622592,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
TRAY TUOHY NEEDLE CATH SET 18G,1622592,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
TUR Y-TYPE SET,1622594,CDM,,,,INPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.13,OTHER,32.25,42.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TUR Y-TYPE SET,1622594,CDM,,,,INPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
TUR Y-TYPE SET,1622594,CDM,,,,INPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,,32.25,,32.25,42.14,
BAG URI-METER DRAIN,1622596,CDM,,,,INPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.97,OTHER,85.69,111.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG URI-METER DRAIN,1622596,CDM,,,,INPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
BAG URI-METER DRAIN,1622596,CDM,,,,INPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,,85.69,,85.69,111.97,
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,87.75,35.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.85,OTHER,65.81,86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,87.75,35.1,MONUMENT,COMMERCIAL,,,,70.2,,65.81,86,
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,87.75,35.1,UNITED HEALTH,UNITED COMMERCIAL,,,,65.81,,65.81,86,
BI PAP DIAP CIRCUITS,1623350,CDM,,,,INPATIENT,,,103.25,41.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.96,OTHER,77.44,101.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BI PAP DIAP CIRCUITS,1623350,CDM,,,,INPATIENT,,,103.25,41.3,MONUMENT,COMMERCIAL,,,,82.6,,77.44,101.19,
BI PAP DIAP CIRCUITS,1623350,CDM,,,,INPATIENT,,,103.25,41.3,UNITED HEALTH,UNITED COMMERCIAL,,,,77.44,,77.44,101.19,
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,199.5,79.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,181.55,OTHER,149.63,195.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,199.5,79.8,MONUMENT,COMMERCIAL,,,,159.6,,149.63,195.51,
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,199.5,79.8,UNITED HEALTH,UNITED COMMERCIAL,,,,149.63,,149.63,195.51,
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,148,59.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.68,OTHER,111,145.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,148,59.2,MONUMENT,COMMERCIAL,,,,118.4,,111,145.04,
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,148,59.2,UNITED HEALTH,UNITED COMMERCIAL,,,,111,,111,145.04,
STERILMED FOOTPAD STD,1624238,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERILMED FOOTPAD STD,1624238,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
STERILMED FOOTPAD STD,1624238,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
STERILMED FOOT PAD LG,1624239,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERILMED FOOT PAD LG,1624239,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
STERILMED FOOT PAD LG,1624239,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
THERAPEUTIC LENS MORGAN,V2797,HCPCS,270,RC,,BOTH,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.07,OTHER,93.19,121.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
THERAPEUTIC LENS MORGAN,V2797,HCPCS,270,RC,,BOTH,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
THERAPEUTIC LENS MORGAN,V2797,HCPCS,270,RC,,BOTH,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,,93.19,,93.19,121.77,
I/A PAK,1631600,CDM,,,,INPATIENT,,,715.25,286.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,650.88,OTHER,536.44,700.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
I/A PAK,1631600,CDM,,,,INPATIENT,,,715.25,286.1,MONUMENT,COMMERCIAL,,,,572.2,,536.44,700.95,
I/A PAK,1631600,CDM,,,,INPATIENT,,,715.25,286.1,UNITED HEALTH,UNITED COMMERCIAL,,,,536.44,,536.44,700.95,
NASAL PACK RHINO POCKET MEDIUM,1631831,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NASAL PACK RHINO POCKET MEDIUM,1631831,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
NASAL PACK RHINO POCKET MEDIUM,1631831,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
NASAL PACK RHIN0 POCKET LARGE,1631832,CDM,,,,INPATIENT,,,64,25.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.24,OTHER,48,62.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NASAL PACK RHIN0 POCKET LARGE,1631832,CDM,,,,INPATIENT,,,64,25.6,MONUMENT,COMMERCIAL,,,,51.2,,48,62.72,
NASAL PACK RHIN0 POCKET LARGE,1631832,CDM,,,,INPATIENT,,,64,25.6,UNITED HEALTH,UNITED COMMERCIAL,,,,48,,48,62.72,
NEEDLE HYPO NERVE BLOCK,1631870,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE HYPO NERVE BLOCK,1631870,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
NEEDLE HYPO NERVE BLOCK,1631870,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
NERVE BLOCK SET CONTINUOUS,1631880,CDM,,,,INPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,192.92,OTHER,159,207.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NERVE BLOCK SET CONTINUOUS,1631880,CDM,,,,INPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
NERVE BLOCK SET CONTINUOUS,1631880,CDM,,,,INPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,,159,,159,207.76,
INSULATED BLOCK SET,1631890,CDM,,,,INPATIENT,,,136.5,54.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.22,OTHER,102.38,133.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INSULATED BLOCK SET,1631890,CDM,,,,INPATIENT,,,136.5,54.6,MONUMENT,COMMERCIAL,,,,109.2,,102.38,133.77,
INSULATED BLOCK SET,1631890,CDM,,,,INPATIENT,,,136.5,54.6,UNITED HEALTH,UNITED COMMERCIAL,,,,102.38,,102.38,133.77,
CUTTING LOOP 24FR,1639376,CDM,,,,INPATIENT,,,496.25,198.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,451.59,OTHER,372.19,486.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUTTING LOOP 24FR,1639376,CDM,,,,INPATIENT,,,496.25,198.5,MONUMENT,COMMERCIAL,,,,397,,372.19,486.33,
CUTTING LOOP 24FR,1639376,CDM,,,,INPATIENT,,,496.25,198.5,UNITED HEALTH,UNITED COMMERCIAL,,,,372.19,,372.19,486.33,
LINEAR CUTTER 75MM,1639377,CDM,,,,INPATIENT,,,995,398,BLUE CROSS ANTHEM,COMMERCIAL,,,,905.45,OTHER,746.25,975.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR CUTTER 75MM,1639377,CDM,,,,INPATIENT,,,995,398,MONUMENT,COMMERCIAL,,,,796,,746.25,975.1,
LINEAR CUTTER 75MM,1639377,CDM,,,,INPATIENT,,,995,398,UNITED HEALTH,UNITED COMMERCIAL,,,,746.25,,746.25,975.1,
CUSHION RING - DONUT,1639378,CDM,,,,INPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.64,OTHER,38.44,50.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUSHION RING - DONUT,1639378,CDM,,,,INPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
CUSHION RING - DONUT,1639378,CDM,,,,INPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,,38.44,,38.44,50.23,
ACDA ANTICOAGULANT,1641000,CDM,,,,INPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.61,OTHER,49.13,64.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ACDA ANTICOAGULANT,1641000,CDM,,,,INPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
ACDA ANTICOAGULANT,1641000,CDM,,,,INPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,49.13,,49.13,64.19,
KNEE FEMORAL COMP 70 LT,1641025,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 70 LT,1641025,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 70 LT,1641025,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 55 RT,1641026,CDM,,,,INPATIENT,,,5414.5,2165.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4927.2,OTHER,4060.88,5306.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 55 RT,1641026,CDM,,,,INPATIENT,,,5414.5,2165.8,MONUMENT,COMMERCIAL,,,,4331.6,,4060.88,5306.21,
KNEE FEMORAL COMP 55 RT,1641026,CDM,,,,INPATIENT,,,5414.5,2165.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4060.88,,4060.88,5306.21,
KNEE FEMORAL COMP 55 LT,1641027,CDM,,,,INPATIENT,,,5414.5,2165.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4927.2,OTHER,4060.88,5306.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 55 LT,1641027,CDM,,,,INPATIENT,,,5414.5,2165.8,MONUMENT,COMMERCIAL,,,,4331.6,,4060.88,5306.21,
KNEE FEMORAL COMP 55 LT,1641027,CDM,,,,INPATIENT,,,5414.5,2165.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4060.88,,4060.88,5306.21,
KNEE FEMORAL COMP 60 RT,1641028,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 60 RT,1641028,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 60 RT,1641028,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 60 LT,C1776,HCPCS,278,RC,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 60 LT,C1776,HCPCS,278,RC,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 60 LT,C1776,HCPCS,278,RC,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 70 RT,C1776,HCPCS,278,RC,,INPATIENT,,,5825.75,2330.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,5301.43,OTHER,4369.31,5709.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 70 RT,C1776,HCPCS,278,RC,,INPATIENT,,,5825.75,2330.3,MONUMENT,COMMERCIAL,,,,4660.6,,4369.31,5709.24,
KNEE FEMORAL COMP 70 RT,C1776,HCPCS,278,RC,,INPATIENT,,,5825.75,2330.3,UNITED HEALTH,UNITED COMMERCIAL,,,,4369.31,,4369.31,5709.24,
KNEE FEMORAL COMP 65 RT,1641031,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 65 RT,1641031,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 65 RT,1641031,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 65 LT,1641032,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 65 LT,1641032,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 65 LT,1641032,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 75 RT,1641033,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 75 RT,1641033,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 75 RT,1641033,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
KNEE FEMORAL COMP 75 LT,1641034,CDM,,,,INPATIENT,,,7982.75,3193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7264.3,OTHER,5987.06,7823.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL COMP 75 LT,1641034,CDM,,,,INPATIENT,,,7982.75,3193.1,MONUMENT,COMMERCIAL,,,,6386.2,,5987.06,7823.1,
KNEE FEMORAL COMP 75 LT,1641034,CDM,,,,INPATIENT,,,7982.75,3193.1,UNITED HEALTH,UNITED COMMERCIAL,,,,5987.06,,5987.06,7823.1,
GEL RATIO APPLICATION ASSEM,1641111,CDM,,,,INPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.16,OTHER,57,74.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GEL RATIO APPLICATION ASSEM,1641111,CDM,,,,INPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
GEL RATIO APPLICATION ASSEM,1641111,CDM,,,,INPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,,57,,57,74.48,
GEL APPLICATOR TIP,1641112,CDM,,,,INPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.49,OTHER,64.69,84.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GEL APPLICATOR TIP,1641112,CDM,,,,INPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
GEL APPLICATOR TIP,1641112,CDM,,,,INPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,,64.69,,64.69,84.53,
DRESSING HYDROCOLLOID REPLICAR,1641635,CDM,,,,INPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43,OTHER,35.44,46.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRESSING HYDROCOLLOID REPLICAR,1641635,CDM,,,,INPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
DRESSING HYDROCOLLOID REPLICAR,1641635,CDM,,,,INPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,,35.44,,35.44,46.31,
"KNEE, TIBIAL COMP 10MM 155306",C1776,HCPCS,278,RC,,INPATIENT,,,6282.5,2513,BLUE CROSS ANTHEM,COMMERCIAL,,,,5717.08,OTHER,4711.88,6156.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 10MM 155306",C1776,HCPCS,278,RC,,INPATIENT,,,6282.5,2513,MONUMENT,COMMERCIAL,,,,5026,,4711.88,6156.85,
"KNEE, TIBIAL COMP 10MM 155306",C1776,HCPCS,278,RC,,INPATIENT,,,6282.5,2513,UNITED HEALTH,UNITED COMMERCIAL,,,,4711.88,,4711.88,6156.85,
KNEE TIBIAL COMP 12 X 65,1641694,CDM,,,,INPATIENT,,,6282.5,2513,BLUE CROSS ANTHEM,COMMERCIAL,,,,5717.08,OTHER,4711.88,6156.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 12 X 65,1641694,CDM,,,,INPATIENT,,,6282.5,2513,MONUMENT,COMMERCIAL,,,,5026,,4711.88,6156.85,
KNEE TIBIAL COMP 12 X 65,1641694,CDM,,,,INPATIENT,,,6282.5,2513,UNITED HEALTH,UNITED COMMERCIAL,,,,4711.88,,4711.88,6156.85,
KNEE TIBIAL COMP 14 X 65,1641695,CDM,,,,INPATIENT,,,6282.5,2513,BLUE CROSS ANTHEM,COMMERCIAL,,,,5717.08,OTHER,4711.88,6156.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 14 X 65,1641695,CDM,,,,INPATIENT,,,6282.5,2513,MONUMENT,COMMERCIAL,,,,5026,,4711.88,6156.85,
KNEE TIBIAL COMP 14 X 65,1641695,CDM,,,,INPATIENT,,,6282.5,2513,UNITED HEALTH,UNITED COMMERCIAL,,,,4711.88,,4711.88,6156.85,
KNEE TIBIAL COMP 16 X 65,C1776,HCPCS,278,RC,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 16 X 65,C1776,HCPCS,278,RC,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 65,C1776,HCPCS,278,RC,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 65,1641697,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 20 X 65,1641697,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 65,1641697,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 10 X 70,1641698,CDM,,,,INPATIENT,,,4822.75,1929.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,4388.7,OTHER,3617.06,4726.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 10 X 70,1641698,CDM,,,,INPATIENT,,,4822.75,1929.1,MONUMENT,COMMERCIAL,,,,3858.2,,3617.06,4726.3,
KNEE TIBIAL COMP 10 X 70,1641698,CDM,,,,INPATIENT,,,4822.75,1929.1,UNITED HEALTH,UNITED COMMERCIAL,,,,3617.06,,3617.06,4726.3,
KNEE TIBIAL COMP 12 X 70,1641699,CDM,,,,INPATIENT,,,6282.5,2513,BLUE CROSS ANTHEM,COMMERCIAL,,,,5717.08,OTHER,4711.88,6156.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 12 X 70,1641699,CDM,,,,INPATIENT,,,6282.5,2513,MONUMENT,COMMERCIAL,,,,5026,,4711.88,6156.85,
KNEE TIBIAL COMP 12 X 70,1641699,CDM,,,,INPATIENT,,,6282.5,2513,UNITED HEALTH,UNITED COMMERCIAL,,,,4711.88,,4711.88,6156.85,
KNEE TIBIAL COMP 14 X 70,1641700,CDM,,,,INPATIENT,,,4822.75,1929.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,4388.7,OTHER,3617.06,4726.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 14 X 70,1641700,CDM,,,,INPATIENT,,,4822.75,1929.1,MONUMENT,COMMERCIAL,,,,3858.2,,3617.06,4726.3,
KNEE TIBIAL COMP 14 X 70,1641700,CDM,,,,INPATIENT,,,4822.75,1929.1,UNITED HEALTH,UNITED COMMERCIAL,,,,3617.06,,3617.06,4726.3,
KNEE TIBIAL COMP 16 X 70,1641701,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 16 X 70,1641701,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 70,1641701,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 70,1641702,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 20 X 70,1641702,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 70,1641702,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 10 X 75,1641703,CDM,,,,INPATIENT,,,4587,1834.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4174.17,OTHER,3440.25,4495.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 10 X 75,1641703,CDM,,,,INPATIENT,,,4587,1834.8,MONUMENT,COMMERCIAL,,,,3669.6,,3440.25,4495.26,
KNEE TIBIAL COMP 10 X 75,1641703,CDM,,,,INPATIENT,,,4587,1834.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3440.25,,3440.25,4495.26,
KNEE TIBIAL COMP 12 X 75,1641704,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 12 X 75,1641704,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
KNEE TIBIAL COMP 12 X 75,1641704,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
KNEE TIBIAL COMP 14 X 75,1641705,CDM,,,,INPATIENT,,,3980,1592,BLUE CROSS ANTHEM,COMMERCIAL,,,,3621.8,OTHER,2985,3900.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 14 X 75,1641705,CDM,,,,INPATIENT,,,3980,1592,MONUMENT,COMMERCIAL,,,,3184,,2985,3900.4,
KNEE TIBIAL COMP 14 X 75,1641705,CDM,,,,INPATIENT,,,3980,1592,UNITED HEALTH,UNITED COMMERCIAL,,,,2985,,2985,3900.4,
KNEE TIBIAL COMP 16 X 75,1641706,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 16 X 75,1641706,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 75,1641706,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 75,1641707,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 20 X 75,1641707,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 75,1641707,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 10 X 80,C1776,HCPCS,278,RC,,INPATIENT,,,4822.75,1929.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,4388.7,OTHER,3617.06,4726.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 10 X 80,C1776,HCPCS,278,RC,,INPATIENT,,,4822.75,1929.1,MONUMENT,COMMERCIAL,,,,3858.2,,3617.06,4726.3,
KNEE TIBIAL COMP 10 X 80,C1776,HCPCS,278,RC,,INPATIENT,,,4822.75,1929.1,UNITED HEALTH,UNITED COMMERCIAL,,,,3617.06,,3617.06,4726.3,
KNEE TIBIAL COMP 12 X 80,1641709,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 12 X 80,1641709,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
KNEE TIBIAL COMP 12 X 80,1641709,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
KNEE TIBIAL COMP 14 X 80,1641710,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 14 X 80,1641710,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 14 X 80,1641710,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 80,1641711,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 16 X 80,1641711,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
KNEE TIBIAL COMP 16 X 80,1641711,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
KNEE TIBIAL COMP 20 X 80,1641712,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 20 X 80,1641712,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 80,1641712,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 10 X 85,1641713,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 10 X 85,1641713,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
KNEE TIBIAL COMP 10 X 85,1641713,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
KNEE TIBIAL COMP 12 X 85,1641714,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 12 X 85,1641714,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
KNEE TIBIAL COMP 12 X 85,1641714,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
KNEE TIBIAL COMP 14 X 85,1641715,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 14 X 85,1641715,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 14 X 85,1641715,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 85,1641716,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 16 X 85,1641716,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 16 X 85,1641716,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 85,1641717,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE TIBIAL COMP 20 X 85,1641717,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
KNEE TIBIAL COMP 20 X 85,1641717,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
KNEE PATELLA BUTTON SMALL,C1776,HCPCS,278,RC,,INPATIENT,,,2730.75,1092.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2484.98,OTHER,2048.06,2676.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE PATELLA BUTTON SMALL,C1776,HCPCS,278,RC,,INPATIENT,,,2730.75,1092.3,MONUMENT,COMMERCIAL,,,,2184.6,,2048.06,2676.14,
KNEE PATELLA BUTTON SMALL,C1776,HCPCS,278,RC,,INPATIENT,,,2730.75,1092.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2048.06,,2048.06,2676.14,
KNEE PATELLA BUTTON MEDIUM,1641900,CDM,,,,INPATIENT,,,2730.75,1092.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2484.98,OTHER,2048.06,2676.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE PATELLA BUTTON MEDIUM,1641900,CDM,,,,INPATIENT,,,2730.75,1092.3,MONUMENT,COMMERCIAL,,,,2184.6,,2048.06,2676.14,
KNEE PATELLA BUTTON MEDIUM,1641900,CDM,,,,INPATIENT,,,2730.75,1092.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2048.06,,2048.06,2676.14,
KNEE PATELLA BUTTON LARGE,C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1820.91,OTHER,1500.75,1960.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE PATELLA BUTTON LARGE,C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,MONUMENT,COMMERCIAL,,,,1600.8,,1500.75,1960.98,
KNEE PATELLA BUTTON LARGE,C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1500.75,,1500.75,1960.98,
BLADE GIGLI SAW,1642020,CDM,,,,INPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.62,OTHER,96.94,126.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE GIGLI SAW,1642020,CDM,,,,INPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
BLADE GIGLI SAW,1642020,CDM,,,,INPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,,96.94,,96.94,126.67,
BLADE BEAVER TYMPANOPLASTY,1642055,CDM,,,,INPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.88,OTHER,90.56,118.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE BEAVER TYMPANOPLASTY,1642055,CDM,,,,INPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
BLADE BEAVER TYMPANOPLASTY,1642055,CDM,,,,INPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,,90.56,,90.56,118.34,
BLADE CUDA 4.2  C9254,1642056,CDM,,,,INPATIENT,,,330,132,BLUE CROSS ANTHEM,COMMERCIAL,,,,300.3,OTHER,247.5,323.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE CUDA 4.2  C9254,1642056,CDM,,,,INPATIENT,,,330,132,MONUMENT,COMMERCIAL,,,,264,,247.5,323.4,
BLADE CUDA 4.2  C9254,1642056,CDM,,,,INPATIENT,,,330,132,UNITED HEALTH,UNITED COMMERCIAL,,,,247.5,,247.5,323.4,
BLADE SAG WIDE MED,1642097,CDM,,,,INPATIENT,,,334.5,133.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.4,OTHER,250.88,327.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE SAG WIDE MED,1642097,CDM,,,,INPATIENT,,,334.5,133.8,MONUMENT,COMMERCIAL,,,,267.6,,250.88,327.81,
BLADE SAG WIDE MED,1642097,CDM,,,,INPATIENT,,,334.5,133.8,UNITED HEALTH,UNITED COMMERCIAL,,,,250.88,,250.88,327.81,
ANKLE TREATMENT KIT CUSTOM LG,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.14,OTHER,155.06,202.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANKLE TREATMENT KIT CUSTOM LG,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
ANKLE TREATMENT KIT CUSTOM LG,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,,155.06,,155.06,202.62,
ANKLE TREATMENT KIT CUSTOM SM,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.14,OTHER,155.06,202.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANKLE TREATMENT KIT CUSTOM SM,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
ANKLE TREATMENT KIT CUSTOM SM,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,,155.06,,155.06,202.62,
BRUSH INTRAMEDULLARY,1642150,CDM,,,,INPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.18,OTHER,33.94,44.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BRUSH INTRAMEDULLARY,1642150,CDM,,,,INPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
BRUSH INTRAMEDULLARY,1642150,CDM,,,,INPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,,33.94,,33.94,44.35,
FEMORAL PRESSURIZER,1642218,CDM,,,,INPATIENT,,,158.25,63.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,144.01,OTHER,118.69,155.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL PRESSURIZER,1642218,CDM,,,,INPATIENT,,,158.25,63.3,MONUMENT,COMMERCIAL,,,,126.6,,118.69,155.09,
FEMORAL PRESSURIZER,1642218,CDM,,,,INPATIENT,,,158.25,63.3,UNITED HEALTH,UNITED COMMERCIAL,,,,118.69,,118.69,155.09,
DRAIN IRRIGATION,1642361,CDM,,,,INPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.32,OTHER,39,50.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN IRRIGATION,1642361,CDM,,,,INPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
DRAIN IRRIGATION,1642361,CDM,,,,INPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,,39,,39,50.96,
SCANDIPHARM FLUTTER VALVE,1642600,CDM,,,,INPATIENT,,,279,111.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,253.89,OTHER,209.25,273.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SCANDIPHARM FLUTTER VALVE,1642600,CDM,,,,INPATIENT,,,279,111.6,MONUMENT,COMMERCIAL,,,,223.2,,209.25,273.42,
SCANDIPHARM FLUTTER VALVE,1642600,CDM,,,,INPATIENT,,,279,111.6,UNITED HEALTH,UNITED COMMERCIAL,,,,209.25,,209.25,273.42,
SCISSORS 5MM CURVED W/CAUTERY,1642605,CDM,,,,INPATIENT,,,360.75,144.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,328.28,OTHER,270.56,353.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SCISSORS 5MM CURVED W/CAUTERY,1642605,CDM,,,,INPATIENT,,,360.75,144.3,MONUMENT,COMMERCIAL,,,,288.6,,270.56,353.54,
SCISSORS 5MM CURVED W/CAUTERY,1642605,CDM,,,,INPATIENT,,,360.75,144.3,UNITED HEALTH,UNITED COMMERCIAL,,,,270.56,,270.56,353.54,
SPLINT ONE STEP 3 X 12,1642720,CDM,271,RC,,INPATIENT,,,29.75,11.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.07,OTHER,22.31,29.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 3 X 12,1642720,CDM,271,RC,,INPATIENT,,,29.75,11.9,MONUMENT,COMMERCIAL,,,,23.8,,22.31,29.16,
SPLINT ONE STEP 3 X 12,1642720,CDM,271,RC,,INPATIENT,,,29.75,11.9,UNITED HEALTH,UNITED COMMERCIAL,,,,22.31,,22.31,29.16,
SPLINT ONE STEP 4 X 30,1642723,CDM,271,RC,,INPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.75,OTHER,89.63,117.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 4 X 30,1642723,CDM,271,RC,,INPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
SPLINT ONE STEP 4 X 30,1642723,CDM,271,RC,,INPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,,89.63,,89.63,117.11,
SUTURE RETRIEVER HEWSON,1642750,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUTURE RETRIEVER HEWSON,1642750,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
SUTURE RETRIEVER HEWSON,1642750,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
WIRE GUIDE 60CM,1642900,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WIRE GUIDE 60CM,1642900,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
WIRE GUIDE 60CM,1642900,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
WRIST JACK AGEE,1642950,CDM,,,,INPATIENT,,,5844.5,2337.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,5318.5,OTHER,4383.38,5727.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WRIST JACK AGEE,1642950,CDM,,,,INPATIENT,,,5844.5,2337.8,MONUMENT,COMMERCIAL,,,,4675.6,,4383.38,5727.61,
WRIST JACK AGEE,1642950,CDM,,,,INPATIENT,,,5844.5,2337.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4383.38,,4383.38,5727.61,
LINEAR CUTTER RELOADS 75MM,1644010,CDM,,,,INPATIENT,,,665,266,BLUE CROSS ANTHEM,COMMERCIAL,,,,605.15,OTHER,498.75,651.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR CUTTER RELOADS 75MM,1644010,CDM,,,,INPATIENT,,,665,266,MONUMENT,COMMERCIAL,,,,532,,498.75,651.7,
LINEAR CUTTER RELOADS 75MM,1644010,CDM,,,,INPATIENT,,,665,266,UNITED HEALTH,UNITED COMMERCIAL,,,,498.75,,498.75,651.7,
CIRCULAR STAPLER 29MM EEA,1644020,CDM,,,,INPATIENT,,,1741.25,696.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1584.54,OTHER,1305.94,1706.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCULAR STAPLER 29MM EEA,1644020,CDM,,,,INPATIENT,,,1741.25,696.5,MONUMENT,COMMERCIAL,,,,1393,,1305.94,1706.43,
CIRCULAR STAPLER 29MM EEA,1644020,CDM,,,,INPATIENT,,,1741.25,696.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1305.94,,1305.94,1706.43,
STAPLER TA90 LONG,1644025,CDM,,,,INPATIENT,,,977.5,391,BLUE CROSS ANTHEM,COMMERCIAL,,,,889.53,OTHER,733.13,957.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STAPLER TA90 LONG,1644025,CDM,,,,INPATIENT,,,977.5,391,MONUMENT,COMMERCIAL,,,,782,,733.13,957.95,
STAPLER TA90 LONG,1644025,CDM,,,,INPATIENT,,,977.5,391,UNITED HEALTH,UNITED COMMERCIAL,,,,733.13,,733.13,957.95,
ENDO LINEAR CUTTER 45MM 2.5 WH,1644030,CDM,,,,INPATIENT,,,1050.75,420.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,956.18,OTHER,788.06,1029.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO LINEAR CUTTER 45MM 2.5 WH,1644030,CDM,,,,INPATIENT,,,1050.75,420.3,MONUMENT,COMMERCIAL,,,,840.6,,788.06,1029.74,
ENDO LINEAR CUTTER 45MM 2.5 WH,1644030,CDM,,,,INPATIENT,,,1050.75,420.3,UNITED HEALTH,UNITED COMMERCIAL,,,,788.06,,788.06,1029.74,
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,589.25,235.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,536.22,OTHER,441.94,577.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,589.25,235.7,MONUMENT,COMMERCIAL,,,,471.4,,441.94,577.47,
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,589.25,235.7,UNITED HEALTH,UNITED COMMERCIAL,,,,441.94,,441.94,577.47,
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,598.25,239.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,544.41,OTHER,448.69,586.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,598.25,239.3,MONUMENT,COMMERCIAL,,,,478.6,,448.69,586.29,
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,598.25,239.3,UNITED HEALTH,UNITED COMMERCIAL,,,,448.69,,448.69,586.29,
LINEAR ENDO CUTTER 45MM 3.5MM,1644060,CDM,,,,INPATIENT,,,1462,584.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1330.42,OTHER,1096.5,1432.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LINEAR ENDO CUTTER 45MM 3.5MM,1644060,CDM,,,,INPATIENT,,,1462,584.8,MONUMENT,COMMERCIAL,,,,1169.6,,1096.5,1432.76,
LINEAR ENDO CUTTER 45MM 3.5MM,1644060,CDM,,,,INPATIENT,,,1462,584.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1096.5,,1096.5,1432.76,
GIA RELOAD 55MM STAND. BLUE,1644065,CDM,,,,INPATIENT,,,384.25,153.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,349.67,OTHER,288.19,376.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GIA RELOAD 55MM STAND. BLUE,1644065,CDM,,,,INPATIENT,,,384.25,153.7,MONUMENT,COMMERCIAL,,,,307.4,,288.19,376.57,
GIA RELOAD 55MM STAND. BLUE,1644065,CDM,,,,INPATIENT,,,384.25,153.7,UNITED HEALTH,UNITED COMMERCIAL,,,,288.19,,288.19,376.57,
MULTIFIRE GIA CART. 60-3.8,1644066,CDM,,,,INPATIENT,,,786.5,314.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,715.72,OTHER,589.88,770.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MULTIFIRE GIA CART. 60-3.8,1644066,CDM,,,,INPATIENT,,,786.5,314.6,MONUMENT,COMMERCIAL,,,,629.2,,589.88,770.77,
MULTIFIRE GIA CART. 60-3.8,1644066,CDM,,,,INPATIENT,,,786.5,314.6,UNITED HEALTH,UNITED COMMERCIAL,,,,589.88,,589.88,770.77,
GIA RELOAD 55MM STAND. WHITE,1644070,CDM,,,,INPATIENT,,,404.25,161.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,367.87,OTHER,303.19,396.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GIA RELOAD 55MM STAND. WHITE,1644070,CDM,,,,INPATIENT,,,404.25,161.7,MONUMENT,COMMERCIAL,,,,323.4,,303.19,396.17,
GIA RELOAD 55MM STAND. WHITE,1644070,CDM,,,,INPATIENT,,,404.25,161.7,UNITED HEALTH,UNITED COMMERCIAL,,,,303.19,,303.19,396.17,
SUTURE PASSER SWANSON,1644074,CDM,,,,INPATIENT,,,295.25,118.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,268.68,OTHER,221.44,289.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUTURE PASSER SWANSON,1644074,CDM,,,,INPATIENT,,,295.25,118.1,MONUMENT,COMMERCIAL,,,,236.2,,221.44,289.35,
SUTURE PASSER SWANSON,1644074,CDM,,,,INPATIENT,,,295.25,118.1,UNITED HEALTH,UNITED COMMERCIAL,,,,221.44,,221.44,289.35,
SUTURE SKIN STAPLER,1644077,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUTURE SKIN STAPLER,1644077,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
SUTURE SKIN STAPLER,1644077,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
STAPLES INT TA-55 3.5 BLUE,1644095,CDM,,,,INPATIENT,,,440,176,BLUE CROSS ANTHEM,COMMERCIAL,,,,400.4,OTHER,330,431.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STAPLES INT TA-55 3.5 BLUE,1644095,CDM,,,,INPATIENT,,,440,176,MONUMENT,COMMERCIAL,,,,352,,330,431.2,
STAPLES INT TA-55 3.5 BLUE,1644095,CDM,,,,INPATIENT,,,440,176,UNITED HEALTH,UNITED COMMERCIAL,,,,330,,330,431.2,
STAPLES INT TA-55 4.8 GREEN,1644096,CDM,,,,INPATIENT,,,269.85,107.94,BLUE CROSS ANTHEM,COMMERCIAL,,,,245.56,OTHER,202.39,264.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STAPLES INT TA-55 4.8 GREEN,1644096,CDM,,,,INPATIENT,,,269.85,107.94,MONUMENT,COMMERCIAL,,,,215.88,,202.39,264.45,
STAPLES INT TA-55 4.8 GREEN,1644096,CDM,,,,INPATIENT,,,269.85,107.94,UNITED HEALTH,UNITED COMMERCIAL,,,,202.39,,202.39,264.45,
KIT DUAL LUMEN (REPAIR),1644222,CDM,,,,INPATIENT,,,649.25,259.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,590.82,OTHER,486.94,636.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KIT DUAL LUMEN (REPAIR),1644222,CDM,,,,INPATIENT,,,649.25,259.7,MONUMENT,COMMERCIAL,,,,519.4,,486.94,636.27,
KIT DUAL LUMEN (REPAIR),1644222,CDM,,,,INPATIENT,,,649.25,259.7,UNITED HEALTH,UNITED COMMERCIAL,,,,486.94,,486.94,636.27,
INSULSCAN WAND MOBILE INSTRUMT,1644822,CDM,,,,INPATIENT,,,130,52,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.3,OTHER,97.5,127.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INSULSCAN WAND MOBILE INSTRUMT,1644822,CDM,,,,INPATIENT,,,130,52,MONUMENT,COMMERCIAL,,,,104,,97.5,127.4,
INSULSCAN WAND MOBILE INSTRUMT,1644822,CDM,,,,INPATIENT,,,130,52,UNITED HEALTH,UNITED COMMERCIAL,,,,97.5,,97.5,127.4,
BLADE SAGITAL K-123,1645025,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE SAGITAL K-123,1645025,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
BLADE SAGITAL K-123,1645025,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
BLADE SAG K-124,1645026,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE SAG K-124,1645026,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
BLADE SAG K-124,1645026,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
BLADE OSC,1645028,CDM,,,,INPATIENT,,,153.5,61.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.69,OTHER,115.13,150.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE OSC,1645028,CDM,,,,INPATIENT,,,153.5,61.4,MONUMENT,COMMERCIAL,,,,122.8,,115.13,150.43,
BLADE OSC,1645028,CDM,,,,INPATIENT,,,153.5,61.4,UNITED HEALTH,UNITED COMMERCIAL,,,,115.13,,115.13,150.43,
TEAR RASP-LARGE,1645029,CDM,,,,INPATIENT,,,27.25,10.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.8,OTHER,20.44,26.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TEAR RASP-LARGE,1645029,CDM,,,,INPATIENT,,,27.25,10.9,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
TEAR RASP-LARGE,1645029,CDM,,,,INPATIENT,,,27.25,10.9,UNITED HEALTH,UNITED COMMERCIAL,,,,20.44,,20.44,26.71,
BLADE SAG 3M  K 121,1645030,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE SAG 3M  K 121,1645030,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
BLADE SAG 3M  K 121,1645030,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
BLADES 15 DEGREE EYES,1645032,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADES 15 DEGREE EYES,1645032,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
BLADES 15 DEGREE EYES,1645032,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
IRR CANNULA 27 GA - EYES,1645034,CDM,,,,INPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.32,OTHER,39,50.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IRR CANNULA 27 GA - EYES,1645034,CDM,,,,INPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
IRR CANNULA 27 GA - EYES,1645034,CDM,,,,INPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,,39,,39,50.96,
BURR ROUND 5.5MM,1645035,CDM,,,,INPATIENT,,,261.75,104.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,238.19,OTHER,196.31,256.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BURR ROUND 5.5MM,1645035,CDM,,,,INPATIENT,,,261.75,104.7,MONUMENT,COMMERCIAL,,,,209.4,,196.31,256.52,
BURR ROUND 5.5MM,1645035,CDM,,,,INPATIENT,,,261.75,104.7,UNITED HEALTH,UNITED COMMERCIAL,,,,196.31,,196.31,256.52,
CYSTITOME FORMED RC SHORT RAD,1645036,CDM,,,,INPATIENT,,,48.5,19.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.14,OTHER,36.38,47.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTITOME FORMED RC SHORT RAD,1645036,CDM,,,,INPATIENT,,,48.5,19.4,MONUMENT,COMMERCIAL,,,,38.8,,36.38,47.53,
CYSTITOME FORMED RC SHORT RAD,1645036,CDM,,,,INPATIENT,,,48.5,19.4,UNITED HEALTH,UNITED COMMERCIAL,,,,36.38,,36.38,47.53,
KNIFE CRESENT STRAIGHT,1645200,CDM,,,,INPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,158.34,OTHER,130.5,170.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNIFE CRESENT STRAIGHT,1645200,CDM,,,,INPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
KNIFE CRESENT STRAIGHT,1645200,CDM,,,,INPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,,130.5,,130.5,170.52,
KNIFE  OPHTHALMIC,1645230,CDM,,,,INPATIENT,,,269.75,107.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,245.47,OTHER,202.31,264.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNIFE  OPHTHALMIC,1645230,CDM,,,,INPATIENT,,,269.75,107.9,MONUMENT,COMMERCIAL,,,,215.8,,202.31,264.36,
KNIFE  OPHTHALMIC,1645230,CDM,,,,INPATIENT,,,269.75,107.9,UNITED HEALTH,UNITED COMMERCIAL,,,,202.31,,202.31,264.36,
LENS ALCON MTA,1645300,CDM,,,,INPATIENT,,,532.75,213.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,484.8,OTHER,399.56,522.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS ALCON MTA,1645300,CDM,,,,INPATIENT,,,532.75,213.1,MONUMENT,COMMERCIAL,,,,426.2,,399.56,522.1,
LENS ALCON MTA,1645300,CDM,,,,INPATIENT,,,532.75,213.1,UNITED HEALTH,UNITED COMMERCIAL,,,,399.56,,399.56,522.1,
HEALON .85 ML,1645301,CDM,,,,INPATIENT,,,524.5,209.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,477.3,OTHER,393.38,514.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALON .85 ML,1645301,CDM,,,,INPATIENT,,,524.5,209.8,MONUMENT,COMMERCIAL,,,,419.6,,393.38,514.01,
HEALON .85 ML,1645301,CDM,,,,INPATIENT,,,524.5,209.8,UNITED HEALTH,UNITED COMMERCIAL,,,,393.38,,393.38,514.01,
LENS PHARMACIA 912,1645302,CDM,,,,INPATIENT,,,635.75,254.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,578.53,OTHER,476.81,623.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS PHARMACIA 912,1645302,CDM,,,,INPATIENT,,,635.75,254.3,MONUMENT,COMMERCIAL,,,,508.6,,476.81,623.04,
LENS PHARMACIA 912,1645302,CDM,,,,INPATIENT,,,635.75,254.3,UNITED HEALTH,UNITED COMMERCIAL,,,,476.81,,476.81,623.04,
LENS PHARMACIA 920,1645303,CDM,,,,INPATIENT,,,635.75,254.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,578.53,OTHER,476.81,623.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS PHARMACIA 920,1645303,CDM,,,,INPATIENT,,,635.75,254.3,MONUMENT,COMMERCIAL,,,,508.6,,476.81,623.04,
LENS PHARMACIA 920,1645303,CDM,,,,INPATIENT,,,635.75,254.3,UNITED HEALTH,UNITED COMMERCIAL,,,,476.81,,476.81,623.04,
LENS  MODEL 911A,1645307,CDM,,,,INPATIENT,,,820,328,BLUE CROSS ANTHEM,COMMERCIAL,,,,746.2,OTHER,615,803.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS  MODEL 911A,1645307,CDM,,,,INPATIENT,,,820,328,MONUMENT,COMMERCIAL,,,,656,,615,803.6,
LENS  MODEL 911A,1645307,CDM,,,,INPATIENT,,,820,328,UNITED HEALTH,UNITED COMMERCIAL,,,,615,,615,803.6,
LENS  MODEL 913A,1645308,CDM,,,,INPATIENT,,,607.5,243,BLUE CROSS ANTHEM,COMMERCIAL,,,,552.83,OTHER,455.63,595.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS  MODEL 913A,1645308,CDM,,,,INPATIENT,,,607.5,243,MONUMENT,COMMERCIAL,,,,486,,455.63,595.35,
LENS  MODEL 913A,1645308,CDM,,,,INPATIENT,,,607.5,243,UNITED HEALTH,UNITED COMMERCIAL,,,,455.63,,455.63,595.35,
LENS PHARMACIA Z9000,1645312,CDM,,,,INPATIENT,,,727.25,290.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,661.8,OTHER,545.44,712.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS PHARMACIA Z9000,1645312,CDM,,,,INPATIENT,,,727.25,290.9,MONUMENT,COMMERCIAL,,,,581.8,,545.44,712.71,
LENS PHARMACIA Z9000,1645312,CDM,,,,INPATIENT,,,727.25,290.9,UNITED HEALTH,UNITED COMMERCIAL,,,,545.44,,545.44,712.71,
LENS TECNIS Z9001,1645314,CDM,,,,INPATIENT,,,708,283.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,644.28,OTHER,531,693.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS TECNIS Z9001,1645314,CDM,,,,INPATIENT,,,708,283.2,MONUMENT,COMMERCIAL,,,,566.4,,531,693.84,
LENS TECNIS Z9001,1645314,CDM,,,,INPATIENT,,,708,283.2,UNITED HEALTH,UNITED COMMERCIAL,,,,531,,531,693.84,
LENS TECHNIS ZA9003,1645315,CDM,,,,INPATIENT,,,583.5,233.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.99,OTHER,437.63,571.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS TECHNIS ZA9003,1645315,CDM,,,,INPATIENT,,,583.5,233.4,MONUMENT,COMMERCIAL,,,,466.8,,437.63,571.83,
LENS TECHNIS ZA9003,1645315,CDM,,,,INPATIENT,,,583.5,233.4,UNITED HEALTH,UNITED COMMERCIAL,,,,437.63,,437.63,571.83,
LENS AMO ZCBOO,1645316,CDM,,,,INPATIENT,,,487.5,195,BLUE CROSS ANTHEM,COMMERCIAL,,,,443.63,OTHER,365.63,477.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS AMO ZCBOO,1645316,CDM,,,,INPATIENT,,,487.5,195,MONUMENT,COMMERCIAL,,,,390,,365.63,477.75,
LENS AMO ZCBOO,1645316,CDM,,,,INPATIENT,,,487.5,195,UNITED HEALTH,UNITED COMMERCIAL,,,,365.63,,365.63,477.75,
LENS AR40,1645317,CDM,,,,INPATIENT,,,532.75,213.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,484.8,OTHER,399.56,522.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS AR40,1645317,CDM,,,,INPATIENT,,,532.75,213.1,MONUMENT,COMMERCIAL,,,,426.2,,399.56,522.1,
LENS AR40,1645317,CDM,,,,INPATIENT,,,532.75,213.1,UNITED HEALTH,UNITED COMMERCIAL,,,,399.56,,399.56,522.1,
LENS AMO ZMBOO,1645318,CDM,,,,INPATIENT,,,1200,480,BLUE CROSS ANTHEM,COMMERCIAL,,,,1092,OTHER,900,1176,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS AMO ZMBOO,1645318,CDM,,,,INPATIENT,,,1200,480,MONUMENT,COMMERCIAL,,,,960,,900,1176,
LENS AMO ZMBOO,1645318,CDM,,,,INPATIENT,,,1200,480,UNITED HEALTH,UNITED COMMERCIAL,,,,900,,900,1176,
LENS MULTIFOCAL ZLBOO,1645320,CDM,,,,INPATIENT,,,939.75,375.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,855.17,OTHER,704.81,920.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL ZLBOO,1645320,CDM,,,,INPATIENT,,,939.75,375.9,MONUMENT,COMMERCIAL,,,,751.8,,704.81,920.96,
LENS MULTIFOCAL ZLBOO,1645320,CDM,,,,INPATIENT,,,939.75,375.9,UNITED HEALTH,UNITED COMMERCIAL,,,,704.81,,704.81,920.96,
LENS ALCON SA60AT,1645454,CDM,,,,INPATIENT,,,835.5,334.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,760.31,OTHER,626.63,818.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS ALCON SA60AT,1645454,CDM,,,,INPATIENT,,,835.5,334.2,MONUMENT,COMMERCIAL,,,,668.4,,626.63,818.79,
LENS ALCON SA60AT,1645454,CDM,,,,INPATIENT,,,835.5,334.2,UNITED HEALTH,UNITED COMMERCIAL,,,,626.63,,626.63,818.79,
LENS  ALCON SN60WF,C1780,HCPCS,276,RC,,INPATIENT,,,338,135.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,307.58,OTHER,253.5,331.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS  ALCON SN60WF,C1780,HCPCS,276,RC,,INPATIENT,,,338,135.2,MONUMENT,COMMERCIAL,,,,270.4,,253.5,331.24,
LENS  ALCON SN60WF,C1780,HCPCS,276,RC,,INPATIENT,,,338,135.2,UNITED HEALTH,UNITED COMMERCIAL,,,,253.5,,253.5,331.24,
LENS MULTIFOCAL SN6,V2787,HCPCS,276,RC,,INPATIENT,,,495,198,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.45,OTHER,371.25,485.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL SN6,V2787,HCPCS,276,RC,,INPATIENT,,,495,198,MONUMENT,COMMERCIAL,,,,396,,371.25,485.1,
LENS MULTIFOCAL SN6,V2787,HCPCS,276,RC,,INPATIENT,,,495,198,UNITED HEALTH,UNITED COMMERCIAL,,,,371.25,,371.25,485.1,
LENS ALCON MA60AC,1645566,CDM,,,,INPATIENT,,,752.5,301,BLUE CROSS ANTHEM,COMMERCIAL,,,,684.78,OTHER,564.38,737.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS ALCON MA60AC,1645566,CDM,,,,INPATIENT,,,752.5,301,MONUMENT,COMMERCIAL,,,,602,,564.38,737.45,
LENS ALCON MA60AC,1645566,CDM,,,,INPATIENT,,,752.5,301,UNITED HEALTH,UNITED COMMERCIAL,,,,564.38,,564.38,737.45,
LENS MULTIFOCAL ZCT400,1645568,CDM,,,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL ZCT400,1645568,CDM,,,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
LENS MULTIFOCAL ZCT400,1645568,CDM,,,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
LENS MULTIFOCAL AMO ZCT225,1645570,CDM,,,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL AMO ZCT225,1645570,CDM,,,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
LENS MULTIFOCAL AMO ZCT225,1645570,CDM,,,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
LENS MULTIFOCAL ZCT300,1645572,CDM,,,,INPATIENT,,,519.75,207.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.97,OTHER,389.81,509.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL ZCT300,1645572,CDM,,,,INPATIENT,,,519.75,207.9,MONUMENT,COMMERCIAL,,,,415.8,,389.81,509.36,
LENS MULTIFOCAL ZCT300,1645572,CDM,,,,INPATIENT,,,519.75,207.9,UNITED HEALTH,UNITED COMMERCIAL,,,,389.81,,389.81,509.36,
LENS MULTIFOCAL ZCT150,1645574,CDM,,,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL ZCT150,1645574,CDM,,,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
LENS MULTIFOCAL ZCT150,1645574,CDM,,,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
LENS MULTIFOCAL 450,1645576,CDM,,,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LENS MULTIFOCAL 450,1645576,CDM,,,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
LENS MULTIFOCAL 450,1645576,CDM,,,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
PACK VITRECTOMY,1645689,CDM,,,,INPATIENT,,,1748.25,699.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1590.91,OTHER,1311.19,1713.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PACK VITRECTOMY,1645689,CDM,,,,INPATIENT,,,1748.25,699.3,MONUMENT,COMMERCIAL,,,,1398.6,,1311.19,1713.29,
PACK VITRECTOMY,1645689,CDM,,,,INPATIENT,,,1748.25,699.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1311.19,,1311.19,1713.29,
PACK HOT REHEATER LG,1645700,CDM,,,,INPATIENT,,,170.25,68.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.93,OTHER,127.69,166.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PACK HOT REHEATER LG,1645700,CDM,,,,INPATIENT,,,170.25,68.1,MONUMENT,COMMERCIAL,,,,136.2,,127.69,166.85,
PACK HOT REHEATER LG,1645700,CDM,,,,INPATIENT,,,170.25,68.1,UNITED HEALTH,UNITED COMMERCIAL,,,,127.69,,127.69,166.85,
POLAR PAD KNEE/SHOULDER,1645775,CDM,,,,INPATIENT,,,233.25,93.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.26,OTHER,174.94,228.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POLAR PAD KNEE/SHOULDER,1645775,CDM,,,,INPATIENT,,,233.25,93.3,MONUMENT,COMMERCIAL,,,,186.6,,174.94,228.59,
POLAR PAD KNEE/SHOULDER,1645775,CDM,,,,INPATIENT,,,233.25,93.3,UNITED HEALTH,UNITED COMMERCIAL,,,,174.94,,174.94,228.59,
CARPEL TUNNELL RELEASE KIT,1646100,CDM,,,,INPATIENT,,,646.25,258.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,588.09,OTHER,484.69,633.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPEL TUNNELL RELEASE KIT,1646100,CDM,,,,INPATIENT,,,646.25,258.5,MONUMENT,COMMERCIAL,,,,517,,484.69,633.33,
CARPEL TUNNELL RELEASE KIT,1646100,CDM,,,,INPATIENT,,,646.25,258.5,UNITED HEALTH,UNITED COMMERCIAL,,,,484.69,,484.69,633.33,
MAGNETIC PAD,1646350,CDM,,,,INPATIENT,,,111.25,44.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.24,OTHER,83.44,109.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAGNETIC PAD,1646350,CDM,,,,INPATIENT,,,111.25,44.5,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
MAGNETIC PAD,1646350,CDM,,,,INPATIENT,,,111.25,44.5,UNITED HEALTH,UNITED COMMERCIAL,,,,83.44,,83.44,109.03,
TUBING INSUFLATION EC1101,1646650,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TUBING INSUFLATION EC1101,1646650,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
TUBING INSUFLATION EC1101,1646650,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
BAG ENDO 3X6,1647055,CDM,,,,INPATIENT,,,168,67.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.88,OTHER,126,164.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG ENDO 3X6,1647055,CDM,,,,INPATIENT,,,168,67.2,MONUMENT,COMMERCIAL,,,,134.4,,126,164.64,
BAG ENDO 3X6,1647055,CDM,,,,INPATIENT,,,168,67.2,UNITED HEALTH,UNITED COMMERCIAL,,,,126,,126,164.64,
BANDAGE ESMARK 6 INCH,1647090,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BANDAGE ESMARK 6 INCH,1647090,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
BANDAGE ESMARK 6 INCH,1647090,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
CANISTER W/GEL,1647092,CDM,,,,INPATIENT,,,576.5,230.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,524.62,OTHER,432.38,564.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANISTER W/GEL,1647092,CDM,,,,INPATIENT,,,576.5,230.6,MONUMENT,COMMERCIAL,,,,461.2,,432.38,564.97,
CANISTER W/GEL,1647092,CDM,,,,INPATIENT,,,576.5,230.6,UNITED HEALTH,UNITED COMMERCIAL,,,,432.38,,432.38,564.97,
CATH HICKMAN INTRO KIT 10FR,1647232,CDM,,,,INPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,307.35,OTHER,253.31,331,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH HICKMAN INTRO KIT 10FR,1647232,CDM,,,,INPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
CATH HICKMAN INTRO KIT 10FR,1647232,CDM,,,,INPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,253.31,,253.31,331,
CATH COUDE 16FR 5CC,1647240,CDM,,,,INPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.06,OTHER,84.94,110.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH COUDE 16FR 5CC,1647240,CDM,,,,INPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
CATH COUDE 16FR 5CC,1647240,CDM,,,,INPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,,84.94,,84.94,110.99,
CATH COUDE 18FR 5CC,1647241,CDM,,,,INPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.06,OTHER,84.94,110.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH COUDE 18FR 5CC,1647241,CDM,,,,INPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
CATH COUDE 18FR 5CC,1647241,CDM,,,,INPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,,84.94,,84.94,110.99,
CATH COUDE 20FR 5CC,1647242,CDM,,,,INPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.06,OTHER,84.94,110.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH COUDE 20FR 5CC,1647242,CDM,,,,INPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
CATH COUDE 20FR 5CC,1647242,CDM,,,,INPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,,84.94,,84.94,110.99,
CAUTERY COAGULATOR SUCTION,1647350,CDM,,,,INPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.35,OTHER,59.63,77.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CAUTERY COAGULATOR SUCTION,1647350,CDM,,,,INPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
CAUTERY COAGULATOR SUCTION,1647350,CDM,,,,INPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,,59.63,,59.63,77.91,
DRAIN MALECTO 24FR,1647435,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN MALECTO 24FR,1647435,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
DRAIN MALECTO 24FR,1647435,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
DRAPE C ARM,1647445,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAPE C ARM,1647445,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
DRAPE C ARM,1647445,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
DRAIN HYER SCHULTE SUCT,1647450,CDM,,,,INPATIENT,,,59.5,23.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.15,OTHER,44.63,58.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN HYER SCHULTE SUCT,1647450,CDM,,,,INPATIENT,,,59.5,23.8,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
DRAIN HYER SCHULTE SUCT,1647450,CDM,,,,INPATIENT,,,59.5,23.8,UNITED HEALTH,UNITED COMMERCIAL,,,,44.63,,44.63,58.31,
DRAIN 10FR J VAC,1647452,CDM,,,,INPATIENT,,,50.25,20.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.73,OTHER,37.69,49.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAIN 10FR J VAC,1647452,CDM,,,,INPATIENT,,,50.25,20.1,MONUMENT,COMMERCIAL,,,,40.2,,37.69,49.25,
DRAIN 10FR J VAC,1647452,CDM,,,,INPATIENT,,,50.25,20.1,UNITED HEALTH,UNITED COMMERCIAL,,,,37.69,,37.69,49.25,
DRAPE ORTHO U,1647455,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAPE ORTHO U,1647455,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
DRAPE ORTHO U,1647455,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
KALTOSTAT WOUND PACKING,1647487,CDM,,,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KALTOSTAT WOUND PACKING,1647487,CDM,,,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
KALTOSTAT WOUND PACKING,1647487,CDM,,,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
ELECTRODE SCALP FETAL,1647590,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELECTRODE SCALP FETAL,1647590,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
ELECTRODE SCALP FETAL,1647590,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
ELECTRODE PACING,1647592,CDM,,,,INPATIENT,,,283.25,113.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,257.76,OTHER,212.44,277.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELECTRODE PACING,1647592,CDM,,,,INPATIENT,,,283.25,113.3,MONUMENT,COMMERCIAL,,,,226.6,,212.44,277.59,
ELECTRODE PACING,1647592,CDM,,,,INPATIENT,,,283.25,113.3,UNITED HEALTH,UNITED COMMERCIAL,,,,212.44,,212.44,277.59,
FLOWMETER  PEAK ADULT,1647594,CDM,,,,INPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.75,OTHER,89.63,117.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FLOWMETER  PEAK ADULT,1647594,CDM,,,,INPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
FLOWMETER  PEAK ADULT,1647594,CDM,,,,INPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,,89.63,,89.63,117.11,
FLOWMETER PEAK PED,1647596,CDM,,,,INPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.75,OTHER,89.63,117.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FLOWMETER PEAK PED,1647596,CDM,,,,INPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
FLOWMETER PEAK PED,1647596,CDM,,,,INPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,,89.63,,89.63,117.11,
FALOPE RING BAND APPL KIT,1647700,CDM,,,,INPATIENT,,,783.75,313.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,713.21,OTHER,587.81,768.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FALOPE RING BAND APPL KIT,1647700,CDM,,,,INPATIENT,,,783.75,313.5,MONUMENT,COMMERCIAL,,,,627,,587.81,768.08,
FALOPE RING BAND APPL KIT,1647700,CDM,,,,INPATIENT,,,783.75,313.5,UNITED HEALTH,UNITED COMMERCIAL,,,,587.81,,587.81,768.08,
GUIDEWIRE .038,1647708,CDM,,,,INPATIENT,,,68.25,27.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.11,OTHER,51.19,66.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE .038,1647708,CDM,,,,INPATIENT,,,68.25,27.3,MONUMENT,COMMERCIAL,,,,54.6,,51.19,66.89,
GUIDEWIRE .038,1647708,CDM,,,,INPATIENT,,,68.25,27.3,UNITED HEALTH,UNITED COMMERCIAL,,,,51.19,,51.19,66.89,
GUIDEWIRE .035 STIFF TYPE,1647709,CDM,,,,INPATIENT,,,381.75,152.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,347.39,OTHER,286.31,374.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE .035 STIFF TYPE,1647709,CDM,,,,INPATIENT,,,381.75,152.7,MONUMENT,COMMERCIAL,,,,305.4,,286.31,374.12,
GUIDEWIRE .035 STIFF TYPE,1647709,CDM,,,,INPATIENT,,,381.75,152.7,UNITED HEALTH,UNITED COMMERCIAL,,,,286.31,,286.31,374.12,
GUIDEWIRE 20 FR,1647710,CDM,,,,INPATIENT,,,654.25,261.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.37,OTHER,490.69,641.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE 20 FR,1647710,CDM,,,,INPATIENT,,,654.25,261.7,MONUMENT,COMMERCIAL,,,,523.4,,490.69,641.17,
GUIDEWIRE 20 FR,1647710,CDM,,,,INPATIENT,,,654.25,261.7,UNITED HEALTH,UNITED COMMERCIAL,,,,490.69,,490.69,641.17,
GROSHONG 8FR SINGLE LUMEM,C1751,HCPCS,272,RC,,INPATIENT,,,1355.5,542.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1233.51,OTHER,1016.63,1328.39,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GROSHONG 8FR SINGLE LUMEM,C1751,HCPCS,272,RC,,INPATIENT,,,1355.5,542.2,MONUMENT,COMMERCIAL,,,,1084.4,,1016.63,1328.39,
GROSHONG 8FR SINGLE LUMEM,C1751,HCPCS,272,RC,,INPATIENT,,,1355.5,542.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1016.63,,1016.63,1328.39,
GELSYTE,1647718,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GELSYTE,1647718,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
GELSYTE,1647718,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
DRESS OP-SITE 5-1/2 X 10,1647722,CDM,,,,INPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.18,OTHER,33.94,44.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRESS OP-SITE 5-1/2 X 10,1647722,CDM,,,,INPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
DRESS OP-SITE 5-1/2 X 10,1647722,CDM,,,,INPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,,33.94,,33.94,44.35,
LOOPS DISP RESECTING 24FR,1647820,CDM,,,,INPATIENT,,,564.75,225.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,513.92,OTHER,423.56,553.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOOPS DISP RESECTING 24FR,1647820,CDM,,,,INPATIENT,,,564.75,225.9,MONUMENT,COMMERCIAL,,,,451.8,,423.56,553.46,
LOOPS DISP RESECTING 24FR,1647820,CDM,,,,INPATIENT,,,564.75,225.9,UNITED HEALTH,UNITED COMMERCIAL,,,,423.56,,423.56,553.46,
METZENBAUM DETACH-A TIP CRVD,1647830,CDM,,,,INPATIENT,,,245,98,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.95,OTHER,183.75,240.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
METZENBAUM DETACH-A TIP CRVD,1647830,CDM,,,,INPATIENT,,,245,98,MONUMENT,COMMERCIAL,,,,196,,183.75,240.1,
METZENBAUM DETACH-A TIP CRVD,1647830,CDM,,,,INPATIENT,,,245,98,UNITED HEALTH,UNITED COMMERCIAL,,,,183.75,,183.75,240.1,
MESH MARLEX PRE-SHAPED W/CUT,1647850,CDM,278,RC,,INPATIENT,,,227.45,90.98,BLUE CROSS ANTHEM,COMMERCIAL,,,,206.98,OTHER,403.88,527.73,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MESH MARLEX PRE-SHAPED W/CUT,1647850,CDM,278,RC,,INPATIENT,,,227.45,90.98,MONUMENT,COMMERCIAL,,,,430.8,,403.88,527.73,
MESH MARLEX PRE-SHAPED W/CUT,1647850,CDM,278,RC,,INPATIENT,,,227.45,90.98,UNITED HEALTH,UNITED COMMERCIAL,,,,403.88,,403.88,527.73,
MESH MARLEX 10 X 14,1647855,CDM,278,RC,,INPATIENT,,,971.75,388.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,884.29,OTHER,728.81,952.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MESH MARLEX 10 X 14,1647855,CDM,278,RC,,INPATIENT,,,971.75,388.7,MONUMENT,COMMERCIAL,,,,777.4,,728.81,952.32,
MESH MARLEX 10 X 14,1647855,CDM,278,RC,,INPATIENT,,,971.75,388.7,UNITED HEALTH,UNITED COMMERCIAL,,,,728.81,,728.81,952.32,
OSTOMY LOOP SYS 2 3/4,1647880,CDM,,,,INPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.86,OTHER,109.5,143.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OSTOMY LOOP SYS 2 3/4,1647880,CDM,,,,INPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
OSTOMY LOOP SYS 2 3/4,1647880,CDM,,,,INPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,,109.5,,109.5,143.08,
OSTOMY LOOP SYS 4,1647882,CDM,,,,INPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,158.34,OTHER,130.5,170.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OSTOMY LOOP SYS 4,1647882,CDM,,,,INPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
OSTOMY LOOP SYS 4,1647882,CDM,,,,INPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,,130.5,,130.5,170.52,
IRRAGATOR VISIFLOW,1647910,CDM,,,,INPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IRRAGATOR VISIFLOW,1647910,CDM,,,,INPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
IRRAGATOR VISIFLOW,1647910,CDM,,,,INPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
TROCAR 1 ENDOPATH TRISTER,1647968,CDM,,,,INPATIENT,,,432.5,173,BLUE CROSS ANTHEM,COMMERCIAL,,,,393.58,OTHER,324.38,423.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR 1 ENDOPATH TRISTER,1647968,CDM,,,,INPATIENT,,,432.5,173,MONUMENT,COMMERCIAL,,,,346,,324.38,423.85,
TROCAR 1 ENDOPATH TRISTER,1647968,CDM,,,,INPATIENT,,,432.5,173,UNITED HEALTH,UNITED COMMERCIAL,,,,324.38,,324.38,423.85,
TROCAR 1 ENDOPATH BLADELESS,1647969,CDM,,,,INPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,155.16,OTHER,127.88,167.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR 1 ENDOPATH BLADELESS,1647969,CDM,,,,INPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
TROCAR 1 ENDOPATH BLADELESS,1647969,CDM,,,,INPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,,127.88,,127.88,167.09,
TROCAR VERSAPORT PLUS 5MM,1647972,CDM,,,,INPATIENT,,,440,176,BLUE CROSS ANTHEM,COMMERCIAL,,,,400.4,OTHER,330,431.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR VERSAPORT PLUS 5MM,1647972,CDM,,,,INPATIENT,,,440,176,MONUMENT,COMMERCIAL,,,,352,,330,431.2,
TROCAR VERSAPORT PLUS 5MM,1647972,CDM,,,,INPATIENT,,,440,176,UNITED HEALTH,UNITED COMMERCIAL,,,,330,,330,431.2,
VOLDYNE BREATHING UNIT,1647998,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VOLDYNE BREATHING UNIT,1647998,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
VOLDYNE BREATHING UNIT,1647998,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
PACING PATCH COMBO DEFIB,1648005,CDM,,,,INPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.7,OTHER,167.06,218.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PACING PATCH COMBO DEFIB,1648005,CDM,,,,INPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
PACING PATCH COMBO DEFIB,1648005,CDM,,,,INPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,167.06,,167.06,218.3,
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3689.82,OTHER,3041.06,3973.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,MONUMENT,COMMERCIAL,,,,3243.8,,3041.06,3973.66,
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3041.06,,3041.06,3973.66,
HANDSWITCH DISP SUCT COAG,1649020,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HANDSWITCH DISP SUCT COAG,1649020,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
HANDSWITCH DISP SUCT COAG,1649020,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
FORCEP BIOPSY HOT/COLD,1649090,CDM,,,,INPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.15,OTHER,48.75,63.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FORCEP BIOPSY HOT/COLD,1649090,CDM,,,,INPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
FORCEP BIOPSY HOT/COLD,1649090,CDM,,,,INPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,,48.75,,48.75,63.7,
DISPOSABLE FORCEPS,1649092,CDM,,,,INPATIENT,,,65.25,26.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.38,OTHER,48.94,63.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DISPOSABLE FORCEPS,1649092,CDM,,,,INPATIENT,,,65.25,26.1,MONUMENT,COMMERCIAL,,,,52.2,,48.94,63.95,
DISPOSABLE FORCEPS,1649092,CDM,,,,INPATIENT,,,65.25,26.1,UNITED HEALTH,UNITED COMMERCIAL,,,,48.94,,48.94,63.95,
CATH INSYTE 16GAX1-1/4,1649340,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 16GAX1-1/4,1649340,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
CATH INSYTE 16GAX1-1/4,1649340,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
CATH URETERAL WHISTLE TIP 5 FR,1649355,CDM,,,,INPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.48,OTHER,60.56,79.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH URETERAL WHISTLE TIP 5 FR,1649355,CDM,,,,INPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
CATH URETERAL WHISTLE TIP 5 FR,1649355,CDM,,,,INPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,,60.56,,60.56,79.14,
CATH URETERAL WHISTLE TIP/AD 5,1649365,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH URETERAL WHISTLE TIP/AD 5,1649365,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
CATH URETERAL WHISTLE TIP/AD 5,1649365,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
CONCHA THERM COLE IRR,1649375,CDM,,,,INPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.97,OTHER,85.69,111.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CONCHA THERM COLE IRR,1649375,CDM,,,,INPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
CONCHA THERM COLE IRR,1649375,CDM,,,,INPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,,85.69,,85.69,111.97,
BIS MONITOR SENSORS,1649376,CDM,,,,INPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.96,OTHER,81.56,106.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIS MONITOR SENSORS,1649376,CDM,,,,INPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
BIS MONITOR SENSORS,1649376,CDM,,,,INPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,,81.56,,81.56,106.58,
EPIDURAL OPEN PORT,1649377,CDM,,,,INPATIENT,,,73,29.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,66.43,OTHER,54.75,71.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EPIDURAL OPEN PORT,1649377,CDM,,,,INPATIENT,,,73,29.2,MONUMENT,COMMERCIAL,,,,58.4,,54.75,71.54,
EPIDURAL OPEN PORT,1649377,CDM,,,,INPATIENT,,,73,29.2,UNITED HEALTH,UNITED COMMERCIAL,,,,54.75,,54.75,71.54,
ELECTRODE FAST PATCH,1649381,CDM,,,,INPATIENT,,,150.75,60.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.18,OTHER,113.06,147.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELECTRODE FAST PATCH,1649381,CDM,,,,INPATIENT,,,150.75,60.3,MONUMENT,COMMERCIAL,,,,120.6,,113.06,147.74,
ELECTRODE FAST PATCH,1649381,CDM,,,,INPATIENT,,,150.75,60.3,UNITED HEALTH,UNITED COMMERCIAL,,,,113.06,,113.06,147.74,
BASKET DISP FOREIGN BODY,1649430,CDM,,,,INPATIENT,,,445.25,178.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,405.18,OTHER,333.94,436.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BASKET DISP FOREIGN BODY,1649430,CDM,,,,INPATIENT,,,445.25,178.1,MONUMENT,COMMERCIAL,,,,356.2,,333.94,436.35,
BASKET DISP FOREIGN BODY,1649430,CDM,,,,INPATIENT,,,445.25,178.1,UNITED HEALTH,UNITED COMMERCIAL,,,,333.94,,333.94,436.35,
STERI-CATH DL TRACH SIZE,1649555,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERI-CATH DL TRACH SIZE,1649555,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
STERI-CATH DL TRACH SIZE,1649555,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
SOFT URETRAL STENT 7FRX24,1649565,CDM,,,,INPATIENT,,,303.25,121.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,275.96,OTHER,227.44,297.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SOFT URETRAL STENT 7FRX24,1649565,CDM,,,,INPATIENT,,,303.25,121.3,MONUMENT,COMMERCIAL,,,,242.6,,227.44,297.19,
SOFT URETRAL STENT 7FRX24,1649565,CDM,,,,INPATIENT,,,303.25,121.3,UNITED HEALTH,UNITED COMMERCIAL,,,,227.44,,227.44,297.19,
BLADE SAW 2108-377,1649650,CDM,,,,INPATIENT,,,334.5,133.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.4,OTHER,250.88,327.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE SAW 2108-377,1649650,CDM,,,,INPATIENT,,,334.5,133.8,MONUMENT,COMMERCIAL,,,,267.6,,250.88,327.81,
BLADE SAW 2108-377,1649650,CDM,,,,INPATIENT,,,334.5,133.8,UNITED HEALTH,UNITED COMMERCIAL,,,,250.88,,250.88,327.81,
KNIFE  MYRINGOTOMY SICKLE,1649700,CDM,,,,INPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,102.38,OTHER,84.38,110.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNIFE  MYRINGOTOMY SICKLE,1649700,CDM,,,,INPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.38,110.25,
KNIFE  MYRINGOTOMY SICKLE,1649700,CDM,,,,INPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,,84.38,,84.38,110.25,
ANCHOR OGDEN 7.4MM NON ST,1651000,CDM,,,,INPATIENT,,,721.25,288.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,656.34,OTHER,540.94,706.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANCHOR OGDEN 7.4MM NON ST,1651000,CDM,,,,INPATIENT,,,721.25,288.5,MONUMENT,COMMERCIAL,,,,577,,540.94,706.83,
ANCHOR OGDEN 7.4MM NON ST,1651000,CDM,,,,INPATIENT,,,721.25,288.5,UNITED HEALTH,UNITED COMMERCIAL,,,,540.94,,540.94,706.83,
ANCHOR BIOKNOTLESS RC W ETHI,1652000,CDM,,,,INPATIENT,,,1408.75,563.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1281.96,OTHER,1056.56,1380.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANCHOR BIOKNOTLESS RC W ETHI,1652000,CDM,,,,INPATIENT,,,1408.75,563.5,MONUMENT,COMMERCIAL,,,,1127,,1056.56,1380.58,
ANCHOR BIOKNOTLESS RC W ETHI,1652000,CDM,,,,INPATIENT,,,1408.75,563.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1056.56,,1056.56,1380.58,
ANCHOR BIOKNOTLESS W PANACRYL,1653000,CDM,,,,INPATIENT,,,1237.5,495,BLUE CROSS ANTHEM,COMMERCIAL,,,,1126.13,OTHER,928.13,1212.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANCHOR BIOKNOTLESS W PANACRYL,1653000,CDM,,,,INPATIENT,,,1237.5,495,MONUMENT,COMMERCIAL,,,,990,,928.13,1212.75,
ANCHOR BIOKNOTLESS W PANACRYL,1653000,CDM,,,,INPATIENT,,,1237.5,495,UNITED HEALTH,UNITED COMMERCIAL,,,,928.13,,928.13,1212.75,
"SCREW, CANCELLOUS 6.5X32MM",1670001,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS 6.5X32MM",1670001,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
"SCREW, CANCELLOUS 6.5X32MM",1670001,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
BAG RESUSCITATION ADULT DISP,1671045,CDM,,,,INPATIENT,,,103.25,41.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.96,OTHER,77.44,101.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG RESUSCITATION ADULT DISP,1671045,CDM,,,,INPATIENT,,,103.25,41.3,MONUMENT,COMMERCIAL,,,,82.6,,77.44,101.19,
BAG RESUSCITATION ADULT DISP,1671045,CDM,,,,INPATIENT,,,103.25,41.3,UNITED HEALTH,UNITED COMMERCIAL,,,,77.44,,77.44,101.19,
CATH CHOLANGIOGRAM TAUT,1671085,CDM,,,,INPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,158.34,OTHER,130.5,170.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH CHOLANGIOGRAM TAUT,1671085,CDM,,,,INPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
CATH CHOLANGIOGRAM TAUT,1671085,CDM,,,,INPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,,130.5,,130.5,170.52,
CATH CHOLANGIOGRAPHY 19GA,1671090,CDM,,,,INPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,111.93,OTHER,92.25,120.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH CHOLANGIOGRAPHY 19GA,1671090,CDM,,,,INPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
CATH CHOLANGIOGRAPHY 19GA,1671090,CDM,,,,INPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,,92.25,,92.25,120.54,
ANESTHESIA EXT SET 20,1671094,CDM,,,,INPATIENT,,,2.75,1.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2.5,OTHER,2.06,2.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA EXT SET 20,1671094,CDM,,,,INPATIENT,,,2.75,1.1,MONUMENT,COMMERCIAL,,,,2.2,,2.06,2.7,
ANESTHESIA EXT SET 20,1671094,CDM,,,,INPATIENT,,,2.75,1.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2.06,,2.06,2.7,
CATH INSYTE 18GA X 2,1671095,CDM,,,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 18GA X 2,1671095,CDM,,,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
CATH INSYTE 18GA X 2,1671095,CDM,,,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
CATH INSYTE 18GA X 1-1/4,1671096,CDM,,,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 18GA X 1-1/4,1671096,CDM,,,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
CATH INSYTE 18GA X 1-1/4,1671096,CDM,,,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
CATH INSYTE 22GA X 1,1671097,CDM,,,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 22GA X 1,1671097,CDM,,,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
CATH INSYTE 22GA X 1,1671097,CDM,,,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
CATH INSYTE 24GA X 3/4,1671098,CDM,,,,INPATIENT,,,20.5,8.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.66,OTHER,15.38,20.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 24GA X 3/4,1671098,CDM,,,,INPATIENT,,,20.5,8.2,MONUMENT,COMMERCIAL,,,,16.4,,15.38,20.09,
CATH INSYTE 24GA X 3/4,1671098,CDM,,,,INPATIENT,,,20.5,8.2,UNITED HEALTH,UNITED COMMERCIAL,,,,15.38,,15.38,20.09,
CATH INSYTE 20GA X 1-1/4,1671099,CDM,,,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 20GA X 1-1/4,1671099,CDM,,,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
CATH INSYTE 20GA X 1-1/4,1671099,CDM,,,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
CATH INSYTE 16GA X 2,1671100,CDM,,,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH INSYTE 16GA X 2,1671100,CDM,,,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
CATH INSYTE 16GA X 2,1671100,CDM,,,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
CATH FOGARTY BILIARY 5FR,1671115,CDM,,,,INPATIENT,,,394.75,157.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.22,OTHER,296.06,386.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH FOGARTY BILIARY 5FR,1671115,CDM,,,,INPATIENT,,,394.75,157.9,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
CATH FOGARTY BILIARY 5FR,1671115,CDM,,,,INPATIENT,,,394.75,157.9,UNITED HEALTH,UNITED COMMERCIAL,,,,296.06,,296.06,386.86,
FEMORAL CANAL TIP W/SUCTION,1671375,CDM,,,,INPATIENT,,,119.75,47.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.97,OTHER,89.81,117.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL CANAL TIP W/SUCTION,1671375,CDM,,,,INPATIENT,,,119.75,47.9,MONUMENT,COMMERCIAL,,,,95.8,,89.81,117.36,
FEMORAL CANAL TIP W/SUCTION,1671375,CDM,,,,INPATIENT,,,119.75,47.9,UNITED HEALTH,UNITED COMMERCIAL,,,,89.81,,89.81,117.36,
NEEDLES  NON-CORING 22GX1,1671480,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLES  NON-CORING 22GX1,1671480,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
NEEDLES  NON-CORING 22GX1,1671480,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
NEEDLES WHITACRE 23GX3,1671481,CDM,,,,INPATIENT,,,59.5,23.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.15,OTHER,44.63,58.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLES WHITACRE 23GX3,1671481,CDM,,,,INPATIENT,,,59.5,23.8,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
NEEDLES WHITACRE 23GX3,1671481,CDM,,,,INPATIENT,,,59.5,23.8,UNITED HEALTH,UNITED COMMERCIAL,,,,44.63,,44.63,58.31,
"NEEDLES 20 X 1 GRIPPER""",1671482,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"NEEDLES 20 X 1 GRIPPER""",1671482,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
"NEEDLES 20 X 1 GRIPPER""",1671482,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
NEEDLE CATH INSYTE 24GU X 0.56,1671486,CDM,,,,INPATIENT,,,13,5.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,11.83,OTHER,9.75,12.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE CATH INSYTE 24GU X 0.56,1671486,CDM,,,,INPATIENT,,,13,5.2,MONUMENT,COMMERCIAL,,,,10.4,,9.75,12.74,
NEEDLE CATH INSYTE 24GU X 0.56,1671486,CDM,,,,INPATIENT,,,13,5.2,UNITED HEALTH,UNITED COMMERCIAL,,,,9.75,,9.75,12.74,
PAPARELLA TYPE 1 VENT TUBE,1671580,CDM,,,,INPATIENT,,,130,52,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.3,OTHER,97.5,127.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PAPARELLA TYPE 1 VENT TUBE,1671580,CDM,,,,INPATIENT,,,130,52,MONUMENT,COMMERCIAL,,,,104,,97.5,127.4,
PAPARELLA TYPE 1 VENT TUBE,1671580,CDM,,,,INPATIENT,,,130,52,UNITED HEALTH,UNITED COMMERCIAL,,,,97.5,,97.5,127.4,
PAPARELLA II EAR TUBE,1671582,CDM,,,,INPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.62,OTHER,96.94,126.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PAPARELLA II EAR TUBE,1671582,CDM,,,,INPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
PAPARELLA II EAR TUBE,1671582,CDM,,,,INPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,,96.94,,96.94,126.67,
PROBE ANTERIOR VITRECTOMY,1671635,CDM,,,,INPATIENT,,,820.75,328.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,746.88,OTHER,615.56,804.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROBE ANTERIOR VITRECTOMY,1671635,CDM,,,,INPATIENT,,,820.75,328.3,MONUMENT,COMMERCIAL,,,,656.6,,615.56,804.34,
PROBE ANTERIOR VITRECTOMY,1671635,CDM,,,,INPATIENT,,,820.75,328.3,UNITED HEALTH,UNITED COMMERCIAL,,,,615.56,,615.56,804.34,
FINGER PROBE PEDIATRIC,1671637,CDM,,,,INPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,159.93,OTHER,131.81,172.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FINGER PROBE PEDIATRIC,1671637,CDM,,,,INPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
FINGER PROBE PEDIATRIC,1671637,CDM,,,,INPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,,131.81,,131.81,172.24,
SEGURA BASKET 3FR,1671650,CDM,,,,INPATIENT,,,484,193.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,440.44,OTHER,363,474.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEGURA BASKET 3FR,1671650,CDM,,,,INPATIENT,,,484,193.6,MONUMENT,COMMERCIAL,,,,387.2,,363,474.32,
SEGURA BASKET 3FR,1671650,CDM,,,,INPATIENT,,,484,193.6,UNITED HEALTH,UNITED COMMERCIAL,,,,363,,363,474.32,
TRAY SPINAL TAP,1671687,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY SPINAL TAP,1671687,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
TRAY SPINAL TAP,1671687,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
SURGICEL #1953,1671688,CDM,,,,INPATIENT,,,160.75,64.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.28,OTHER,120.56,157.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SURGICEL #1953,1671688,CDM,,,,INPATIENT,,,160.75,64.3,MONUMENT,COMMERCIAL,,,,128.6,,120.56,157.54,
SURGICEL #1953,1671688,CDM,,,,INPATIENT,,,160.75,64.3,UNITED HEALTH,UNITED COMMERCIAL,,,,120.56,,120.56,157.54,
CANNULA KIT CONCEPT,1674025,CDM,,,,INPATIENT,,,66.25,26.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.29,OTHER,49.69,64.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANNULA KIT CONCEPT,1674025,CDM,,,,INPATIENT,,,66.25,26.5,MONUMENT,COMMERCIAL,,,,53,,49.69,64.93,
CANNULA KIT CONCEPT,1674025,CDM,,,,INPATIENT,,,66.25,26.5,UNITED HEALTH,UNITED COMMERCIAL,,,,49.69,,49.69,64.93,
OPTI-GUARD,1674440,CDM,,,,INPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OPTI-GUARD,1674440,CDM,,,,INPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
OPTI-GUARD,1674440,CDM,,,,INPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
PILLOW ABDUCTION,1674500,CDM,,,,INPATIENT,,,221.25,88.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,201.34,OTHER,165.94,216.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PILLOW ABDUCTION,1674500,CDM,,,,INPATIENT,,,221.25,88.5,MONUMENT,COMMERCIAL,,,,177,,165.94,216.83,
PILLOW ABDUCTION,1674500,CDM,,,,INPATIENT,,,221.25,88.5,UNITED HEALTH,UNITED COMMERCIAL,,,,165.94,,165.94,216.83,
PIN GUIDE 3/32MM,1674562,CDM,,,,INPATIENT,,,151.5,60.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.87,OTHER,113.63,148.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PIN GUIDE 3/32MM,1674562,CDM,,,,INPATIENT,,,151.5,60.6,MONUMENT,COMMERCIAL,,,,121.2,,113.63,148.47,
PIN GUIDE 3/32MM,1674562,CDM,,,,INPATIENT,,,151.5,60.6,UNITED HEALTH,UNITED COMMERCIAL,,,,113.63,,113.63,148.47,
PILLOW  PRONE,1674600,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PILLOW  PRONE,1674600,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
PILLOW  PRONE,1674600,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
M.R.I IMPLANTED PORT,1675077,CDM,,,,INPATIENT,,,1668.25,667.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1518.11,OTHER,1251.19,1634.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
M.R.I IMPLANTED PORT,1675077,CDM,,,,INPATIENT,,,1668.25,667.3,MONUMENT,COMMERCIAL,,,,1334.6,,1251.19,1634.89,
M.R.I IMPLANTED PORT,1675077,CDM,,,,INPATIENT,,,1668.25,667.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1251.19,,1251.19,1634.89,
SCREW  CORTICAL 24MM DEPUY,1675502,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SCREW  CORTICAL 24MM DEPUY,1675502,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
SCREW  CORTICAL 24MM DEPUY,1675502,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
"SCREW, BONE MULCH 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1784.74,OTHER,1470.94,1922.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE MULCH 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,MONUMENT,COMMERCIAL,,,,1569,,1470.94,1922.03,
"SCREW, BONE MULCH 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1470.94,,1470.94,1922.03,
"SCREW, CANCELLOUS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
"SCREW, CANCELLOUS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
"SCREW, CORTEX 12MM 202.812",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,62.44,81.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 12MM 202.812",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,66.6,,62.44,81.59,
"SCREW, CORTEX 12MM 202.812",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,62.44,,62.44,81.59,
"SCREW, CORTEX ST 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,84.5,33.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.9,OTHER,63.38,82.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,84.5,33.8,MONUMENT,COMMERCIAL,,,,67.6,,63.38,82.81,
"SCREW, CORTEX ST 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,84.5,33.8,UNITED HEALTH,UNITED COMMERCIAL,,,,63.38,,63.38,82.81,
"SCREW, CORTEX 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,62.44,81.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,66.6,,62.44,81.59,
"SCREW, CORTEX 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,62.44,,62.44,81.59,
"SCREW, CORTEX ST 4.5MM 214.834",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.8,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 214.834",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 214.834",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 214.838",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.8,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 214.838",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 214.838",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,62.44,81.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,66.6,,62.44,81.59,
"SCREW, CORTEX 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,62.44,,62.44,81.59,
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"SCREW, LAG DHS/DCS 12.7MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,1021.25,408.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,929.34,OTHER,765.94,1000.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG DHS/DCS 12.7MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,1021.25,408.5,MONUMENT,COMMERCIAL,,,,817,,765.94,1000.83,
"SCREW, LAG DHS/DCS 12.7MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,1021.25,408.5,UNITED HEALTH,UNITED COMMERCIAL,,,,765.94,,765.94,1000.83,
"SCREW, COMPRESS DHC/DCS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,159.75,63.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.37,OTHER,119.81,156.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, COMPRESS DHC/DCS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,159.75,63.9,MONUMENT,COMMERCIAL,,,,127.8,,119.81,156.56,
"SCREW, COMPRESS DHC/DCS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,159.75,63.9,UNITED HEALTH,UNITED COMMERCIAL,,,,119.81,,119.81,156.56,
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"SCREW, BONE CAN 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE CAN 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, LOCKING 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,578.25,231.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,526.21,OTHER,433.69,566.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,578.25,231.3,MONUMENT,COMMERCIAL,,,,462.6,,433.69,566.69,
"SCREW, LOCKING 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,578.25,231.3,UNITED HEALTH,UNITED COMMERCIAL,,,,433.69,,433.69,566.69,
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,BLUE CROSS ANTHEM,COMMERCIAL,,,,518.7,OTHER,427.5,558.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,MONUMENT,COMMERCIAL,,,,456,,427.5,558.6,
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UNITED HEALTH,UNITED COMMERCIAL,,,,427.5,,427.5,558.6,
"SCREW, LOCKING TI 5.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,BLUE CROSS ANTHEM,COMMERCIAL,,,,518.7,OTHER,427.5,558.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,MONUMENT,COMMERCIAL,,,,456,,427.5,558.6,
"SCREW, LOCKING TI 5.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UNITED HEALTH,UNITED COMMERCIAL,,,,427.5,,427.5,558.6,
"SCREW, LOCKING 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING TI 5.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,BLUE CROSS ANTHEM,COMMERCIAL,,,,518.7,OTHER,427.5,558.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,MONUMENT,COMMERCIAL,,,,456,,427.5,558.6,
"SCREW, LOCKING TI 5.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UNITED HEALTH,UNITED COMMERCIAL,,,,427.5,,427.5,558.6,
"SCREW, LOCKING 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, CORTEX 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.47,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, LOCKING 62MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 62MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 62MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, CORTEX 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,76.5,99.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
"SCREW, CORTEX 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,76.5,,76.5,99.96,
"SCREW, LOCKING 74MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 74MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 74MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, BONE SYS 3.0MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,1270,508,BLUE CROSS ANTHEM,COMMERCIAL,,,,1155.7,OTHER,952.5,1244.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SYS 3.0MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,1270,508,MONUMENT,COMMERCIAL,,,,1016,,952.5,1244.6,
"SCREW, BONE SYS 3.0MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,1270,508,UNITED HEALTH,UNITED COMMERCIAL,,,,952.5,,952.5,1244.6,
"SCREW, LOCKING 78MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 78MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 78MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.78,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, LOCKING 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, CORTEX 3.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.47,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX 3.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, CANN LOCK 5.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN LOCK 5.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, CANN LOCK 5.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, CORTEX 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,92.82,OTHER,76.5,99.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
"SCREW, CORTEX 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UNITED HEALTH,UNITED COMMERCIAL,,,,76.5,,76.5,99.96,
"SCREW, CANN 4.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN 4.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN 4.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, CANN LOCK 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN LOCK 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, CANN LOCK 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, CANN 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.49,OTHER,493.13,644.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,MONUMENT,COMMERCIAL,,,,526,,493.13,644.35,
"SCREW, CANN 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UNITED HEALTH,UNITED COMMERCIAL,,,,493.13,,493.13,644.35,
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.4,OTHER,279.94,365.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,MONUMENT,COMMERCIAL,,,,298.6,,279.94,365.79,
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UNITED HEALTH,UNITED COMMERCIAL,,,,279.94,,279.94,365.79,
"SCREW, CANN TI 4.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,656,262.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,596.96,OTHER,492,642.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,656,262.4,MONUMENT,COMMERCIAL,,,,524.8,,492,642.88,
"SCREW, CANN TI 4.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,656,262.4,UNITED HEALTH,UNITED COMMERCIAL,,,,492,,492,642.88,
"SCREW, LOCKING 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCKING 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, LOCKING 4.0MM 54MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.0MM 54MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCKING 4.0MM 54MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, CANN LOCK 7.3MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,832.55,333.02,BLUE CROSS ANTHEM,COMMERCIAL,,,,757.62,OTHER,698.25,912.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN LOCK 7.3MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,832.55,333.02,MONUMENT,COMMERCIAL,,,,744.8,,698.25,912.38,
"SCREW, CANN LOCK 7.3MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,832.55,333.02,UNITED HEALTH,UNITED COMMERCIAL,,,,698.25,,698.25,912.38,
"SCREW, CORTEX ST 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,59,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 214.836",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,59,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 214.836",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 214.836",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX 4.5MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,59,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX 4.5MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX ST 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,92.82,OTHER,76.5,99.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
"SCREW, CORTEX ST 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UNITED HEALTH,UNITED COMMERCIAL,,,,76.5,,76.5,99.96,
"SCREW, CORTEX 4.5MM 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.32,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX 4.5MM 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX ST 3.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,92.82,OTHER,76.5,99.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 3.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
"SCREW, CORTEX ST 3.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UNITED HEALTH,UNITED COMMERCIAL,,,,76.5,,76.5,99.96,
"SCREW, LOCKING 5.0MM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,BLUE CROSS ANTHEM,COMMERCIAL,,,,509.38,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 5.0MM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING 5.0MM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING 5.0MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 5.0MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING 5.0MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING 5.0MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,BLUE CROSS ANTHEM,COMMERCIAL,,,,509.38,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 5.0MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING 5.0MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING ST 2.4MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 2.4MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING ST 2.4MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, LOCKING 7.3MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,847.21,OTHER,698.25,912.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 7.3MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,MONUMENT,COMMERCIAL,,,,744.8,,698.25,912.38,
"SCREW, LOCKING 7.3MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,UNITED HEALTH,UNITED COMMERCIAL,,,,698.25,,698.25,912.38,
"SCREW, LOCKING ST 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING ST 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, LOCKING 2.4MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 2.4MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING 2.4MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, TAPERED 8-10MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,739.5,295.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,672.95,OTHER,554.63,724.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, TAPERED 8-10MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,739.5,295.8,MONUMENT,COMMERCIAL,,,,591.6,,554.63,724.71,
"SCREW, TAPERED 8-10MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,739.5,295.8,UNITED HEALTH,UNITED COMMERCIAL,,,,554.63,,554.63,724.71,
"SCREW, LOCKING 2.4MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 2.4MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING 2.4MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, LOCKING 2.4MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,375.5,150.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,341.71,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 2.4MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,375.5,150.2,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING 2.4MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,375.5,150.2,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, CORTEX 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,212.75,85.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,193.6,OTHER,159.56,208.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,212.75,85.1,MONUMENT,COMMERCIAL,,,,170.2,,159.56,208.5,
"SCREW, CORTEX 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,212.75,85.1,UNITED HEALTH,UNITED COMMERCIAL,,,,159.56,,159.56,208.5,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,130.75,52.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.98,OTHER,98.06,128.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,130.75,52.3,MONUMENT,COMMERCIAL,,,,104.6,,98.06,128.14,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,130.75,52.3,UNITED HEALTH,UNITED COMMERCIAL,,,,98.06,,98.06,128.14,
"SCREW, CORTEX 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,96.39,38.556,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.71,OTHER,108.38,141.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,96.39,38.556,MONUMENT,COMMERCIAL,,,,115.6,,108.38,141.61,
"SCREW, CORTEX 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,96.39,38.556,UNITED HEALTH,UNITED COMMERCIAL,,,,108.38,,108.38,141.61,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.37,OTHER,98.06,128.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,MONUMENT,COMMERCIAL,,,,104.6,,98.06,128.14,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,UNITED HEALTH,UNITED COMMERCIAL,,,,98.06,,98.06,128.14,
"SCREW, CORTEX 2.7MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,153.75,61.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.91,OTHER,108.38,141.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,153.75,61.5,MONUMENT,COMMERCIAL,,,,115.6,,108.38,141.61,
"SCREW, CORTEX 2.7MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,153.75,61.5,UNITED HEALTH,UNITED COMMERCIAL,,,,108.38,,108.38,141.61,
"SCREW, BONE 6.5MM 30MM 103533",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE 6.5MM 30MM 103533",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, BONE 6.5MM 30MM 103533",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, CORTEX 3.5MM",1680071,CDM,,,,INPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.41,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM",1680071,CDM,,,,INPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX 3.5MM",1680071,CDM,,,,INPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, CORTEX CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, CORTEX CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, LOCKING 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.78,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, CORTEX 3.5MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX 3.5MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, CANN TI 20MM 245844",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,730.73,OTHER,602.25,786.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 20MM 245844",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,MONUMENT,COMMERCIAL,,,,642.4,,602.25,786.94,
"SCREW, CANN TI 20MM 245844",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,UNITED HEALTH,UNITED COMMERCIAL,,,,602.25,,602.25,786.94,
"SCREW, CORTEX 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, LOCKING 2.4MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 2.4MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING 2.4MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, CANN TI 6.5MM 245-846",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,730.73,OTHER,602.25,786.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 6.5MM 245-846",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,MONUMENT,COMMERCIAL,,,,642.4,,602.25,786.94,
"SCREW, CANN TI 6.5MM 245-846",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,UNITED HEALTH,UNITED COMMERCIAL,,,,602.25,,602.25,786.94,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.37,OTHER,92.63,121.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,UNITED HEALTH,UNITED COMMERCIAL,,,,92.63,,92.63,121.03,
"SCREW, LOCKING 2.4MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.64,OTHER,281.63,367.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 2.4MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,MONUMENT,COMMERCIAL,,,,300.4,,281.63,367.99,
"SCREW, LOCKING 2.4MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UNITED HEALTH,UNITED COMMERCIAL,,,,281.63,,281.63,367.99,
"SCREW, SD SCHANZ 4.0MM 2.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,338.69,135.476,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.21,OTHER,357.75,467.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, SD SCHANZ 4.0MM 2.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,338.69,135.476,MONUMENT,COMMERCIAL,,,,381.6,,357.75,467.46,
"SCREW, SD SCHANZ 4.0MM 2.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,338.69,135.476,UNITED HEALTH,UNITED COMMERCIAL,,,,357.75,,357.75,467.46,
"SCREW, LOCKING ST 3.5MM 10MM",C1713,HCPCS,278,RC,,INPATIENT,,,388,155.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,353.08,OTHER,291,380.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 3.5MM 10MM",C1713,HCPCS,278,RC,,INPATIENT,,,388,155.2,MONUMENT,COMMERCIAL,,,,310.4,,291,380.24,
"SCREW, LOCKING ST 3.5MM 10MM",C1713,HCPCS,278,RC,,INPATIENT,,,388,155.2,UNITED HEALTH,UNITED COMMERCIAL,,,,291,,291,380.24,
"SCREW, LOCKING 3.5MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.78,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.78,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, CANN TI LONG TRD 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.49,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI LONG TRD 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI LONG TRD 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, CANN TI LT 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.49,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI LT 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI LT 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, SCHANZ SD 4.0MM 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,378,151.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,343.98,OTHER,398.81,521.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, SCHANZ SD 4.0MM 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,378,151.2,MONUMENT,COMMERCIAL,,,,425.4,,398.81,521.12,
"SCREW, SCHANZ SD 4.0MM 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,378,151.2,UNITED HEALTH,UNITED COMMERCIAL,,,,398.81,,398.81,521.12,
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, LOCKING TI 5.0MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,497.32,OTHER,409.88,535.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,MONUMENT,COMMERCIAL,,,,437.2,,409.88,535.57,
"SCREW, LOCKING TI 5.0MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,UNITED HEALTH,UNITED COMMERCIAL,,,,409.88,,409.88,535.57,
"SCREW, BONE CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"SCREW, BONE CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, CORTEX TAPS 3.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,370.25,148.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,336.93,OTHER,277.69,362.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX TAPS 3.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,370.25,148.1,MONUMENT,COMMERCIAL,,,,296.2,,277.69,362.85,
"SCREW, CORTEX TAPS 3.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,370.25,148.1,UNITED HEALTH,UNITED COMMERCIAL,,,,277.69,,277.69,362.85,
"SCREW, CANN TI 4.0MM 407.650",C1713,HCPCS,278,RC,,INPATIENT,,,682,272.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,620.62,OTHER,511.5,668.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 407.650",C1713,HCPCS,278,RC,,INPATIENT,,,682,272.8,MONUMENT,COMMERCIAL,,,,545.6,,511.5,668.36,
"SCREW, CANN TI 4.0MM 407.650",C1713,HCPCS,278,RC,,INPATIENT,,,682,272.8,UNITED HEALTH,UNITED COMMERCIAL,,,,511.5,,511.5,668.36,
"SCREW, LOCKING TI 5MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 45MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 45MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 45MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, CORTEX ST 3.5MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.29,OTHER,76.5,99.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 3.5MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
"SCREW, CORTEX ST 3.5MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UNITED HEALTH,UNITED COMMERCIAL,,,,76.5,,76.5,99.96,
"SCREW, LOCKING TI 5MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LAG DHS12.7MM 280.900",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,627.42,OTHER,750.56,980.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG DHS12.7MM 280.900",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,MONUMENT,COMMERCIAL,,,,800.6,,750.56,980.74,
"SCREW, LAG DHS12.7MM 280.900",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UNITED HEALTH,UNITED COMMERCIAL,,,,750.56,,750.56,980.74,
"SCREW, LOCKING TI 5MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,BLUE CROSS ANTHEM,COMMERCIAL,,,,473.32,OTHER,640.69,837.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,MONUMENT,COMMERCIAL,,,,683.4,,640.69,837.17,
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,UNITED HEALTH,UNITED COMMERCIAL,,,,640.69,,640.69,837.17,
"SCREW, 7.3MM 95MM TL 95MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,BLUE CROSS ANTHEM,COMMERCIAL,,,,473.32,OTHER,640.69,837.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, 7.3MM 95MM TL 95MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,MONUMENT,COMMERCIAL,,,,683.4,,640.69,837.17,
"SCREW, 7.3MM 95MM TL 95MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,UNITED HEALTH,UNITED COMMERCIAL,,,,640.69,,640.69,837.17,
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, CORTEX SP 2.0MM 8MM",C1713,HCPCS,278,RC,,INPATIENT,,,125.5,50.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.21,OTHER,94.13,122.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX SP 2.0MM 8MM",C1713,HCPCS,278,RC,,INPATIENT,,,125.5,50.2,MONUMENT,COMMERCIAL,,,,100.4,,94.13,122.99,
"SCREW, CORTEX SP 2.0MM 8MM",C1713,HCPCS,278,RC,,INPATIENT,,,125.5,50.2,UNITED HEALTH,UNITED COMMERCIAL,,,,94.13,,94.13,122.99,
"SCREW, CANN TI 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, CORTEX TAPS 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,287.11,OTHER,236.63,309.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX TAPS 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,MONUMENT,COMMERCIAL,,,,252.4,,236.63,309.19,
"SCREW, CORTEX TAPS 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,UNITED HEALTH,UNITED COMMERCIAL,,,,236.63,,236.63,309.19,
"SCREW, LOCKING TI 5.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,BLUE CROSS ANTHEM,COMMERCIAL,,,,518.7,OTHER,427.5,558.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,MONUMENT,COMMERCIAL,,,,456,,427.5,558.6,
"SCREW, LOCKING TI 5.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UNITED HEALTH,UNITED COMMERCIAL,,,,427.5,,427.5,558.6,
"SCREW, CORTEX ST 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.47,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
"SCREW, CORTEX ST 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
"SCREW, CANN TI 4.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI 4.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, NONLOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, NONLOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
"SCREW, NONLOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
"SCREW, NONLOCKING 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, NONLOCKING 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
"SCREW, NONLOCKING 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
"SCREW, NONLOCKING 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, NONLOCKING 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
"SCREW, NONLOCKING 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
"SCREW, LOCKING 4.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,451.36,OTHER,372,486.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,MONUMENT,COMMERCIAL,,,,396.8,,372,486.08,
"SCREW, LOCKING 4.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UNITED HEALTH,UNITED COMMERCIAL,,,,372,,372,486.08,
"SCREW, LOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,451.36,OTHER,372,486.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,MONUMENT,COMMERCIAL,,,,396.8,,372,486.08,
"SCREW, LOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UNITED HEALTH,UNITED COMMERCIAL,,,,372,,372,486.08,
"SCREW, LOCKING 4.5MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,451.36,OTHER,372,486.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.5MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,MONUMENT,COMMERCIAL,,,,396.8,,372,486.08,
"SCREW, LOCKING 4.5MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UNITED HEALTH,UNITED COMMERCIAL,,,,372,,372,486.08,
"SCREW, LOCKING 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,451.36,OTHER,372,486.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,MONUMENT,COMMERCIAL,,,,396.8,,372,486.08,
"SCREW, LOCKING 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UNITED HEALTH,UNITED COMMERCIAL,,,,372,,372,486.08,
"SCREW, CANN TI ST 4.0MM 48MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.82,OTHER,491.06,641.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI ST 4.0MM 48MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,MONUMENT,COMMERCIAL,,,,523.8,,491.06,641.66,
"SCREW, CANN TI ST 4.0MM 48MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UNITED HEALTH,UNITED COMMERCIAL,,,,491.06,,491.06,641.66,
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.78,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCK TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.69,OTHER,419.25,547.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,MONUMENT,COMMERCIAL,,,,447.2,,419.25,547.82,
"SCREW, LOCK TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UNITED HEALTH,UNITED COMMERCIAL,,,,419.25,,419.25,547.82,
"SCREW, LOCKING TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,497.32,OTHER,409.88,535.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,MONUMENT,COMMERCIAL,,,,437.2,,409.88,535.57,
"SCREW, LOCKING TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,UNITED HEALTH,UNITED COMMERCIAL,,,,409.88,,409.88,535.57,
"SCREW, CORTEX TI 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX TI 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTEX TI 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, LOCK ST TI 2.7MM 10MM",1680148,CDM,,,,INPATIENT,,,373.25,149.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,339.66,OTHER,279.94,365.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK ST TI 2.7MM 10MM",1680148,CDM,,,,INPATIENT,,,373.25,149.3,MONUMENT,COMMERCIAL,,,,298.6,,279.94,365.79,
"SCREW, LOCK ST TI 2.7MM 10MM",1680148,CDM,,,,INPATIENT,,,373.25,149.3,UNITED HEALTH,UNITED COMMERCIAL,,,,279.94,,279.94,365.79,
"SCREW, LOCK STT8 2.7MM 202.214",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.4,OTHER,279.94,365.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK STT8 2.7MM 202.214",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,MONUMENT,COMMERCIAL,,,,298.6,,279.94,365.79,
"SCREW, LOCK STT8 2.7MM 202.214",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UNITED HEALTH,UNITED COMMERCIAL,,,,279.94,,279.94,365.79,
"SCREW, CORTEX TI 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.98,OTHER,58.5,76.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX TI 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
"SCREW, CORTEX TI 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,,58.5,,58.5,76.44,
"SCREW, CORTEX TI 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX TI 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTEX TI 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, LOCK ST T8 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.4,OTHER,279.94,365.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK ST T8 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,MONUMENT,COMMERCIAL,,,,298.6,,279.94,365.79,
"SCREW, LOCK ST T8 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UNITED HEALTH,UNITED COMMERCIAL,,,,279.94,,279.94,365.79,
"SCREW, CANN BONE FT 4.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN BONE FT 4.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, CANN BONE FT 4.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, CORTEX ST 4.5MM 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
"SCREW, CORTEX ST 4.5MM 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
"SCREW, CORTEX ST 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.32,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, LOCKING W/HX 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING W/HX 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCKING W/HX 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, LOCKING W/HX 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING W/HX 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCKING W/HX 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, BONE MULCH 10.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1784.74,OTHER,1470.94,1922.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE MULCH 10.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,MONUMENT,COMMERCIAL,,,,1569,,1470.94,1922.03,
"SCREW, BONE MULCH 10.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1470.94,,1470.94,1922.03,
"SCREW, LOCKING W/HX 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING W/HX 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
"SCREW, LOCKING W/HX 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
"SCREW, CAN WASHERLOC 8MM 52MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,501.64,OTHER,413.44,540.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CAN WASHERLOC 8MM 52MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,MONUMENT,COMMERCIAL,,,,441,,413.44,540.23,
"SCREW, CAN WASHERLOC 8MM 52MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,UNITED HEALTH,UNITED COMMERCIAL,,,,413.44,,413.44,540.23,
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.07,OTHER,472.31,617.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,MONUMENT,COMMERCIAL,,,,503.8,,472.31,617.16,
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UNITED HEALTH,UNITED COMMERCIAL,,,,472.31,,472.31,617.16,
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,847.21,OTHER,698.25,912.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,MONUMENT,COMMERCIAL,,,,744.8,,698.25,912.38,
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,UNITED HEALTH,UNITED COMMERCIAL,,,,698.25,,698.25,912.38,
"SCREW, CORTEX ST 4.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,59,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX ST 4.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX ST 4.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, LAG DHS 12.7MM 103535",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,627.42,OTHER,765.94,1000.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG DHS 12.7MM 103535",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,MONUMENT,COMMERCIAL,,,,817,,765.94,1000.83,
"SCREW, LAG DHS 12.7MM 103535",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UNITED HEALTH,UNITED COMMERCIAL,,,,765.94,,765.94,1000.83,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,419.06,OTHER,345.38,451.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,MONUMENT,COMMERCIAL,,,,368.4,,345.38,451.29,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UNITED HEALTH,UNITED COMMERCIAL,,,,345.38,,345.38,451.29,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,419.06,OTHER,345.38,451.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,MONUMENT,COMMERCIAL,,,,368.4,,345.38,451.29,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UNITED HEALTH,UNITED COMMERCIAL,,,,345.38,,345.38,451.29,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,419.06,OTHER,345.38,451.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,MONUMENT,COMMERCIAL,,,,368.4,,345.38,451.29,
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UNITED HEALTH,UNITED COMMERCIAL,,,,345.38,,345.38,451.29,
"SCREW, DHS/DCS LAG 12.7MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,627.42,OTHER,794.44,1038.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, DHS/DCS LAG 12.7MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,MONUMENT,COMMERCIAL,,,,847.4,,794.44,1038.07,
"SCREW, DHS/DCS LAG 12.7MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UNITED HEALTH,UNITED COMMERCIAL,,,,794.44,,794.44,1038.07,
GUIDEWIRE DRILL POINT,C1769,HCPCS,278,RC,,INPATIENT,,,523.75,209.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,476.61,OTHER,392.81,513.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE DRILL POINT,C1769,HCPCS,278,RC,,INPATIENT,,,523.75,209.5,MONUMENT,COMMERCIAL,,,,419,,392.81,513.28,
GUIDEWIRE DRILL POINT,C1769,HCPCS,278,RC,,INPATIENT,,,523.75,209.5,UNITED HEALTH,UNITED COMMERCIAL,,,,392.81,,392.81,513.28,
GUIDEWIRE 3.2MM 400MM,C1769,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,287.11,OTHER,236.63,309.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE 3.2MM 400MM,C1769,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,MONUMENT,COMMERCIAL,,,,252.4,,236.63,309.19,
GUIDEWIRE 3.2MM 400MM,C1769,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,UNITED HEALTH,UNITED COMMERCIAL,,,,236.63,,236.63,309.19,
GUIDEWIRE 0.38MM 18MM,C1769,HCPCS,278,RC,,INPATIENT,,,432.75,173.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,393.8,OTHER,324.56,424.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE 0.38MM 18MM,C1769,HCPCS,278,RC,,INPATIENT,,,432.75,173.1,MONUMENT,COMMERCIAL,,,,346.2,,324.56,424.1,
GUIDEWIRE 0.38MM 18MM,C1769,HCPCS,278,RC,,INPATIENT,,,432.75,173.1,UNITED HEALTH,UNITED COMMERCIAL,,,,324.56,,324.56,424.1,
GUIDEWIRETHRD1.25MM 900.722,C1769,HCPCS,278,RC,,INPATIENT,,,74.46,29.784,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.76,OTHER,85.31,111.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRETHRD1.25MM 900.722,C1769,HCPCS,278,RC,,INPATIENT,,,74.46,29.784,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
GUIDEWIRETHRD1.25MM 900.722,C1769,HCPCS,278,RC,,INPATIENT,,,74.46,29.784,UNITED HEALTH,UNITED COMMERCIAL,,,,85.31,,85.31,111.48,
GUIDEWIRE 2.5MM 200MM,C1769,HCPCS,278,RC,,INPATIENT,,,263,105.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.33,OTHER,197.25,257.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE 2.5MM 200MM,C1769,HCPCS,278,RC,,INPATIENT,,,263,105.2,MONUMENT,COMMERCIAL,,,,210.4,,197.25,257.74,
GUIDEWIRE 2.5MM 200MM,C1769,HCPCS,278,RC,,INPATIENT,,,263,105.2,UNITED HEALTH,UNITED COMMERCIAL,,,,197.25,,197.25,257.74,
"GUIDEWIRE,THRD 2.5MM 900.723",C1769,HCPCS,278,RC,,INPATIENT,,,121.91,48.764,BLUE CROSS ANTHEM,COMMERCIAL,,,,110.94,OTHER,141.19,184.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"GUIDEWIRE,THRD 2.5MM 900.723",C1769,HCPCS,278,RC,,INPATIENT,,,121.91,48.764,MONUMENT,COMMERCIAL,,,,150.6,,141.19,184.49,
"GUIDEWIRE,THRD 2.5MM 900.723",C1769,HCPCS,278,RC,,INPATIENT,,,121.91,48.764,UNITED HEALTH,UNITED COMMERCIAL,,,,141.19,,141.19,184.49,
GUIDEWIRE,C1769,HCPCS,278,RC,,INPATIENT,,,50.35,20.14,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.82,OTHER,392.25,512.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE,C1769,HCPCS,278,RC,,INPATIENT,,,50.35,20.14,MONUMENT,COMMERCIAL,,,,418.4,,392.25,512.54,
GUIDEWIRE,C1769,HCPCS,278,RC,,INPATIENT,,,50.35,20.14,UNITED HEALTH,UNITED COMMERCIAL,,,,392.25,,392.25,512.54,
"GUIDEWIRE,THRD 2.8MM 292.68",C1769,HCPCS,278,RC,,INPATIENT,,,115.29,46.116,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.91,OTHER,133.88,174.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"GUIDEWIRE,THRD 2.8MM 292.68",C1769,HCPCS,278,RC,,INPATIENT,,,115.29,46.116,MONUMENT,COMMERCIAL,,,,142.8,,133.88,174.93,
"GUIDEWIRE,THRD 2.8MM 292.68",C1769,HCPCS,278,RC,,INPATIENT,,,115.29,46.116,UNITED HEALTH,UNITED COMMERCIAL,,,,133.88,,133.88,174.93,
"GUIDEWIRE,THRD 1.25MM 292.62",C1769,HCPCS,278,RC,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"GUIDEWIRE,THRD 1.25MM 292.62",C1769,HCPCS,278,RC,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
"GUIDEWIRE,THRD 1.25MM 292.62",C1769,HCPCS,278,RC,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
GUIDE PIN 3/32MM 35-329640,C1776,HCPCS,278,RC,,INPATIENT,,,654.25,261.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.37,OTHER,490.69,641.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDE PIN 3/32MM 35-329640,C1776,HCPCS,278,RC,,INPATIENT,,,654.25,261.7,MONUMENT,COMMERCIAL,,,,523.4,,490.69,641.17,
GUIDE PIN 3/32MM 35-329640,C1776,HCPCS,278,RC,,INPATIENT,,,654.25,261.7,UNITED HEALTH,UNITED COMMERCIAL,,,,490.69,,490.69,641.17,
"PIN, POSITION 4.5MM 298.3803S",C1776,HCPCS,278,RC,,INPATIENT,,,504.5,201.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,459.1,OTHER,378.38,494.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PIN, POSITION 4.5MM 298.3803S",C1776,HCPCS,278,RC,,INPATIENT,,,504.5,201.8,MONUMENT,COMMERCIAL,,,,403.6,,378.38,494.41,
"PIN, POSITION 4.5MM 298.3803S",C1776,HCPCS,278,RC,,INPATIENT,,,504.5,201.8,UNITED HEALTH,UNITED COMMERCIAL,,,,378.38,,378.38,494.41,
"PIN, RESTORE BAYONET W/EYELET",C1776,HCPCS,278,RC,,INPATIENT,,,657.5,263,BLUE CROSS ANTHEM,COMMERCIAL,,,,598.33,OTHER,493.13,644.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PIN, RESTORE BAYONET W/EYELET",C1776,HCPCS,278,RC,,INPATIENT,,,657.5,263,MONUMENT,COMMERCIAL,,,,526,,493.13,644.35,
"PIN, RESTORE BAYONET W/EYELET",C1776,HCPCS,278,RC,,INPATIENT,,,657.5,263,UNITED HEALTH,UNITED COMMERCIAL,,,,493.13,,493.13,644.35,
"LOCKING, SCREW 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.25,223.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,508.92,OTHER,419.44,548.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LOCKING, SCREW 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.25,223.7,MONUMENT,COMMERCIAL,,,,447.4,,419.44,548.07,
"LOCKING, SCREW 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.25,223.7,UNITED HEALTH,UNITED COMMERCIAL,,,,419.44,,419.44,548.07,
"PLATE, DHS 4 HOLE 25MM 135DEG",C1713,HCPCS,278,RC,,INPATIENT,,,1661.5,664.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1511.97,OTHER,1246.13,1628.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DHS 4 HOLE 25MM 135DEG",C1713,HCPCS,278,RC,,INPATIENT,,,1661.5,664.6,MONUMENT,COMMERCIAL,,,,1329.2,,1246.13,1628.27,
"PLATE, DHS 4 HOLE 25MM 135DEG",C1713,HCPCS,278,RC,,INPATIENT,,,1661.5,664.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1246.13,,1246.13,1628.27,
"KNEE, PATELLAR BUTTON 184764",C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1820.91,OTHER,1500.75,1960.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, PATELLAR BUTTON 184764",C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,MONUMENT,COMMERCIAL,,,,1600.8,,1500.75,1960.98,
"KNEE, PATELLAR BUTTON 184764",C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1500.75,,1500.75,1960.98,
"KNEE, PATELLAR BUTTON 37MM",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,701.72,OTHER,833.33,1088.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, PATELLAR BUTTON 37MM",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,MONUMENT,COMMERCIAL,,,,888.88,,833.33,1088.88,
"KNEE, PATELLAR BUTTON 37MM",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UNITED HEALTH,UNITED COMMERCIAL,,,,833.33,,833.33,1088.88,
"KNEE, PATELLAR 34MM 11-150842",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,701.72,OTHER,833.33,1088.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, PATELLAR 34MM 11-150842",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,MONUMENT,COMMERCIAL,,,,888.88,,833.33,1088.88,
"KNEE, PATELLAR 34MM 11-150842",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UNITED HEALTH,UNITED COMMERCIAL,,,,833.33,,833.33,1088.88,
"KNEE, PATELLAR BUTTN 11-150840",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,701.72,OTHER,833.33,1088.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, PATELLAR BUTTN 11-150840",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,MONUMENT,COMMERCIAL,,,,888.88,,833.33,1088.88,
"KNEE, PATELLAR BUTTN 11-150840",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UNITED HEALTH,UNITED COMMERCIAL,,,,833.33,,833.33,1088.88,
"KNEE, PATELLAR BUTTON ALL POLY",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,701.72,OTHER,833.33,1088.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, PATELLAR BUTTON ALL POLY",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,MONUMENT,COMMERCIAL,,,,888.88,,833.33,1088.88,
"KNEE, PATELLAR BUTTON ALL POLY",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UNITED HEALTH,UNITED COMMERCIAL,,,,833.33,,833.33,1088.88,
IMPLANT SYSTEM SPEEDBRIDGE,C1776,HCPCS,278,RC,,INPATIENT,,,3323,1329.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3023.93,OTHER,2492.25,3256.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMPLANT SYSTEM SPEEDBRIDGE,C1776,HCPCS,278,RC,,INPATIENT,,,3323,1329.2,MONUMENT,COMMERCIAL,,,,2658.4,,2492.25,3256.54,
IMPLANT SYSTEM SPEEDBRIDGE,C1776,HCPCS,278,RC,,INPATIENT,,,3323,1329.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2492.25,,2492.25,3256.54,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC 103205",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC 103205",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC 103205",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,10397.25,4158.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,9461.5,OTHER,7797.94,10189.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,10397.25,4158.9,MONUMENT,COMMERCIAL,,,,8317.8,,7797.94,10189.31,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,10397.25,4158.9,UNITED HEALTH,UNITED COMMERCIAL,,,,7797.94,,7797.94,10189.31,
"HIP, FEMORAL TAPERLOC 103202",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC 103202",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC 103202",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,5259.24,OTHER,4334.54,5663.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,MONUMENT,COMMERCIAL,,,,4623.5,,4334.54,5663.79,
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UNITED HEALTH,UNITED COMMERCIAL,,,,4334.54,,4334.54,5663.79,
"KNEE, FEMORAL INTERLOK RT VNGR",C1713,HCPCS,278,RC,,INPATIENT,,,8257.75,3303.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7514.55,OTHER,6193.31,8092.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK RT VNGR",C1713,HCPCS,278,RC,,INPATIENT,,,8257.75,3303.1,MONUMENT,COMMERCIAL,,,,6606.2,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK RT VNGR",C1713,HCPCS,278,RC,,INPATIENT,,,8257.75,3303.1,UNITED HEALTH,UNITED COMMERCIAL,,,,6193.31,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589,1835.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,4175.99,OTHER,3441.75,4497.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589,1835.6,MONUMENT,COMMERCIAL,,,,3671.2,,3441.75,4497.22,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589,1835.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.75,,3441.75,4497.22,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,3324.32,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,6193.31,8092.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,6606.2,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,6193.31,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOC 183028",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOC 183028",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOC 183028",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,3324.32,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,6193.31,8092.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,6606.2,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,6193.31,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK 183006",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176.9,OTHER,3442.5,4498.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK 183006",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,MONUMENT,COMMERCIAL,,,,3672,,3442.5,4498.2,
"KNEE, FEMORAL INTERLOK 183006",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,UNITED HEALTH,UNITED COMMERCIAL,,,,3442.5,,3442.5,4498.2,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,3324.32,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,6193.31,8092.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,6606.2,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,6193.31,,6193.31,8092.6,
"KNEE, FEMORAL INTERLOK 183034",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,3324.32,OTHER,3441.75,4497.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK 183034",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,MONUMENT,COMMERCIAL,,,,3671.2,,3441.75,4497.22,
"KNEE, FEMORAL INTERLOK 183034",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.75,,3441.75,4497.22,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176.9,OTHER,3442.5,4498.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,MONUMENT,COMMERCIAL,,,,3672,,3442.5,4498.2,
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,UNITED HEALTH,UNITED COMMERCIAL,,,,3442.5,,3442.5,4498.2,
"KNEE, TIBIAL BEARING I-BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,6953.77,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING I-BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL BEARING I-BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1894.84,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
"KNEE, TIBIAL BEARING ANT STAB",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING ANT STAB",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARING ANT STAB",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
"KNEE, TIBIAL EARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,6953.77,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL EARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL EARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING 183480",C1776,HCPCS,278,RC,,INPATIENT,,,2967.5,1187,BLUE CROSS ANTHEM,COMMERCIAL,,,,2700.43,OTHER,2225.63,2908.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 183480",C1776,HCPCS,278,RC,,INPATIENT,,,2967.5,1187,MONUMENT,COMMERCIAL,,,,2374,,2225.63,2908.15,
"KNEE, TIBIAL BEARING 183480",C1776,HCPCS,278,RC,,INPATIENT,,,2967.5,1187,UNITED HEALTH,UNITED COMMERCIAL,,,,2225.63,,2225.63,2908.15,
"KNEE, TIBIAL BEARING 189064",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1894.84,OTHER,2315.81,3026,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 189064",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,MONUMENT,COMMERCIAL,,,,2470.2,,2315.81,3026,
"KNEE, TIBIAL BEARING 189064",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UNITED HEALTH,UNITED COMMERCIAL,,,,2315.81,,2315.81,3026,
"KNEE, TIBIAL BEARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,4099.1,1639.64,BLUE CROSS ANTHEM,COMMERCIAL,,,,3730.18,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,4099.1,1639.64,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL BEARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,4099.1,1639.64,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,6953.77,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING DCM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1894.84,OTHER,2315.81,3026,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING DCM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,MONUMENT,COMMERCIAL,,,,2470.2,,2315.81,3026,
"KNEE, TIBIAL BEARING DCM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UNITED HEALTH,UNITED COMMERCIAL,,,,2315.81,,2315.81,3026,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,BLUE CROSS ANTHEM,COMMERCIAL,,,,3864.64,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,6953.77,OTHER,5731.13,7488.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,MONUMENT,COMMERCIAL,,,,6113.2,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UNITED HEALTH,UNITED COMMERCIAL,,,,5731.13,,5731.13,7488.67,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,BLUE CROSS ANTHEM,COMMERCIAL,,,,3864.64,OTHER,3185.15,4161.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,MONUMENT,COMMERCIAL,,,,3397.49,,3185.15,4161.92,
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UNITED HEALTH,UNITED COMMERCIAL,,,,3185.15,,3185.15,4161.92,
"KNEE, TIBIAL BEARING 189062",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,2315.81,3026,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 189062",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,2470.2,,2315.81,3026,
"KNEE, TIBIAL BEARING 189062",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,2315.81,,2315.81,3026,
"SCREW, LAG 90MM 135'",1680231,CDM,,,,INPATIENT,,,1369,547.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1245.79,OTHER,1026.75,1341.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 90MM 135'",1680231,CDM,,,,INPATIENT,,,1369,547.6,MONUMENT,COMMERCIAL,,,,1095.2,,1026.75,1341.62,
"SCREW, LAG 90MM 135'",1680231,CDM,,,,INPATIENT,,,1369,547.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1026.75,,1026.75,1341.62,
"SCREW, LAG 100MM 135'",1680232,CDM,,,,INPATIENT,,,1369,547.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1245.79,OTHER,1026.75,1341.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 100MM 135'",1680232,CDM,,,,INPATIENT,,,1369,547.6,MONUMENT,COMMERCIAL,,,,1095.2,,1026.75,1341.62,
"SCREW, LAG 100MM 135'",1680232,CDM,,,,INPATIENT,,,1369,547.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1026.75,,1026.75,1341.62,
"SCREW, LAG 130MM 135'",1680234,CDM,,,,INPATIENT,,,1338.25,535.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1217.81,OTHER,1003.69,1311.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 130MM 135'",1680234,CDM,,,,INPATIENT,,,1338.25,535.3,MONUMENT,COMMERCIAL,,,,1070.6,,1003.69,1311.49,
"SCREW, LAG 130MM 135'",1680234,CDM,,,,INPATIENT,,,1338.25,535.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1003.69,,1003.69,1311.49,
"SCREW, LAG 160MM 135'",1680235,CDM,,,,INPATIENT,,,1308,523.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1190.28,OTHER,981,1281.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 160MM 135'",1680235,CDM,,,,INPATIENT,,,1308,523.2,MONUMENT,COMMERCIAL,,,,1046.4,,981,1281.84,
"SCREW, LAG 160MM 135'",1680235,CDM,,,,INPATIENT,,,1308,523.2,UNITED HEALTH,UNITED COMMERCIAL,,,,981,,981,1281.84,
"SCREW, LAG 100MM 140'",1680236,CDM,,,,INPATIENT,,,1247.25,498.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1135,OTHER,935.44,1222.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 100MM 140'",1680236,CDM,,,,INPATIENT,,,1247.25,498.9,MONUMENT,COMMERCIAL,,,,997.8,,935.44,1222.31,
"SCREW, LAG 100MM 140'",1680236,CDM,,,,INPATIENT,,,1247.25,498.9,UNITED HEALTH,UNITED COMMERCIAL,,,,935.44,,935.44,1222.31,
"SCREW, LAG 130MM 140'",1680237,CDM,,,,INPATIENT,,,1107.5,443,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.83,OTHER,830.63,1085.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 130MM 140'",1680237,CDM,,,,INPATIENT,,,1107.5,443,MONUMENT,COMMERCIAL,,,,886,,830.63,1085.35,
"SCREW, LAG 130MM 140'",1680237,CDM,,,,INPATIENT,,,1107.5,443,UNITED HEALTH,UNITED COMMERCIAL,,,,830.63,,830.63,1085.35,
"SCREW, LAG 160MM 140'",1680238,CDM,,,,INPATIENT,,,1308,523.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1190.28,OTHER,981,1281.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 160MM 140'",1680238,CDM,,,,INPATIENT,,,1308,523.2,MONUMENT,COMMERCIAL,,,,1046.4,,981,1281.84,
"SCREW, LAG 160MM 140'",1680238,CDM,,,,INPATIENT,,,1308,523.2,UNITED HEALTH,UNITED COMMERCIAL,,,,981,,981,1281.84,
"SCREW, LAG 100MM 150'",1680239,CDM,,,,INPATIENT,,,1107.5,443,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.83,OTHER,830.63,1085.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 100MM 150'",1680239,CDM,,,,INPATIENT,,,1107.5,443,MONUMENT,COMMERCIAL,,,,886,,830.63,1085.35,
"SCREW, LAG 100MM 150'",1680239,CDM,,,,INPATIENT,,,1107.5,443,UNITED HEALTH,UNITED COMMERCIAL,,,,830.63,,830.63,1085.35,
"SCREW, LAG 130MM 150'",1680240,CDM,,,,INPATIENT,,,1107.5,443,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.83,OTHER,830.63,1085.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 130MM 150'",1680240,CDM,,,,INPATIENT,,,1107.5,443,MONUMENT,COMMERCIAL,,,,886,,830.63,1085.35,
"SCREW, LAG 130MM 150'",1680240,CDM,,,,INPATIENT,,,1107.5,443,UNITED HEALTH,UNITED COMMERCIAL,,,,830.63,,830.63,1085.35,
"SCREW, LAG 160MM 150'",1680242,CDM,,,,INPATIENT,,,1308,523.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1190.28,OTHER,981,1281.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 160MM 150'",1680242,CDM,,,,INPATIENT,,,1308,523.2,MONUMENT,COMMERCIAL,,,,1046.4,,981,1281.84,
"SCREW, LAG 160MM 150'",1680242,CDM,,,,INPATIENT,,,1308,523.2,UNITED HEALTH,UNITED COMMERCIAL,,,,981,,981,1281.84,
"SCREW, LAG 100MM 145'",1680243,CDM,,,,INPATIENT,,,1107.5,443,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.83,OTHER,830.63,1085.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 100MM 145'",1680243,CDM,,,,INPATIENT,,,1107.5,443,MONUMENT,COMMERCIAL,,,,886,,830.63,1085.35,
"SCREW, LAG 100MM 145'",1680243,CDM,,,,INPATIENT,,,1107.5,443,UNITED HEALTH,UNITED COMMERCIAL,,,,830.63,,830.63,1085.35,
"SCREW, LAG 130MM 145'",1680244,CDM,,,,INPATIENT,,,1107.5,443,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.83,OTHER,830.63,1085.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 130MM 145'",1680244,CDM,,,,INPATIENT,,,1107.5,443,MONUMENT,COMMERCIAL,,,,886,,830.63,1085.35,
"SCREW, LAG 130MM 145'",1680244,CDM,,,,INPATIENT,,,1107.5,443,UNITED HEALTH,UNITED COMMERCIAL,,,,830.63,,830.63,1085.35,
"SCREW, LAG 160MM 145'",1680245,CDM,,,,INPATIENT,,,1308,523.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1190.28,OTHER,981,1281.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LAG 160MM 145'",1680245,CDM,,,,INPATIENT,,,1308,523.2,MONUMENT,COMMERCIAL,,,,1046.4,,981,1281.84,
"SCREW, LAG 160MM 145'",1680245,CDM,,,,INPATIENT,,,1308,523.2,UNITED HEALTH,UNITED COMMERCIAL,,,,981,,981,1281.84,
"SCREW, CORTICAL BONE 20MM",1680246,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 20MM",1680246,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, CORTICAL BONE 20MM",1680246,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, CORTICAL BONE 22MM",1680247,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 22MM",1680247,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, CORTICAL BONE 22MM",1680247,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, CORTICAL BONE 24MM",1680248,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 24MM",1680248,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, CORTICAL BONE 24MM",1680248,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, CORTICAL BONE 26MM",1680249,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 26MM",1680249,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, CORTICAL BONE 26MM",1680249,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, CORTICAL BONE 28MM",1680250,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 28MM",1680250,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, CORTICAL BONE 28MM",1680250,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, CORTICAL BONE 30MM",1680252,CDM,,,,INPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.66,OTHER,94.5,123.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 30MM",1680252,CDM,,,,INPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
"SCREW, CORTICAL BONE 30MM",1680252,CDM,,,,INPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,,94.5,,94.5,123.48,
"SCREW, CORTICAL BONE 32MM",1680253,CDM,,,,INPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.66,OTHER,94.5,123.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 32MM",1680253,CDM,,,,INPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
"SCREW, CORTICAL BONE 32MM",1680253,CDM,,,,INPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,,94.5,,94.5,123.48,
"SCREW, CORTICAL BONE 34MM",1680254,CDM,,,,INPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.66,OTHER,94.5,123.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 34MM",1680254,CDM,,,,INPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
"SCREW, CORTICAL BONE 34MM",1680254,CDM,,,,INPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,,94.5,,94.5,123.48,
"SCREW, CORTICAL BONE 36MM",1680255,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 36MM",1680255,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTICAL BONE 36MM",1680255,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, CORTICAL BONE 38MM",1680256,CDM,,,,INPATIENT,,,78.5,31.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.44,OTHER,58.88,76.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 38MM",1680256,CDM,,,,INPATIENT,,,78.5,31.4,MONUMENT,COMMERCIAL,,,,62.8,,58.88,76.93,
"SCREW, CORTICAL BONE 38MM",1680256,CDM,,,,INPATIENT,,,78.5,31.4,UNITED HEALTH,UNITED COMMERCIAL,,,,58.88,,58.88,76.93,
"SCREW, CORTICAL BONE 40MM",1680257,CDM,,,,INPATIENT,,,78.5,31.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.44,OTHER,58.88,76.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 40MM",1680257,CDM,,,,INPATIENT,,,78.5,31.4,MONUMENT,COMMERCIAL,,,,62.8,,58.88,76.93,
"SCREW, CORTICAL BONE 40MM",1680257,CDM,,,,INPATIENT,,,78.5,31.4,UNITED HEALTH,UNITED COMMERCIAL,,,,58.88,,58.88,76.93,
"SCREW, CORTICAL BONE 42MM",1680258,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 42MM",1680258,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
"SCREW, CORTICAL BONE 42MM",1680258,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
"SCREW, CORTICAL BONE 44MM",1680259,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 44MM",1680259,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
"SCREW, CORTICAL BONE 44MM",1680259,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
"SCREW, CORTICAL BONE 46MM",1680260,CDM,,,,INPATIENT,,,82.75,33.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.3,OTHER,62.06,81.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 46MM",1680260,CDM,,,,INPATIENT,,,82.75,33.1,MONUMENT,COMMERCIAL,,,,66.2,,62.06,81.1,
"SCREW, CORTICAL BONE 46MM",1680260,CDM,,,,INPATIENT,,,82.75,33.1,UNITED HEALTH,UNITED COMMERCIAL,,,,62.06,,62.06,81.1,
"SCREW, CORTICAL BONE 48MM",1680262,CDM,,,,INPATIENT,,,82.75,33.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.3,OTHER,62.06,81.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 48MM",1680262,CDM,,,,INPATIENT,,,82.75,33.1,MONUMENT,COMMERCIAL,,,,66.2,,62.06,81.1,
"SCREW, CORTICAL BONE 48MM",1680262,CDM,,,,INPATIENT,,,82.75,33.1,UNITED HEALTH,UNITED COMMERCIAL,,,,62.06,,62.06,81.1,
"SCREW, CORTICAL BONE 50MM",1680263,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 50MM",1680263,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTICAL BONE 50MM",1680263,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, CORTICAL BONE 52MM",1680264,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 52MM",1680264,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTICAL BONE 52MM",1680264,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, CORTICAL BONE 56MM",1680265,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 56MM",1680265,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTICAL BONE 56MM",1680265,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"SCREW, CORTICAL BONE 70MM",1680268,CDM,,,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 70MM",1680268,CDM,,,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"SCREW, CORTICAL BONE 70MM",1680268,CDM,,,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"SCREW, CORTICAL BONE 75MM",1680269,CDM,,,,INPATIENT,,,114.75,45.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.42,OTHER,86.06,112.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 75MM",1680269,CDM,,,,INPATIENT,,,114.75,45.9,MONUMENT,COMMERCIAL,,,,91.8,,86.06,112.46,
"SCREW, CORTICAL BONE 75MM",1680269,CDM,,,,INPATIENT,,,114.75,45.9,UNITED HEALTH,UNITED COMMERCIAL,,,,86.06,,86.06,112.46,
"SCREW, CORTICAL BONE 80MM",1680270,CDM,,,,INPATIENT,,,114.75,45.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.42,OTHER,86.06,112.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 80MM",1680270,CDM,,,,INPATIENT,,,114.75,45.9,MONUMENT,COMMERCIAL,,,,91.8,,86.06,112.46,
"SCREW, CORTICAL BONE 80MM",1680270,CDM,,,,INPATIENT,,,114.75,45.9,UNITED HEALTH,UNITED COMMERCIAL,,,,86.06,,86.06,112.46,
"SCREW, CORTICAL BONE 85MM",1680272,CDM,,,,INPATIENT,,,114.75,45.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.42,OTHER,86.06,112.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTICAL BONE 85MM",1680272,CDM,,,,INPATIENT,,,114.75,45.9,MONUMENT,COMMERCIAL,,,,91.8,,86.06,112.46,
"SCREW, CORTICAL BONE 85MM",1680272,CDM,,,,INPATIENT,,,114.75,45.9,UNITED HEALTH,UNITED COMMERCIAL,,,,86.06,,86.06,112.46,
"SCREW, CORTEX 4.5MM 214.14",1680273,CDM,,,,INPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.81,OTHER,32.81,42.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.14",1680273,CDM,,,,INPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.14",1680273,CDM,,,,INPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,,32.81,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.16",1680274,CDM,,,,INPATIENT,,,34,13.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.94,OTHER,25.5,33.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.16",1680274,CDM,,,,INPATIENT,,,34,13.6,MONUMENT,COMMERCIAL,,,,27.2,,25.5,33.32,
"SCREW, CORTEX 4.5MM 214.16",1680274,CDM,,,,INPATIENT,,,34,13.6,UNITED HEALTH,UNITED COMMERCIAL,,,,25.5,,25.5,33.32,
"SCREW, CORTEX 4.5MM 214.18",1680275,CDM,,,,INPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.99,OTHER,31.31,40.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.18",1680275,CDM,,,,INPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
"SCREW, CORTEX 4.5MM 214.18",1680275,CDM,,,,INPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,,31.31,,31.31,40.92,
"SCREW, CORTEX 4.5MM 214.20",1680276,CDM,,,,INPATIENT,,,48.25,19.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.91,OTHER,36.19,47.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.20",1680276,CDM,,,,INPATIENT,,,48.25,19.3,MONUMENT,COMMERCIAL,,,,38.6,,36.19,47.29,
"SCREW, CORTEX 4.5MM 214.20",1680276,CDM,,,,INPATIENT,,,48.25,19.3,UNITED HEALTH,UNITED COMMERCIAL,,,,36.19,,36.19,47.29,
"SCREW, CORTEX 4.5MM 214.22",1680277,CDM,,,,INPATIENT,,,23.25,9.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,21.16,OTHER,17.44,22.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.22",1680277,CDM,,,,INPATIENT,,,23.25,9.3,MONUMENT,COMMERCIAL,,,,18.6,,17.44,22.79,
"SCREW, CORTEX 4.5MM 214.22",1680277,CDM,,,,INPATIENT,,,23.25,9.3,UNITED HEALTH,UNITED COMMERCIAL,,,,17.44,,17.44,22.79,
"SCREW, CORTEX 4.5MM 214.24",1680278,CDM,,,,INPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.72,OTHER,33.56,43.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.24",1680278,CDM,,,,INPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
"SCREW, CORTEX 4.5MM 214.24",1680278,CDM,,,,INPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,,33.56,,33.56,43.86,
"SCREW, CORTEX 4.5MM 214.26",1680279,CDM,,,,INPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.81,OTHER,32.81,42.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.26",1680279,CDM,,,,INPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.26",1680279,CDM,,,,INPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,,32.81,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.28",1680280,CDM,,,,INPATIENT,,,48.25,19.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.91,OTHER,36.19,47.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.28",1680280,CDM,,,,INPATIENT,,,48.25,19.3,MONUMENT,COMMERCIAL,,,,38.6,,36.19,47.29,
"SCREW, CORTEX 4.5MM 214.28",1680280,CDM,,,,INPATIENT,,,48.25,19.3,UNITED HEALTH,UNITED COMMERCIAL,,,,36.19,,36.19,47.29,
"SCREW, CORTEX 4.5MM 214.30",1680282,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.30",1680282,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.30",1680282,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.32",1680283,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.32",1680283,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.32",1680283,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.34",1680284,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.34",1680284,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.34",1680284,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.36",1680285,CDM,,,,INPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.69,OTHER,44.25,57.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.36",1680285,CDM,,,,INPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.36",1680285,CDM,,,,INPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,,44.25,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.38",1680286,CDM,,,,INPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.69,OTHER,44.25,57.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.38",1680286,CDM,,,,INPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.38",1680286,CDM,,,,INPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,,44.25,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.40",1680287,CDM,,,,INPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.69,OTHER,44.25,57.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.40",1680287,CDM,,,,INPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.40",1680287,CDM,,,,INPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,,44.25,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.42",1680288,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.42",1680288,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.42",1680288,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.44",1680289,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.44",1680289,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.44",1680289,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.46",1680290,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.46",1680290,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.46",1680290,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.48",1680292,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.48",1680292,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.48",1680292,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.50",1680293,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.50",1680293,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.50",1680293,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.52",1680294,CDM,,,,INPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.95,OTHER,33.75,44.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.52",1680294,CDM,,,,INPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.75,44.1,
"SCREW, CORTEX 4.5MM 214.52",1680294,CDM,,,,INPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,,33.75,,33.75,44.1,
"SCREW, CORTEX 4.5MM 214.54",1680295,CDM,,,,INPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.69,OTHER,44.25,57.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.54",1680295,CDM,,,,INPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.54",1680295,CDM,,,,INPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,,44.25,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.56",1680296,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.56",1680296,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
"SCREW, CORTEX 4.5MM 214.56",1680296,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
"SCREW, CORTEX 4.5MM 214.58",1680297,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.58",1680297,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.58",1680297,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.60",1680298,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.60",1680298,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.60",1680298,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.64",1680299,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.64",1680299,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.64",1680299,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 4.5MM 214.68",1680300,CDM,,,,INPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.81,OTHER,32.81,42.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.68",1680300,CDM,,,,INPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.68",1680300,CDM,,,,INPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,,32.81,,32.81,42.88,
"SCREW, CORTEX 4.5MM 214.70",1680302,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.70",1680302,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.70",1680302,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CORTEX 4.5MM 214.72",1680303,CDM,,,,INPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.99,OTHER,31.31,40.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.72",1680303,CDM,,,,INPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
"SCREW, CORTEX 4.5MM 214.72",1680303,CDM,,,,INPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,,31.31,,31.31,40.92,
"SCREW, CORTEX 4.5MM 214.76",1680304,CDM,,,,INPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.55,OTHER,39.19,51.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.76",1680304,CDM,,,,INPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.76",1680304,CDM,,,,INPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,,39.19,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.80",1680305,CDM,,,,INPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.69,OTHER,44.25,57.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.80",1680305,CDM,,,,INPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.80",1680305,CDM,,,,INPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,,44.25,,44.25,57.82,
"SCREW, CORTEX 4.5MM 214.85",1680306,CDM,,,,INPATIENT,,,76.25,30.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.39,OTHER,57.19,74.73,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.85",1680306,CDM,,,,INPATIENT,,,76.25,30.5,MONUMENT,COMMERCIAL,,,,61,,57.19,74.73,
"SCREW, CORTEX 4.5MM 214.85",1680306,CDM,,,,INPATIENT,,,76.25,30.5,UNITED HEALTH,UNITED COMMERCIAL,,,,57.19,,57.19,74.73,
"SCREW, CORTEX 4.5MM 214.90",1680307,CDM,,,,INPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.55,OTHER,39.19,51.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.90",1680307,CDM,,,,INPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.90",1680307,CDM,,,,INPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,,39.19,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.844",1680308,CDM,,,,INPATIENT,,,99.25,39.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.32,OTHER,74.44,97.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.844",1680308,CDM,,,,INPATIENT,,,99.25,39.7,MONUMENT,COMMERCIAL,,,,79.4,,74.44,97.27,
"SCREW, CORTEX 4.5MM 214.844",1680308,CDM,,,,INPATIENT,,,99.25,39.7,UNITED HEALTH,UNITED COMMERCIAL,,,,74.44,,74.44,97.27,
"SCREW, CORTEX 4.5MM 214.95",1680309,CDM,,,,INPATIENT,,,65.75,26.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.83,OTHER,49.31,64.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.95",1680309,CDM,,,,INPATIENT,,,65.75,26.3,MONUMENT,COMMERCIAL,,,,52.6,,49.31,64.44,
"SCREW, CORTEX 4.5MM 214.95",1680309,CDM,,,,INPATIENT,,,65.75,26.3,UNITED HEALTH,UNITED COMMERCIAL,,,,49.31,,49.31,64.44,
"SCREW, CORTEX 4.5MM 214.05",1680310,CDM,,,,INPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.55,OTHER,39.19,51.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.05",1680310,CDM,,,,INPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.05",1680310,CDM,,,,INPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,,39.19,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.06",1680311,CDM,,,,INPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.55,OTHER,39.19,51.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 4.5MM 214.06",1680311,CDM,,,,INPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
"SCREW, CORTEX 4.5MM 214.06",1680311,CDM,,,,INPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,,39.19,,39.19,51.21,
"SCREW, MALLEOLAR 215.025",1680312,CDM,,,,INPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.16,OTHER,52.88,69.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.025",1680312,CDM,,,,INPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
"SCREW, MALLEOLAR 215.025",1680312,CDM,,,,INPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,,52.88,,52.88,69.09,
"SCREW, MALLEOLAR 215.030",1680313,CDM,,,,INPATIENT,,,69.5,27.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.25,OTHER,52.13,68.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.030",1680313,CDM,,,,INPATIENT,,,69.5,27.8,MONUMENT,COMMERCIAL,,,,55.6,,52.13,68.11,
"SCREW, MALLEOLAR 215.030",1680313,CDM,,,,INPATIENT,,,69.5,27.8,UNITED HEALTH,UNITED COMMERCIAL,,,,52.13,,52.13,68.11,
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, MALLEOLAR 215.040",1680316,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.040",1680316,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, MALLEOLAR 215.040",1680316,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, MALLEOLAR 215.045",1680317,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.045",1680317,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, MALLEOLAR 215.045",1680317,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, MALLEOLAR 215.050",1680318,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.050",1680318,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, MALLEOLAR 215.050",1680318,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, MALLEOLAR 215.055",1680319,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.055",1680319,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"SCREW, MALLEOLAR 215.055",1680319,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"SCREW, MALLEOLAR 215.060",1680320,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.060",1680320,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"SCREW, MALLEOLAR 215.060",1680320,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"SCREW, MALLEOLAR 215.065",1680322,CDM,,,,INPATIENT,,,69.5,27.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.25,OTHER,52.13,68.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.065",1680322,CDM,,,,INPATIENT,,,69.5,27.8,MONUMENT,COMMERCIAL,,,,55.6,,52.13,68.11,
"SCREW, MALLEOLAR 215.065",1680322,CDM,,,,INPATIENT,,,69.5,27.8,UNITED HEALTH,UNITED COMMERCIAL,,,,52.13,,52.13,68.11,
"SCREW, MALLEOLAR 215.070",1680323,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, MALLEOLAR 215.070",1680323,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, MALLEOLAR 215.070",1680323,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.2,OTHER,50.44,65.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,,50.44,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,70.75,28.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.38,OTHER,53.06,69.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,70.75,28.3,MONUMENT,COMMERCIAL,,,,56.6,,53.06,69.34,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,70.75,28.3,UNITED HEALTH,UNITED COMMERCIAL,,,,53.06,,53.06,69.34,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.52,OTHER,93.56,122.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,MONUMENT,COMMERCIAL,,,,99.8,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UNITED HEALTH,UNITED COMMERCIAL,,,,93.56,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.52,OTHER,93.56,122.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,MONUMENT,COMMERCIAL,,,,99.8,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UNITED HEALTH,UNITED COMMERCIAL,,,,93.56,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,66.2,OTHER,54.56,71.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,MONUMENT,COMMERCIAL,,,,58.2,,54.56,71.3,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,UNITED HEALTH,UNITED COMMERCIAL,,,,54.56,,54.56,71.3,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,66.2,OTHER,54.56,71.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,MONUMENT,COMMERCIAL,,,,58.2,,54.56,71.3,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,UNITED HEALTH,UNITED COMMERCIAL,,,,54.56,,54.56,71.3,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.52,OTHER,93.56,122.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,MONUMENT,COMMERCIAL,,,,99.8,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UNITED HEALTH,UNITED COMMERCIAL,,,,93.56,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.2,OTHER,50.44,65.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,,50.44,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.2,OTHER,50.44,65.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,,50.44,,50.44,65.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,117.25,46.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.7,OTHER,87.94,114.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,117.25,46.9,MONUMENT,COMMERCIAL,,,,93.8,,87.94,114.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,117.25,46.9,UNITED HEALTH,UNITED COMMERCIAL,,,,87.94,,87.94,114.91,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.52,OTHER,93.56,122.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,MONUMENT,COMMERCIAL,,,,99.8,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UNITED HEALTH,UNITED COMMERCIAL,,,,93.56,,93.56,122.26,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.16,OTHER,57,74.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,,57,,57,74.48,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,88.75,35.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.76,OTHER,66.56,86.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,88.75,35.5,MONUMENT,COMMERCIAL,,,,71,,66.56,86.98,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,88.75,35.5,UNITED HEALTH,UNITED COMMERCIAL,,,,66.56,,66.56,86.98,
"SCREW, CAN BONE 6.5MM 70MM",1680350,CDM,,,,INPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.88,OTHER,90.56,118.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CAN BONE 6.5MM 70MM",1680350,CDM,,,,INPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
"SCREW, CAN BONE 6.5MM 70MM",1680350,CDM,,,,INPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,,90.56,,90.56,118.34,
"SCREW, CAN BONE 6.5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.88,OTHER,90.56,118.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CAN BONE 6.5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
"SCREW, CAN BONE 6.5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,,90.56,,90.56,118.34,
"SCREW, CAN BONE 6.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,70.75,28.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.38,OTHER,53.06,69.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CAN BONE 6.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,70.75,28.3,MONUMENT,COMMERCIAL,,,,56.6,,53.06,69.34,
"SCREW, CAN BONE 6.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,70.75,28.3,UNITED HEALTH,UNITED COMMERCIAL,,,,53.06,,53.06,69.34,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,83.5,33.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.99,OTHER,62.63,81.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,83.5,33.4,MONUMENT,COMMERCIAL,,,,66.8,,62.63,81.83,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,83.5,33.4,UNITED HEALTH,UNITED COMMERCIAL,,,,62.63,,62.63,81.83,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.98,OTHER,58.5,76.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,,58.5,,58.5,76.44,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,81.75,32.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.39,OTHER,61.31,80.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,81.75,32.7,MONUMENT,COMMERCIAL,,,,65.4,,61.31,80.12,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,81.75,32.7,UNITED HEALTH,UNITED COMMERCIAL,,,,61.31,,61.31,80.12,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.8,OTHER,55.88,73.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,MONUMENT,COMMERCIAL,,,,59.6,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UNITED HEALTH,UNITED COMMERCIAL,,,,55.88,,55.88,73.01,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,49,19.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.59,OTHER,36.75,48.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,49,19.6,MONUMENT,COMMERCIAL,,,,39.2,,36.75,48.02,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,49,19.6,UNITED HEALTH,UNITED COMMERCIAL,,,,36.75,,36.75,48.02,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANN TI 20MM 245848",C1713,HCPCS,278,RC,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 20MM 245848",C1713,HCPCS,278,RC,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, CANN TI 20MM 245848",C1713,HCPCS,278,RC,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,69.25,27.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.02,OTHER,51.94,67.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,69.25,27.7,MONUMENT,COMMERCIAL,,,,55.4,,51.94,67.87,
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,69.25,27.7,UNITED HEALTH,UNITED COMMERCIAL,,,,51.94,,51.94,67.87,
"SCREW, CORTEX 1.5MM 200.06",1680365,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.06",1680365,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.06",1680365,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.07",1680366,CDM,,,,INPATIENT,,,89.25,35.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.22,OTHER,66.94,87.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.07",1680366,CDM,,,,INPATIENT,,,89.25,35.7,MONUMENT,COMMERCIAL,,,,71.4,,66.94,87.47,
"SCREW, CORTEX 1.5MM 200.07",1680366,CDM,,,,INPATIENT,,,89.25,35.7,UNITED HEALTH,UNITED COMMERCIAL,,,,66.94,,66.94,87.47,
"SCREW, CORTEX 1.5MM 200.08",1680367,CDM,,,,INPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.75,OTHER,93.75,122.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.08",1680367,CDM,,,,INPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
"SCREW, CORTEX 1.5MM 200.08",1680367,CDM,,,,INPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,,93.75,,93.75,122.5,
"SCREW, CORTEX 1.5MM 200.09",1680368,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.09",1680368,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.09",1680368,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.10",1680369,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.10",1680369,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.10",1680369,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
"SCREW, CORTEX 1.5MM 200.11",1680370,CDM,,,,INPATIENT,,,123.5,49.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.39,OTHER,92.63,121.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.11",1680370,CDM,,,,INPATIENT,,,123.5,49.4,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
"SCREW, CORTEX 1.5MM 200.11",1680370,CDM,,,,INPATIENT,,,123.5,49.4,UNITED HEALTH,UNITED COMMERCIAL,,,,92.63,,92.63,121.03,
"SCREW, CORTEX 1.5MM 200.12",1680372,CDM,,,,INPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.98,OTHER,58.5,76.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.12",1680372,CDM,,,,INPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
"SCREW, CORTEX 1.5MM 200.12",1680372,CDM,,,,INPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,,58.5,,58.5,76.44,
"SCREW, CORTEX 1.5MM 200.14",1680373,CDM,,,,INPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.98,OTHER,58.5,76.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.14",1680373,CDM,,,,INPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
"SCREW, CORTEX 1.5MM 200.14",1680373,CDM,,,,INPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,,58.5,,58.5,76.44,
"SCREW, CORTEX 1.5MM 200.16",1680374,CDM,,,,INPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.98,OTHER,58.5,76.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 1.5MM 200.16",1680374,CDM,,,,INPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
"SCREW, CORTEX 1.5MM 200.16",1680374,CDM,,,,INPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,,58.5,,58.5,76.44,
"SCREW, CORTEX 2.0MM 201.06",1680375,CDM,,,,INPATIENT,,,46.25,18.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.09,OTHER,34.69,45.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.06",1680375,CDM,,,,INPATIENT,,,46.25,18.5,MONUMENT,COMMERCIAL,,,,37,,34.69,45.33,
"SCREW, CORTEX 2.0MM 201.06",1680375,CDM,,,,INPATIENT,,,46.25,18.5,UNITED HEALTH,UNITED COMMERCIAL,,,,34.69,,34.69,45.33,
"SCREW, CORTEX 2.0MM 201.008",1680376,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.008",1680376,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.008",1680376,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.010",1680377,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.010",1680377,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.010",1680377,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.012",1680378,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.012",1680378,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.012",1680378,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.014",1680379,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.014",1680379,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.014",1680379,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.16",1680380,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.16",1680380,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.16",1680380,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.18",1680382,CDM,,,,INPATIENT,,,59.75,23.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.37,OTHER,44.81,58.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.18",1680382,CDM,,,,INPATIENT,,,59.75,23.9,MONUMENT,COMMERCIAL,,,,47.8,,44.81,58.56,
"SCREW, CORTEX 2.0MM 201.18",1680382,CDM,,,,INPATIENT,,,59.75,23.9,UNITED HEALTH,UNITED COMMERCIAL,,,,44.81,,44.81,58.56,
"SCREW, CORTEX 2.0MM 201.20",1680383,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.0MM 201.20",1680383,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, CORTEX 2.0MM 201.20",1680383,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, CORTEX 2.7MM 202.06",1680384,CDM,,,,INPATIENT,,,43.5,17.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.59,OTHER,32.63,42.63,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.06",1680384,CDM,,,,INPATIENT,,,43.5,17.4,MONUMENT,COMMERCIAL,,,,34.8,,32.63,42.63,
"SCREW, CORTEX 2.7MM 202.06",1680384,CDM,,,,INPATIENT,,,43.5,17.4,UNITED HEALTH,UNITED COMMERCIAL,,,,32.63,,32.63,42.63,
"SCREW, CORTEX 2.7MM 202.08",1680385,CDM,,,,INPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.99,OTHER,31.31,40.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.08",1680385,CDM,,,,INPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
"SCREW, CORTEX 2.7MM 202.08",1680385,CDM,,,,INPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,,31.31,,31.31,40.92,
"SCREW, CORTEX 2.7MM 202.10",1680386,CDM,,,,INPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.72,OTHER,33.56,43.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.10",1680386,CDM,,,,INPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
"SCREW, CORTEX 2.7MM 202.10",1680386,CDM,,,,INPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,,33.56,,33.56,43.86,
"SCREW, CORTEX 2.7MM 202.12",1680387,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.12",1680387,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 202.12",1680387,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 202.14",1680388,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.14",1680388,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 202.14",1680388,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 202.16",1680389,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.16",1680389,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.16",1680389,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.18",1680390,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.18",1680390,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.18",1680390,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.20",1680392,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.20",1680392,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.20",1680392,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.22",1680393,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.22",1680393,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.22",1680393,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.24",1680394,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.24",1680394,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
"SCREW, CORTEX 2.7MM 202.24",1680394,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
"SCREW, CORTEX 2.7MM 204.10",1680395,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.10",1680395,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.10",1680395,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.12",1680396,CDM,,,,INPATIENT,,,53.5,21.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.69,OTHER,40.13,52.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.12",1680396,CDM,,,,INPATIENT,,,53.5,21.4,MONUMENT,COMMERCIAL,,,,42.8,,40.13,52.43,
"SCREW, CORTEX 2.7MM 204.12",1680396,CDM,,,,INPATIENT,,,53.5,21.4,UNITED HEALTH,UNITED COMMERCIAL,,,,40.13,,40.13,52.43,
"SCREW, CORTEX 2.7MM 204.14",1680397,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.14",1680397,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.14",1680397,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.16",1680398,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.16",1680398,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.16",1680398,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.18",1680400,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.18",1680400,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.18",1680400,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.20",1680402,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.20",1680402,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.20",1680402,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.22",1680403,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.22",1680403,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.22",1680403,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.24",1680404,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.24",1680404,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.24",1680404,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.28",1680406,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.28",1680406,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
"SCREW, CORTEX 2.7MM 204.28",1680406,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
"SCREW, CORTEX 2.7MM 204.32",1680407,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.32",1680407,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.32",1680407,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.36",1680408,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.36",1680408,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.36",1680408,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.40",1680409,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.40",1680409,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.40",1680409,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.45",1680410,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.45",1680410,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.45",1680410,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"SCREW, CORTEX 2.7MM 204.50",1680412,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 204.50",1680412,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
"SCREW, CORTEX 2.7MM 204.50",1680412,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,81,32.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.71,OTHER,60.75,79.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,81,32.4,MONUMENT,COMMERCIAL,,,,64.8,,60.75,79.38,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,81,32.4,UNITED HEALTH,UNITED COMMERCIAL,,,,60.75,,60.75,79.38,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,26.75,10.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.34,OTHER,20.06,26.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,26.75,10.7,MONUMENT,COMMERCIAL,,,,21.4,,20.06,26.22,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,26.75,10.7,UNITED HEALTH,UNITED COMMERCIAL,,,,20.06,,20.06,26.22,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.45,OTHER,35.81,46.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,,35.81,,35.81,46.8,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.18,OTHER,38.06,49.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,MONUMENT,COMMERCIAL,,,,40.6,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UNITED HEALTH,UNITED COMMERCIAL,,,,38.06,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.18,OTHER,38.06,49.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,MONUMENT,COMMERCIAL,,,,40.6,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UNITED HEALTH,UNITED COMMERCIAL,,,,38.06,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.18,OTHER,38.06,49.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,MONUMENT,COMMERCIAL,,,,40.6,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UNITED HEALTH,UNITED COMMERCIAL,,,,38.06,,38.06,49.74,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,49,19.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.59,OTHER,36.75,48.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,49,19.6,MONUMENT,COMMERCIAL,,,,39.2,,36.75,48.02,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,49,19.6,UNITED HEALTH,UNITED COMMERCIAL,,,,36.75,,36.75,48.02,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,59.75,23.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.37,OTHER,44.81,58.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,59.75,23.9,MONUMENT,COMMERCIAL,,,,47.8,,44.81,58.56,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,59.75,23.9,UNITED HEALTH,UNITED COMMERCIAL,,,,44.81,,44.81,58.56,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,57.25,22.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.1,OTHER,42.94,56.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,57.25,22.9,MONUMENT,COMMERCIAL,,,,45.8,,42.94,56.11,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,57.25,22.9,UNITED HEALTH,UNITED COMMERCIAL,,,,42.94,,42.94,56.11,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,27,10.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.57,OTHER,20.25,26.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,27,10.8,MONUMENT,COMMERCIAL,,,,21.6,,20.25,26.46,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,27,10.8,UNITED HEALTH,UNITED COMMERCIAL,,,,20.25,,20.25,26.46,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.96,OTHER,37.88,49.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,MONUMENT,COMMERCIAL,,,,40.4,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UNITED HEALTH,UNITED COMMERCIAL,,,,37.88,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.96,OTHER,37.88,49.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,MONUMENT,COMMERCIAL,,,,40.4,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UNITED HEALTH,UNITED COMMERCIAL,,,,37.88,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.5,19.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.14,OTHER,36.38,47.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.5,19.4,MONUMENT,COMMERCIAL,,,,38.8,,36.38,47.53,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.5,19.4,UNITED HEALTH,UNITED COMMERCIAL,,,,36.38,,36.38,47.53,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.23,OTHER,39.75,51.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,,39.75,,39.75,51.94,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,28.25,11.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.71,OTHER,21.19,27.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,28.25,11.3,MONUMENT,COMMERCIAL,,,,22.6,,21.19,27.69,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,28.25,11.3,UNITED HEALTH,UNITED COMMERCIAL,,,,21.19,,21.19,27.69,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.96,OTHER,37.88,49.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,MONUMENT,COMMERCIAL,,,,40.4,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UNITED HEALTH,UNITED COMMERCIAL,,,,37.88,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.96,OTHER,37.88,49.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,MONUMENT,COMMERCIAL,,,,40.4,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UNITED HEALTH,UNITED COMMERCIAL,,,,37.88,,37.88,49.49,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.36,OTHER,36.56,47.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,,36.56,,36.56,47.78,
WASHER 219.98,1680447,CDM,,,,INPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.87,OTHER,78.19,102.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WASHER 219.98,1680447,CDM,,,,INPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
WASHER 219.98,1680447,CDM,,,,INPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,,78.19,,78.19,102.17,
WASHER 219.95S,1680448,CDM,,,,INPATIENT,,,87.5,35,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.63,OTHER,65.63,85.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WASHER 219.95S,1680448,CDM,,,,INPATIENT,,,87.5,35,MONUMENT,COMMERCIAL,,,,70,,65.63,85.75,
WASHER 219.95S,1680448,CDM,,,,INPATIENT,,,87.5,35,UNITED HEALTH,UNITED COMMERCIAL,,,,65.63,,65.63,85.75,
WASHER 219.99,1680449,CDM,,,,INPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.01,OTHER,83.25,108.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WASHER 219.99,1680449,CDM,,,,INPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
WASHER 219.99,1680449,CDM,,,,INPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,,83.25,,83.25,108.78,
"NUTS,LAG BOLT 219.96",1680450,CDM,,,,INPATIENT,,,28.5,11.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.94,OTHER,21.38,27.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"NUTS,LAG BOLT 219.96",1680450,CDM,,,,INPATIENT,,,28.5,11.4,MONUMENT,COMMERCIAL,,,,22.8,,21.38,27.93,
"NUTS,LAG BOLT 219.96",1680450,CDM,,,,INPATIENT,,,28.5,11.4,UNITED HEALTH,UNITED COMMERCIAL,,,,21.38,,21.38,27.93,
"PLATE, 1/3 TUBULAR 241.32",1680451,CDM,,,,INPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.32,OTHER,34.88,45.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.32",1680451,CDM,,,,INPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
"PLATE, 1/3 TUBULAR 241.32",1680451,CDM,,,,INPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,,34.88,,34.88,45.57,
"PLATE, 1/3 TUBULAR 241.33",1680452,CDM,,,,INPATIENT,,,51,20.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.41,OTHER,38.25,49.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.33",1680452,CDM,,,,INPATIENT,,,51,20.4,MONUMENT,COMMERCIAL,,,,40.8,,38.25,49.98,
"PLATE, 1/3 TUBULAR 241.33",1680452,CDM,,,,INPATIENT,,,51,20.4,UNITED HEALTH,UNITED COMMERCIAL,,,,38.25,,38.25,49.98,
"PLATE, 1/3 TUBULAR 241.34",1680453,CDM,,,,INPATIENT,,,103.5,41.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.19,OTHER,77.63,101.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.34",1680453,CDM,,,,INPATIENT,,,103.5,41.4,MONUMENT,COMMERCIAL,,,,82.8,,77.63,101.43,
"PLATE, 1/3 TUBULAR 241.34",1680453,CDM,,,,INPATIENT,,,103.5,41.4,UNITED HEALTH,UNITED COMMERCIAL,,,,77.63,,77.63,101.43,
"PLATE, 1/3 TUBULAR 241.35",1680454,CDM,,,,INPATIENT,,,125.25,50.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.98,OTHER,93.94,122.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.35",1680454,CDM,,,,INPATIENT,,,125.25,50.1,MONUMENT,COMMERCIAL,,,,100.2,,93.94,122.75,
"PLATE, 1/3 TUBULAR 241.35",1680454,CDM,,,,INPATIENT,,,125.25,50.1,UNITED HEALTH,UNITED COMMERCIAL,,,,93.94,,93.94,122.75,
"PLATE, 1/3 TUBULAR 241.36",1680455,CDM,,,,INPATIENT,,,244.25,97.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.27,OTHER,183.19,239.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.36",1680455,CDM,,,,INPATIENT,,,244.25,97.7,MONUMENT,COMMERCIAL,,,,195.4,,183.19,239.37,
"PLATE, 1/3 TUBULAR 241.36",1680455,CDM,,,,INPATIENT,,,244.25,97.7,UNITED HEALTH,UNITED COMMERCIAL,,,,183.19,,183.19,239.37,
"PLATE, 1/3 TUBULAR 241.37",1680456,CDM,,,,INPATIENT,,,297.5,119,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.73,OTHER,223.13,291.55,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.37",1680456,CDM,,,,INPATIENT,,,297.5,119,MONUMENT,COMMERCIAL,,,,238,,223.13,291.55,
"PLATE, 1/3 TUBULAR 241.37",1680456,CDM,,,,INPATIENT,,,297.5,119,UNITED HEALTH,UNITED COMMERCIAL,,,,223.13,,223.13,291.55,
"PLATE, 1/3 TUBULAR 241.38",1680457,CDM,,,,INPATIENT,,,269.5,107.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,245.25,OTHER,202.13,264.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 241.38",1680457,CDM,,,,INPATIENT,,,269.5,107.8,MONUMENT,COMMERCIAL,,,,215.6,,202.13,264.11,
"PLATE, 1/3 TUBULAR 241.38",1680457,CDM,,,,INPATIENT,,,269.5,107.8,UNITED HEALTH,UNITED COMMERCIAL,,,,202.13,,202.13,264.11,
"PLATE, 1/3 TUBULAR 242.13",1680458,CDM,,,,INPATIENT,,,127,50.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.57,OTHER,95.25,124.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 242.13",1680458,CDM,,,,INPATIENT,,,127,50.8,MONUMENT,COMMERCIAL,,,,101.6,,95.25,124.46,
"PLATE, 1/3 TUBULAR 242.13",1680458,CDM,,,,INPATIENT,,,127,50.8,UNITED HEALTH,UNITED COMMERCIAL,,,,95.25,,95.25,124.46,
"PLATE, 1/3 TUBULAR 242.14",1680459,CDM,,,,INPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.15,OTHER,48.75,63.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 242.14",1680459,CDM,,,,INPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
"PLATE, 1/3 TUBULAR 242.14",1680459,CDM,,,,INPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,,48.75,,48.75,63.7,
"PLATE, 1/3 TUBULAR 242.15",1680460,CDM,,,,INPATIENT,,,145,58,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.95,OTHER,108.75,142.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 242.15",1680460,CDM,,,,INPATIENT,,,145,58,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
"PLATE, 1/3 TUBULAR 242.15",1680460,CDM,,,,INPATIENT,,,145,58,UNITED HEALTH,UNITED COMMERCIAL,,,,108.75,,108.75,142.1,
"PLATE, 1/3 TUBULAR 242.16",1680461,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR 242.16",1680461,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
"PLATE, 1/3 TUBULAR 242.16",1680461,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
"PLATE, 1/4 TUBULAR 242.17",1680462,CDM,,,,INPATIENT,,,137.75,55.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.35,OTHER,103.31,135,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/4 TUBULAR 242.17",1680462,CDM,,,,INPATIENT,,,137.75,55.1,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
"PLATE, 1/4 TUBULAR 242.17",1680462,CDM,,,,INPATIENT,,,137.75,55.1,UNITED HEALTH,UNITED COMMERCIAL,,,,103.31,,103.31,135,
"PLATE, 1/4 TUBULAR 242.18",1680463,CDM,,,,INPATIENT,,,145,58,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.95,OTHER,108.75,142.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/4 TUBULAR 242.18",1680463,CDM,,,,INPATIENT,,,145,58,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
"PLATE, 1/4 TUBULAR 242.18",1680463,CDM,,,,INPATIENT,,,145,58,UNITED HEALTH,UNITED COMMERCIAL,,,,108.75,,108.75,142.1,
"PLATE, SEMI-TUBULAR 222.02",1680464,CDM,,,,INPATIENT,,,56,22.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.96,OTHER,42,54.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.02",1680464,CDM,,,,INPATIENT,,,56,22.4,MONUMENT,COMMERCIAL,,,,44.8,,42,54.88,
"PLATE, SEMI-TUBULAR 222.02",1680464,CDM,,,,INPATIENT,,,56,22.4,UNITED HEALTH,UNITED COMMERCIAL,,,,42,,42,54.88,
"PLATE, SEMI-TUBULAR 222.03",1680465,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.03",1680465,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
"PLATE, SEMI-TUBULAR 222.03",1680465,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
"PLATE, SEMI-TUBULAR 222.04",1680466,CDM,,,,INPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.15,OTHER,48.75,63.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.04",1680466,CDM,,,,INPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
"PLATE, SEMI-TUBULAR 222.04",1680466,CDM,,,,INPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,,48.75,,48.75,63.7,
"PLATE, SEMI-TUBULAR 222.05",1680467,CDM,,,,INPATIENT,,,69.5,27.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.25,OTHER,52.13,68.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.05",1680467,CDM,,,,INPATIENT,,,69.5,27.8,MONUMENT,COMMERCIAL,,,,55.6,,52.13,68.11,
"PLATE, SEMI-TUBULAR 222.05",1680467,CDM,,,,INPATIENT,,,69.5,27.8,UNITED HEALTH,UNITED COMMERCIAL,,,,52.13,,52.13,68.11,
"PLATE, SEMI-TUBULAR 222.06",1680468,CDM,,,,INPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.34,OTHER,55.5,72.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.06",1680468,CDM,,,,INPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
"PLATE, SEMI-TUBULAR 222.06",1680468,CDM,,,,INPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,,55.5,,55.5,72.52,
"PLATE, SEMI-TUBULAR 222.07",1680469,CDM,,,,INPATIENT,,,78.5,31.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.44,OTHER,58.88,76.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.07",1680469,CDM,,,,INPATIENT,,,78.5,31.4,MONUMENT,COMMERCIAL,,,,62.8,,58.88,76.93,
"PLATE, SEMI-TUBULAR 222.07",1680469,CDM,,,,INPATIENT,,,78.5,31.4,UNITED HEALTH,UNITED COMMERCIAL,,,,58.88,,58.88,76.93,
"PLATE, SEMI-TUBULAR 222.08",1680470,CDM,,,,INPATIENT,,,82.75,33.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.3,OTHER,62.06,81.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.08",1680470,CDM,,,,INPATIENT,,,82.75,33.1,MONUMENT,COMMERCIAL,,,,66.2,,62.06,81.1,
"PLATE, SEMI-TUBULAR 222.08",1680470,CDM,,,,INPATIENT,,,82.75,33.1,UNITED HEALTH,UNITED COMMERCIAL,,,,62.06,,62.06,81.1,
"PLATE, SEMI-TUBULAR 222.09",1680471,CDM,,,,INPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,111.93,OTHER,92.25,120.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.09",1680471,CDM,,,,INPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
"PLATE, SEMI-TUBULAR 222.09",1680471,CDM,,,,INPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,,92.25,,92.25,120.54,
"PLATE, SEMI-TUBULAR 222.10",1680472,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.10",1680472,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
"PLATE, SEMI-TUBULAR 222.10",1680472,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
"PLATE, SEMI-TUBULAR 222.11",1680473,CDM,,,,INPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.48,OTHER,60.56,79.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.11",1680473,CDM,,,,INPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
"PLATE, SEMI-TUBULAR 222.11",1680473,CDM,,,,INPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,,60.56,,60.56,79.14,
"PLATE, SEMI-TUBULAR 222.12",1680474,CDM,,,,INPATIENT,,,84.75,33.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.12,OTHER,63.56,83.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SEMI-TUBULAR 222.12",1680474,CDM,,,,INPATIENT,,,84.75,33.9,MONUMENT,COMMERCIAL,,,,67.8,,63.56,83.06,
"PLATE, SEMI-TUBULAR 222.12",1680474,CDM,,,,INPATIENT,,,84.75,33.9,UNITED HEALTH,UNITED COMMERCIAL,,,,63.56,,63.56,83.06,
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,179.25,71.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.12,OTHER,134.44,175.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,179.25,71.7,MONUMENT,COMMERCIAL,,,,143.4,,134.44,175.67,
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,179.25,71.7,UNITED HEALTH,UNITED COMMERCIAL,,,,134.44,,134.44,175.67,
"PLATE, DCP 2.7MM 244.04",1680476,CDM,,,,INPATIENT,,,183.5,73.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,166.99,OTHER,137.63,179.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.04",1680476,CDM,,,,INPATIENT,,,183.5,73.4,MONUMENT,COMMERCIAL,,,,146.8,,137.63,179.83,
"PLATE, DCP 2.7MM 244.04",1680476,CDM,,,,INPATIENT,,,183.5,73.4,UNITED HEALTH,UNITED COMMERCIAL,,,,137.63,,137.63,179.83,
"PLATE, DCP 2.7MM 244.05",1680477,CDM,,,,INPATIENT,,,225,90,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.75,OTHER,168.75,220.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.05",1680477,CDM,,,,INPATIENT,,,225,90,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
"PLATE, DCP 2.7MM 244.05",1680477,CDM,,,,INPATIENT,,,225,90,UNITED HEALTH,UNITED COMMERCIAL,,,,168.75,,168.75,220.5,
"PLATE, DCP 2.7MM 244.06",1680478,CDM,,,,INPATIENT,,,251.75,100.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.09,OTHER,188.81,246.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.06",1680478,CDM,,,,INPATIENT,,,251.75,100.7,MONUMENT,COMMERCIAL,,,,201.4,,188.81,246.72,
"PLATE, DCP 2.7MM 244.06",1680478,CDM,,,,INPATIENT,,,251.75,100.7,UNITED HEALTH,UNITED COMMERCIAL,,,,188.81,,188.81,246.72,
"PLATE, DCP 2.7MM 244.07",1680479,CDM,,,,INPATIENT,,,251.75,100.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.09,OTHER,188.81,246.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.07",1680479,CDM,,,,INPATIENT,,,251.75,100.7,MONUMENT,COMMERCIAL,,,,201.4,,188.81,246.72,
"PLATE, DCP 2.7MM 244.07",1680479,CDM,,,,INPATIENT,,,251.75,100.7,UNITED HEALTH,UNITED COMMERCIAL,,,,188.81,,188.81,246.72,
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,153,61.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.23,OTHER,114.75,149.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,153,61.2,MONUMENT,COMMERCIAL,,,,122.4,,114.75,149.94,
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,153,61.2,UNITED HEALTH,UNITED COMMERCIAL,,,,114.75,,114.75,149.94,
"PLATE, DCP 2.7MM 244.09",1680481,CDM,,,,INPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.65,OTHER,125.81,164.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.09",1680481,CDM,,,,INPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
"PLATE, DCP 2.7MM 244.09",1680481,CDM,,,,INPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,,125.81,,125.81,164.4,
"PLATE, DCP 2.7MM 244.10",1680482,CDM,,,,INPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,159.93,OTHER,131.81,172.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.10",1680482,CDM,,,,INPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
"PLATE, DCP 2.7MM 244.10",1680482,CDM,,,,INPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,,131.81,,131.81,172.24,
"PLATE, DCP 2.7MM 244.12",1680483,CDM,,,,INPATIENT,,,194.75,77.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,177.22,OTHER,146.06,190.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 2.7MM 244.12",1680483,CDM,,,,INPATIENT,,,194.75,77.9,MONUMENT,COMMERCIAL,,,,155.8,,146.06,190.86,
"PLATE, DCP 2.7MM 244.12",1680483,CDM,,,,INPATIENT,,,194.75,77.9,UNITED HEALTH,UNITED COMMERCIAL,,,,146.06,,146.06,190.86,
"PLATE, DCP 3.5MM 248.02",1680484,CDM,,,,INPATIENT,,,92.25,36.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.95,OTHER,69.19,90.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.02",1680484,CDM,,,,INPATIENT,,,92.25,36.9,MONUMENT,COMMERCIAL,,,,73.8,,69.19,90.41,
"PLATE, DCP 3.5MM 248.02",1680484,CDM,,,,INPATIENT,,,92.25,36.9,UNITED HEALTH,UNITED COMMERCIAL,,,,69.19,,69.19,90.41,
"PLATE, DCP 3.5MM 248.03",1680485,CDM,,,,INPATIENT,,,96,38.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.36,OTHER,72,94.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.03",1680485,CDM,,,,INPATIENT,,,96,38.4,MONUMENT,COMMERCIAL,,,,76.8,,72,94.08,
"PLATE, DCP 3.5MM 248.03",1680485,CDM,,,,INPATIENT,,,96,38.4,UNITED HEALTH,UNITED COMMERCIAL,,,,72,,72,94.08,
"PLATE, DCP 3.5MM 248.04",1680486,CDM,,,,INPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.28,OTHER,151.88,198.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.04",1680486,CDM,,,,INPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
"PLATE, DCP 3.5MM 248.04",1680486,CDM,,,,INPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,,151.88,,151.88,198.45,
"PLATE, DCP 3.5MM 248.05",1680487,CDM,,,,INPATIENT,,,247.75,99.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.45,OTHER,185.81,242.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.05",1680487,CDM,,,,INPATIENT,,,247.75,99.1,MONUMENT,COMMERCIAL,,,,198.2,,185.81,242.8,
"PLATE, DCP 3.5MM 248.05",1680487,CDM,,,,INPATIENT,,,247.75,99.1,UNITED HEALTH,UNITED COMMERCIAL,,,,185.81,,185.81,242.8,
"PLATE, DCP 3.5MM 248.06",1680488,CDM,,,,INPATIENT,,,263.5,105.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.79,OTHER,197.63,258.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.06",1680488,CDM,,,,INPATIENT,,,263.5,105.4,MONUMENT,COMMERCIAL,,,,210.8,,197.63,258.23,
"PLATE, DCP 3.5MM 248.06",1680488,CDM,,,,INPATIENT,,,263.5,105.4,UNITED HEALTH,UNITED COMMERCIAL,,,,197.63,,197.63,258.23,
"PLATE, DCP 3.5MM 248.07",1680489,CDM,,,,INPATIENT,,,274.5,109.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.8,OTHER,205.88,269.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.07",1680489,CDM,,,,INPATIENT,,,274.5,109.8,MONUMENT,COMMERCIAL,,,,219.6,,205.88,269.01,
"PLATE, DCP 3.5MM 248.07",1680489,CDM,,,,INPATIENT,,,274.5,109.8,UNITED HEALTH,UNITED COMMERCIAL,,,,205.88,,205.88,269.01,
"PLATE, DCP 3.5MM 248.08",1680490,CDM,,,,INPATIENT,,,276.75,110.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,251.84,OTHER,207.56,271.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.08",1680490,CDM,,,,INPATIENT,,,276.75,110.7,MONUMENT,COMMERCIAL,,,,221.4,,207.56,271.22,
"PLATE, DCP 3.5MM 248.08",1680490,CDM,,,,INPATIENT,,,276.75,110.7,UNITED HEALTH,UNITED COMMERCIAL,,,,207.56,,207.56,271.22,
"PLATE, DCP 3.5MM 248.10",1680491,CDM,,,,INPATIENT,,,145,58,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.95,OTHER,108.75,142.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 3.5MM 248.10",1680491,CDM,,,,INPATIENT,,,145,58,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
"PLATE, DCP 3.5MM 248.10",1680491,CDM,,,,INPATIENT,,,145,58,UNITED HEALTH,UNITED COMMERCIAL,,,,108.75,,108.75,142.1,
"PLATE, DCP 4.5MM BROAD 226.06",1680492,CDM,,,,INPATIENT,,,187,74.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,170.17,OTHER,140.25,183.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.06",1680492,CDM,,,,INPATIENT,,,187,74.8,MONUMENT,COMMERCIAL,,,,149.6,,140.25,183.26,
"PLATE, DCP 4.5MM BROAD 226.06",1680492,CDM,,,,INPATIENT,,,187,74.8,UNITED HEALTH,UNITED COMMERCIAL,,,,140.25,,140.25,183.26,
"PLATE, DCP 4.5MM BROAD 226.07",1680493,CDM,,,,INPATIENT,,,187,74.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,170.17,OTHER,140.25,183.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.07",1680493,CDM,,,,INPATIENT,,,187,74.8,MONUMENT,COMMERCIAL,,,,149.6,,140.25,183.26,
"PLATE, DCP 4.5MM BROAD 226.07",1680493,CDM,,,,INPATIENT,,,187,74.8,UNITED HEALTH,UNITED COMMERCIAL,,,,140.25,,140.25,183.26,
"PLATE, DCP 4.5MM BROAD 226.10",1680495,CDM,,,,INPATIENT,,,221.5,88.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,201.57,OTHER,166.13,217.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.10",1680495,CDM,,,,INPATIENT,,,221.5,88.6,MONUMENT,COMMERCIAL,,,,177.2,,166.13,217.07,
"PLATE, DCP 4.5MM BROAD 226.10",1680495,CDM,,,,INPATIENT,,,221.5,88.6,UNITED HEALTH,UNITED COMMERCIAL,,,,166.13,,166.13,217.07,
"PLATE, DCP 4.5MM BROAD 226.12",1680496,CDM,,,,INPATIENT,,,221.5,88.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,201.57,OTHER,166.13,217.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.12",1680496,CDM,,,,INPATIENT,,,221.5,88.6,MONUMENT,COMMERCIAL,,,,177.2,,166.13,217.07,
"PLATE, DCP 4.5MM BROAD 226.12",1680496,CDM,,,,INPATIENT,,,221.5,88.6,UNITED HEALTH,UNITED COMMERCIAL,,,,166.13,,166.13,217.07,
"PLATE, DCP 4.5MM BROAD 226.14",1680497,CDM,,,,INPATIENT,,,244.5,97.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.5,OTHER,183.38,239.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.14",1680497,CDM,,,,INPATIENT,,,244.5,97.8,MONUMENT,COMMERCIAL,,,,195.6,,183.38,239.61,
"PLATE, DCP 4.5MM BROAD 226.14",1680497,CDM,,,,INPATIENT,,,244.5,97.8,UNITED HEALTH,UNITED COMMERCIAL,,,,183.38,,183.38,239.61,
"PLATE, DCP 4.5MM BROAD 226.16",1680498,CDM,,,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.16",1680498,CDM,,,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"PLATE, DCP 4.5MM BROAD 226.16",1680498,CDM,,,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"PLATE, DCP 4.5MM BROAD 226.18",1680499,CDM,,,,INPATIENT,,,396,158.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.36,OTHER,297,388.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DCP 4.5MM BROAD 226.18",1680499,CDM,,,,INPATIENT,,,396,158.4,MONUMENT,COMMERCIAL,,,,316.8,,297,388.08,
"PLATE, DCP 4.5MM BROAD 226.18",1680499,CDM,,,,INPATIENT,,,396,158.4,UNITED HEALTH,UNITED COMMERCIAL,,,,297,,297,388.08,
"PLATE, T OBLIQUE ANG. 241.23",1680500,CDM,,,,INPATIENT,,,33.25,13.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.26,OTHER,24.94,32.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T OBLIQUE ANG. 241.23",1680500,CDM,,,,INPATIENT,,,33.25,13.3,MONUMENT,COMMERCIAL,,,,26.6,,24.94,32.59,
"PLATE, T OBLIQUE ANG. 241.23",1680500,CDM,,,,INPATIENT,,,33.25,13.3,UNITED HEALTH,UNITED COMMERCIAL,,,,24.94,,24.94,32.59,
"PLATE, T OBLIQUE ANG. 241.25",1680501,CDM,,,,INPATIENT,,,323.75,129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,294.61,OTHER,242.81,317.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T OBLIQUE ANG. 241.25",1680501,CDM,,,,INPATIENT,,,323.75,129.5,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
"PLATE, T OBLIQUE ANG. 241.25",1680501,CDM,,,,INPATIENT,,,323.75,129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,242.81,,242.81,317.28,
"PLATE, T RIGHT ANG. 241.13",1680502,CDM,,,,INPATIENT,,,187,74.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,170.17,OTHER,140.25,183.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T RIGHT ANG. 241.13",1680502,CDM,,,,INPATIENT,,,187,74.8,MONUMENT,COMMERCIAL,,,,149.6,,140.25,183.26,
"PLATE, T RIGHT ANG. 241.13",1680502,CDM,,,,INPATIENT,,,187,74.8,UNITED HEALTH,UNITED COMMERCIAL,,,,140.25,,140.25,183.26,
"PLATE, T RIGHT ANG. 241.14",1680503,CDM,,,,INPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.66,OTHER,94.5,123.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T RIGHT ANG. 241.14",1680503,CDM,,,,INPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
"PLATE, T RIGHT ANG. 241.14",1680503,CDM,,,,INPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,,94.5,,94.5,123.48,
"PLATE, T RIGHT ANG. 241.16",1680504,CDM,,,,INPATIENT,,,160.75,64.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.28,OTHER,120.56,157.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T RIGHT ANG. 241.16",1680504,CDM,,,,INPATIENT,,,160.75,64.3,MONUMENT,COMMERCIAL,,,,128.6,,120.56,157.54,
"PLATE, T RIGHT ANG. 241.16",1680504,CDM,,,,INPATIENT,,,160.75,64.3,UNITED HEALTH,UNITED COMMERCIAL,,,,120.56,,120.56,157.54,
"PLATE, L 2.7MM 242.31(L)",1680505,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.7MM 242.31(L)",1680505,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
"PLATE, L 2.7MM 242.31(L)",1680505,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
"PLATE, L 2.7MM 242.33(L)",1680507,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.7MM 242.33(L)",1680507,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
"PLATE, L 2.7MM 242.33(L)",1680507,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
"PLATE, L 2.7MM 242.34",1680508,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.7MM 242.34",1680508,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"PLATE, L 2.7MM 242.34",1680508,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"PLATE, L 2.0MM 243.31(L)",1680509,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.0MM 243.31(L)",1680509,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
"PLATE, L 2.0MM 243.31(L)",1680509,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
"PLATE, L 2.0MM 243.32(R)",1680510,CDM,,,,INPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.81,OTHER,68.25,89.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.0MM 243.32(R)",1680510,CDM,,,,INPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
"PLATE, L 2.0MM 243.32(R)",1680510,CDM,,,,INPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,,68.25,,68.25,89.18,
"PLATE, L 2.0MM 243.33 (L)",1680511,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.0MM 243.33 (L)",1680511,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
"PLATE, L 2.0MM 243.33 (L)",1680511,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
"PLATE, L 2.0MM 243.34(R)",1680512,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.0MM 243.34(R)",1680512,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
"PLATE, L 2.0MM 243.34(R)",1680512,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
"PLATE, T 240.13",1680513,CDM,,,,INPATIENT,,,190.75,76.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.58,OTHER,143.06,186.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 240.13",1680513,CDM,,,,INPATIENT,,,190.75,76.3,MONUMENT,COMMERCIAL,,,,152.6,,143.06,186.94,
"PLATE, T 240.13",1680513,CDM,,,,INPATIENT,,,190.75,76.3,UNITED HEALTH,UNITED COMMERCIAL,,,,143.06,,143.06,186.94,
"PLATE, T 240.14",1680514,CDM,,,,INPATIENT,,,366,146.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,333.06,OTHER,274.5,358.68,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 240.14",1680514,CDM,,,,INPATIENT,,,366,146.4,MONUMENT,COMMERCIAL,,,,292.8,,274.5,358.68,
"PLATE, T 240.14",1680514,CDM,,,,INPATIENT,,,366,146.4,UNITED HEALTH,UNITED COMMERCIAL,,,,274.5,,274.5,358.68,
"PLATE, T 240.15",1680515,CDM,,,,INPATIENT,,,312.25,124.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,284.15,OTHER,234.19,306.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 240.15",1680515,CDM,,,,INPATIENT,,,312.25,124.9,MONUMENT,COMMERCIAL,,,,249.8,,234.19,306.01,
"PLATE, T 240.15",1680515,CDM,,,,INPATIENT,,,312.25,124.9,UNITED HEALTH,UNITED COMMERCIAL,,,,234.19,,234.19,306.01,
"PLATE, T 240.16",1680516,CDM,,,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 240.16",1680516,CDM,,,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"PLATE, T 240.16",1680516,CDM,,,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"PLATE, T 240.18",1680517,CDM,,,,INPATIENT,,,554.25,221.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,504.37,OTHER,415.69,543.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 240.18",1680517,CDM,,,,INPATIENT,,,554.25,221.7,MONUMENT,COMMERCIAL,,,,443.4,,415.69,543.17,
"PLATE, T 240.18",1680517,CDM,,,,INPATIENT,,,554.25,221.7,UNITED HEALTH,UNITED COMMERCIAL,,,,415.69,,415.69,543.17,
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,178.5,71.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,162.44,OTHER,133.88,174.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,178.5,71.4,MONUMENT,COMMERCIAL,,,,142.8,,133.88,174.93,
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,178.5,71.4,UNITED HEALTH,UNITED COMMERCIAL,,,,133.88,,133.88,174.93,
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"PLATE, STRAIGHT 2.0MM 243.13",1680520,CDM,,,,INPATIENT,,,53.5,21.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.69,OTHER,40.13,52.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, STRAIGHT 2.0MM 243.13",1680520,CDM,,,,INPATIENT,,,53.5,21.4,MONUMENT,COMMERCIAL,,,,42.8,,40.13,52.43,
"PLATE, STRAIGHT 2.0MM 243.13",1680520,CDM,,,,INPATIENT,,,53.5,21.4,UNITED HEALTH,UNITED COMMERCIAL,,,,40.13,,40.13,52.43,
"PLATE, STRAIGHT 2.0MM 243.14",1680521,CDM,,,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, STRAIGHT 2.0MM 243.14",1680521,CDM,,,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
"PLATE, STRAIGHT 2.0MM 243.14",1680521,CDM,,,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
"PLATE, STRAIGHT 2.0MM 243.15",1680522,CDM,,,,INPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,223.41,OTHER,184.13,240.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, STRAIGHT 2.0MM 243.15",1680522,CDM,,,,INPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
"PLATE, STRAIGHT 2.0MM 243.15",1680522,CDM,,,,INPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,184.13,,184.13,240.59,
"PLATE, STRAIGHT 2.0MM 243.16",1680523,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, STRAIGHT 2.0MM 243.16",1680523,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
"PLATE, STRAIGHT 2.0MM 243.16",1680523,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
"PLATE, CLOVERLEAF 240.23",1680524,CDM,,,,INPATIENT,,,229,91.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.39,OTHER,171.75,224.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CLOVERLEAF 240.23",1680524,CDM,,,,INPATIENT,,,229,91.6,MONUMENT,COMMERCIAL,,,,183.2,,171.75,224.42,
"PLATE, CLOVERLEAF 240.23",1680524,CDM,,,,INPATIENT,,,229,91.6,UNITED HEALTH,UNITED COMMERCIAL,,,,171.75,,171.75,224.42,
"PLATE, CLOVERLEAF 240.24",1680525,CDM,,,,INPATIENT,,,247.75,99.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.45,OTHER,185.81,242.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CLOVERLEAF 240.24",1680525,CDM,,,,INPATIENT,,,247.75,99.1,MONUMENT,COMMERCIAL,,,,198.2,,185.81,242.8,
"PLATE, CLOVERLEAF 240.24",1680525,CDM,,,,INPATIENT,,,247.75,99.1,UNITED HEALTH,UNITED COMMERCIAL,,,,185.81,,185.81,242.8,
"PLATE, SPOON 240.05",1680526,CDM,,,,INPATIENT,,,233,93.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.03,OTHER,174.75,228.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SPOON 240.05",1680526,CDM,,,,INPATIENT,,,233,93.2,MONUMENT,COMMERCIAL,,,,186.4,,174.75,228.34,
"PLATE, SPOON 240.05",1680526,CDM,,,,INPATIENT,,,233,93.2,UNITED HEALTH,UNITED COMMERCIAL,,,,174.75,,174.75,228.34,
"PLATE, SPOON 240.06",1680527,CDM,,,,INPATIENT,,,233,93.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.03,OTHER,174.75,228.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, SPOON 240.06",1680527,CDM,,,,INPATIENT,,,233,93.2,MONUMENT,COMMERCIAL,,,,186.4,,174.75,228.34,
"PLATE, SPOON 240.06",1680527,CDM,,,,INPATIENT,,,233,93.2,UNITED HEALTH,UNITED COMMERCIAL,,,,174.75,,174.75,228.34,
"PLATE, T-BUTTRESS 240.34",1680528,CDM,,,,INPATIENT,,,308,123.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.28,OTHER,231,301.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T-BUTTRESS 240.34",1680528,CDM,,,,INPATIENT,,,308,123.2,MONUMENT,COMMERCIAL,,,,246.4,,231,301.84,
"PLATE, T-BUTTRESS 240.34",1680528,CDM,,,,INPATIENT,,,308,123.2,UNITED HEALTH,UNITED COMMERCIAL,,,,231,,231,301.84,
"PLATE, T-BUTTRESS 240.35",1680529,CDM,,,,INPATIENT,,,444.75,177.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,404.72,OTHER,333.56,435.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T-BUTTRESS 240.35",1680529,CDM,,,,INPATIENT,,,444.75,177.9,MONUMENT,COMMERCIAL,,,,355.8,,333.56,435.86,
"PLATE, T-BUTTRESS 240.35",1680529,CDM,,,,INPATIENT,,,444.75,177.9,UNITED HEALTH,UNITED COMMERCIAL,,,,333.56,,333.56,435.86,
"PLATE, T-BUTTRESS 240.36",1680530,CDM,,,,INPATIENT,,,343.25,137.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,312.36,OTHER,257.44,336.39,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, T-BUTTRESS 240.36",1680530,CDM,,,,INPATIENT,,,343.25,137.3,MONUMENT,COMMERCIAL,,,,274.6,,257.44,336.39,
"PLATE, T-BUTTRESS 240.36",1680530,CDM,,,,INPATIENT,,,343.25,137.3,UNITED HEALTH,UNITED COMMERCIAL,,,,257.44,,257.44,336.39,
"PLATE, L-BUTTRESS 240.44",1680531,CDM,,,,INPATIENT,,,323.75,129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,294.61,OTHER,242.81,317.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L-BUTTRESS 240.44",1680531,CDM,,,,INPATIENT,,,323.75,129.5,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
"PLATE, L-BUTTRESS 240.44",1680531,CDM,,,,INPATIENT,,,323.75,129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,242.81,,242.81,317.28,
"PLATE, L-BUTTRESS 240.54",1680532,CDM,,,,INPATIENT,,,490.25,196.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.13,OTHER,367.69,480.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L-BUTTRESS 240.54",1680532,CDM,,,,INPATIENT,,,490.25,196.1,MONUMENT,COMMERCIAL,,,,392.2,,367.69,480.45,
"PLATE, L-BUTTRESS 240.54",1680532,CDM,,,,INPATIENT,,,490.25,196.1,UNITED HEALTH,UNITED COMMERCIAL,,,,367.69,,367.69,480.45,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,593.75,237.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,540.31,OTHER,445.31,581.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,593.75,237.5,MONUMENT,COMMERCIAL,,,,475,,445.31,581.88,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,593.75,237.5,UNITED HEALTH,UNITED COMMERCIAL,,,,445.31,,445.31,581.88,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,563.5,225.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,512.79,OTHER,422.63,552.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,563.5,225.4,MONUMENT,COMMERCIAL,,,,450.8,,422.63,552.23,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,563.5,225.4,UNITED HEALTH,UNITED COMMERCIAL,,,,422.63,,422.63,552.23,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,991.75,396.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,902.49,OTHER,743.81,971.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,991.75,396.7,MONUMENT,COMMERCIAL,,,,793.4,,743.81,971.92,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,991.75,396.7,UNITED HEALTH,UNITED COMMERCIAL,,,,743.81,,743.81,971.92,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,BLUE CROSS ANTHEM,COMMERCIAL,,,,930.48,OTHER,766.88,1002.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,MONUMENT,COMMERCIAL,,,,818,,766.88,1002.05,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,UNITED HEALTH,UNITED COMMERCIAL,,,,766.88,,766.88,1002.05,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,BLUE CROSS ANTHEM,COMMERCIAL,,,,930.48,OTHER,766.88,1002.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,MONUMENT,COMMERCIAL,,,,818,,766.88,1002.05,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,UNITED HEALTH,UNITED COMMERCIAL,,,,766.88,,766.88,1002.05,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1055.75,422.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,960.73,OTHER,791.81,1034.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1055.75,422.3,MONUMENT,COMMERCIAL,,,,844.6,,791.81,1034.64,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1055.75,422.3,UNITED HEALTH,UNITED COMMERCIAL,,,,791.81,,791.81,1034.64,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,732.5,293,BLUE CROSS ANTHEM,COMMERCIAL,,,,666.58,OTHER,549.38,717.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,732.5,293,MONUMENT,COMMERCIAL,,,,586,,549.38,717.85,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,732.5,293,UNITED HEALTH,UNITED COMMERCIAL,,,,549.38,,549.38,717.85,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1085.75,434.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,988.03,OTHER,814.31,1064.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1085.75,434.3,MONUMENT,COMMERCIAL,,,,868.6,,814.31,1064.04,
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1085.75,434.3,UNITED HEALTH,UNITED COMMERCIAL,,,,814.31,,814.31,1064.04,
"PLATE, RECONSTRUCTION 245.35",1680543,CDM,,,,INPATIENT,,,694,277.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.54,OTHER,520.5,680.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, RECONSTRUCTION 245.35",1680543,CDM,,,,INPATIENT,,,694,277.6,MONUMENT,COMMERCIAL,,,,555.2,,520.5,680.12,
"PLATE, RECONSTRUCTION 245.35",1680543,CDM,,,,INPATIENT,,,694,277.6,UNITED HEALTH,UNITED COMMERCIAL,,,,520.5,,520.5,680.12,
"PLATE, RECONSTRUCTION 245.32",1680544,CDM,,,,INPATIENT,,,539,215.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,490.49,OTHER,404.25,528.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, RECONSTRUCTION 245.32",1680544,CDM,,,,INPATIENT,,,539,215.6,MONUMENT,COMMERCIAL,,,,431.2,,404.25,528.22,
"PLATE, RECONSTRUCTION 245.32",1680544,CDM,,,,INPATIENT,,,539,215.6,UNITED HEALTH,UNITED COMMERCIAL,,,,404.25,,404.25,528.22,
"PLATE, RECONSTRUCTION 229.44",1680545,CDM,,,,INPATIENT,,,660.5,264.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,601.06,OTHER,495.38,647.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, RECONSTRUCTION 229.44",1680545,CDM,,,,INPATIENT,,,660.5,264.2,MONUMENT,COMMERCIAL,,,,528.4,,495.38,647.29,
"PLATE, RECONSTRUCTION 229.44",1680545,CDM,,,,INPATIENT,,,660.5,264.2,UNITED HEALTH,UNITED COMMERCIAL,,,,495.38,,495.38,647.29,
"WIRE, CERCLAGE EYE 291.11",1680546,CDM,,,,INPATIENT,,,123.75,49.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.61,OTHER,92.81,121.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WIRE, CERCLAGE EYE 291.11",1680546,CDM,,,,INPATIENT,,,123.75,49.5,MONUMENT,COMMERCIAL,,,,99,,92.81,121.28,
"WIRE, CERCLAGE EYE 291.11",1680546,CDM,,,,INPATIENT,,,123.75,49.5,UNITED HEALTH,UNITED COMMERCIAL,,,,92.81,,92.81,121.28,
"WIRE, CERCLAGE COIL 291.05",1680547,CDM,,,,INPATIENT,,,104.75,41.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.32,OTHER,78.56,102.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WIRE, CERCLAGE COIL 291.05",1680547,CDM,,,,INPATIENT,,,104.75,41.9,MONUMENT,COMMERCIAL,,,,83.8,,78.56,102.66,
"WIRE, CERCLAGE COIL 291.05",1680547,CDM,,,,INPATIENT,,,104.75,41.9,UNITED HEALTH,UNITED COMMERCIAL,,,,78.56,,78.56,102.66,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,111.5,44.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.47,OTHER,83.63,109.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,111.5,44.6,MONUMENT,COMMERCIAL,,,,89.2,,83.63,109.27,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,111.5,44.6,UNITED HEALTH,UNITED COMMERCIAL,,,,83.63,,83.63,109.27,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.41,OTHER,148.69,194.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,MONUMENT,COMMERCIAL,,,,158.6,,148.69,194.29,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,UNITED HEALTH,UNITED COMMERCIAL,,,,148.69,,148.69,194.29,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.41,OTHER,148.69,194.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,MONUMENT,COMMERCIAL,,,,158.6,,148.69,194.29,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,UNITED HEALTH,UNITED COMMERCIAL,,,,148.69,,148.69,194.29,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,265.25,106.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,241.38,OTHER,198.94,259.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,265.25,106.1,MONUMENT,COMMERCIAL,,,,212.2,,198.94,259.95,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,265.25,106.1,UNITED HEALTH,UNITED COMMERCIAL,,,,198.94,,198.94,259.95,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.53,OTHER,97.69,127.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,,97.69,,97.69,127.65,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.28,OTHER,120.56,157.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,MONUMENT,COMMERCIAL,,,,128.6,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UNITED HEALTH,UNITED COMMERCIAL,,,,120.56,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.28,OTHER,120.56,157.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,MONUMENT,COMMERCIAL,,,,128.6,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UNITED HEALTH,UNITED COMMERCIAL,,,,120.56,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.28,OTHER,120.56,157.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,MONUMENT,COMMERCIAL,,,,128.6,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UNITED HEALTH,UNITED COMMERCIAL,,,,120.56,,120.56,157.54,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.28,OTHER,151.88,198.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,,151.88,,151.88,198.45,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.28,OTHER,151.88,198.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,,151.88,,151.88,198.45,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.28,OTHER,151.88,198.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,,151.88,,151.88,198.45,
HIP SET DEPUY CAPTURED 2-HOLE,1680562,CDM,,,,INPATIENT,,,748.75,299.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,681.36,OTHER,561.56,733.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED 2-HOLE,1680562,CDM,,,,INPATIENT,,,748.75,299.5,MONUMENT,COMMERCIAL,,,,599,,561.56,733.78,
HIP SET DEPUY CAPTURED 2-HOLE,1680562,CDM,,,,INPATIENT,,,748.75,299.5,UNITED HEALTH,UNITED COMMERCIAL,,,,561.56,,561.56,733.78,
HIP SET DEPUY CAPTURED 4-HOLE,1680563,CDM,,,,INPATIENT,,,897.25,358.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,816.5,OTHER,672.94,879.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED 4-HOLE,1680563,CDM,,,,INPATIENT,,,897.25,358.9,MONUMENT,COMMERCIAL,,,,717.8,,672.94,879.31,
HIP SET DEPUY CAPTURED 4-HOLE,1680563,CDM,,,,INPATIENT,,,897.25,358.9,UNITED HEALTH,UNITED COMMERCIAL,,,,672.94,,672.94,879.31,
HIP SET DEPUY CAPTURED 6-HOLE,1680564,CDM,,,,INPATIENT,,,748.75,299.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,681.36,OTHER,561.56,733.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED 6-HOLE,1680564,CDM,,,,INPATIENT,,,748.75,299.5,MONUMENT,COMMERCIAL,,,,599,,561.56,733.78,
HIP SET DEPUY CAPTURED 6-HOLE,1680564,CDM,,,,INPATIENT,,,748.75,299.5,UNITED HEALTH,UNITED COMMERCIAL,,,,561.56,,561.56,733.78,
HIP SET DEPUY CAPTURED 8-HOLE,1680565,CDM,,,,INPATIENT,,,824.75,329.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,750.52,OTHER,618.56,808.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED 8-HOLE,1680565,CDM,,,,INPATIENT,,,824.75,329.9,MONUMENT,COMMERCIAL,,,,659.8,,618.56,808.26,
HIP SET DEPUY CAPTURED 8-HOLE,1680565,CDM,,,,INPATIENT,,,824.75,329.9,UNITED HEALTH,UNITED COMMERCIAL,,,,618.56,,618.56,808.26,
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,824.75,329.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,750.52,OTHER,618.56,808.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,824.75,329.9,MONUMENT,COMMERCIAL,,,,659.8,,618.56,808.26,
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,824.75,329.9,UNITED HEALTH,UNITED COMMERCIAL,,,,618.56,,618.56,808.26,
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,824.75,329.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,750.52,OTHER,618.56,808.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,824.75,329.9,MONUMENT,COMMERCIAL,,,,659.8,,618.56,808.26,
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,824.75,329.9,UNITED HEALTH,UNITED COMMERCIAL,,,,618.56,,618.56,808.26,
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,1049.5,419.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,955.05,OTHER,787.13,1028.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,1049.5,419.8,MONUMENT,COMMERCIAL,,,,839.6,,787.13,1028.51,
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,1049.5,419.8,UNITED HEALTH,UNITED COMMERCIAL,,,,787.13,,787.13,1028.51,
"PIN, CANNULATED GUIDE",1680569,CDM,,,,INPATIENT,,,320.25,128.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,291.43,OTHER,240.19,313.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PIN, CANNULATED GUIDE",1680569,CDM,,,,INPATIENT,,,320.25,128.1,MONUMENT,COMMERCIAL,,,,256.2,,240.19,313.85,
"PIN, CANNULATED GUIDE",1680569,CDM,,,,INPATIENT,,,320.25,128.1,UNITED HEALTH,UNITED COMMERCIAL,,,,240.19,,240.19,313.85,
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,1089.25,435.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.22,OTHER,816.94,1067.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,1089.25,435.7,MONUMENT,COMMERCIAL,,,,871.4,,816.94,1067.47,
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,1089.25,435.7,UNITED HEALTH,UNITED COMMERCIAL,,,,816.94,,816.94,1067.47,
MITEK MINI QUICKANCHOR,1680571,CDM,,,,INPATIENT,,,982.75,393.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,894.3,OTHER,737.06,963.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MITEK MINI QUICKANCHOR,1680571,CDM,,,,INPATIENT,,,982.75,393.1,MONUMENT,COMMERCIAL,,,,786.2,,737.06,963.1,
MITEK MINI QUICKANCHOR,1680571,CDM,,,,INPATIENT,,,982.75,393.1,UNITED HEALTH,UNITED COMMERCIAL,,,,737.06,,737.06,963.1,
MITEK GII QUICKANCHOR,1680572,CDM,,,,INPATIENT,,,1004.25,401.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,913.87,OTHER,753.19,984.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MITEK GII QUICKANCHOR,1680572,CDM,,,,INPATIENT,,,1004.25,401.7,MONUMENT,COMMERCIAL,,,,803.4,,753.19,984.17,
MITEK GII QUICKANCHOR,1680572,CDM,,,,INPATIENT,,,1004.25,401.7,UNITED HEALTH,UNITED COMMERCIAL,,,,753.19,,753.19,984.17,
MITEK SUPER QUICKANCHOR,1680573,CDM,,,,INPATIENT,,,1748.25,699.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1590.91,OTHER,1311.19,1713.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MITEK SUPER QUICKANCHOR,1680573,CDM,,,,INPATIENT,,,1748.25,699.3,MONUMENT,COMMERCIAL,,,,1398.6,,1311.19,1713.29,
MITEK SUPER QUICKANCHOR,1680573,CDM,,,,INPATIENT,,,1748.25,699.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1311.19,,1311.19,1713.29,
CANCELLOUS BONE CHIPS 30CC,1680574,CDM,,,,INPATIENT,,,1323,529.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1203.93,OTHER,992.25,1296.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANCELLOUS BONE CHIPS 30CC,1680574,CDM,,,,INPATIENT,,,1323,529.2,MONUMENT,COMMERCIAL,,,,1058.4,,992.25,1296.54,
CANCELLOUS BONE CHIPS 30CC,1680574,CDM,,,,INPATIENT,,,1323,529.2,UNITED HEALTH,UNITED COMMERCIAL,,,,992.25,,992.25,1296.54,
BIOMET ACL WASHER 14MM,1680575,CDM,,,,INPATIENT,,,402,160.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,365.82,OTHER,301.5,393.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOMET ACL WASHER 14MM,1680575,CDM,,,,INPATIENT,,,402,160.8,MONUMENT,COMMERCIAL,,,,321.6,,301.5,393.96,
BIOMET ACL WASHER 14MM,1680575,CDM,,,,INPATIENT,,,402,160.8,UNITED HEALTH,UNITED COMMERCIAL,,,,301.5,,301.5,393.96,
"WASHER, ACL 18MM",1680576,CDM,,,,INPATIENT,,,578.5,231.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,526.44,OTHER,433.88,566.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WASHER, ACL 18MM",1680576,CDM,,,,INPATIENT,,,578.5,231.4,MONUMENT,COMMERCIAL,,,,462.8,,433.88,566.93,
"WASHER, ACL 18MM",1680576,CDM,,,,INPATIENT,,,578.5,231.4,UNITED HEALTH,UNITED COMMERCIAL,,,,433.88,,433.88,566.93,
"SCREW, ANCHORING 30MM",1680577,CDM,,,,INPATIENT,,,183.5,73.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,166.99,OTHER,137.63,179.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 30MM",1680577,CDM,,,,INPATIENT,,,183.5,73.4,MONUMENT,COMMERCIAL,,,,146.8,,137.63,179.83,
"SCREW, ANCHORING 30MM",1680577,CDM,,,,INPATIENT,,,183.5,73.4,UNITED HEALTH,UNITED COMMERCIAL,,,,137.63,,137.63,179.83,
"SCREW, ANCHORING 35MM",1680578,CDM,,,,INPATIENT,,,183.5,73.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,166.99,OTHER,137.63,179.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 35MM",1680578,CDM,,,,INPATIENT,,,183.5,73.4,MONUMENT,COMMERCIAL,,,,146.8,,137.63,179.83,
"SCREW, ANCHORING 35MM",1680578,CDM,,,,INPATIENT,,,183.5,73.4,UNITED HEALTH,UNITED COMMERCIAL,,,,137.63,,137.63,179.83,
"SCREW, ANCHORING 40MM",1680579,CDM,,,,INPATIENT,,,210,84,BLUE CROSS ANTHEM,COMMERCIAL,,,,191.1,OTHER,157.5,205.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 40MM",1680579,CDM,,,,INPATIENT,,,210,84,MONUMENT,COMMERCIAL,,,,168,,157.5,205.8,
"SCREW, ANCHORING 40MM",1680579,CDM,,,,INPATIENT,,,210,84,UNITED HEALTH,UNITED COMMERCIAL,,,,157.5,,157.5,205.8,
"SCREW, ANCHORING 45MM",1680580,CDM,,,,INPATIENT,,,225,90,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.75,OTHER,168.75,220.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 45MM",1680580,CDM,,,,INPATIENT,,,225,90,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
"SCREW, ANCHORING 45MM",1680580,CDM,,,,INPATIENT,,,225,90,UNITED HEALTH,UNITED COMMERCIAL,,,,168.75,,168.75,220.5,
"SCREW, ANCHORING 50MM",1680581,CDM,,,,INPATIENT,,,225,90,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.75,OTHER,168.75,220.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 50MM",1680581,CDM,,,,INPATIENT,,,225,90,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
"SCREW, ANCHORING 50MM",1680581,CDM,,,,INPATIENT,,,225,90,UNITED HEALTH,UNITED COMMERCIAL,,,,168.75,,168.75,220.5,
"SCREW, ANCHORING 55MM",1680582,CDM,,,,INPATIENT,,,225,90,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.75,OTHER,168.75,220.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 55MM",1680582,CDM,,,,INPATIENT,,,225,90,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
"SCREW, ANCHORING 55MM",1680582,CDM,,,,INPATIENT,,,225,90,UNITED HEALTH,UNITED COMMERCIAL,,,,168.75,,168.75,220.5,
"SCREW, ANCHORING 60MM",1680583,CDM,,,,INPATIENT,,,164.25,65.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.47,OTHER,123.19,160.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, ANCHORING 60MM",1680583,CDM,,,,INPATIENT,,,164.25,65.7,MONUMENT,COMMERCIAL,,,,131.4,,123.19,160.97,
"SCREW, ANCHORING 60MM",1680583,CDM,,,,INPATIENT,,,164.25,65.7,UNITED HEALTH,UNITED COMMERCIAL,,,,123.19,,123.19,160.97,
CANN. INTERSCREW 7X25MM,1680584,CDM,,,,INPATIENT,,,339.25,135.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.72,OTHER,254.44,332.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANN. INTERSCREW 7X25MM,1680584,CDM,,,,INPATIENT,,,339.25,135.7,MONUMENT,COMMERCIAL,,,,271.4,,254.44,332.47,
CANN. INTERSCREW 7X25MM,1680584,CDM,,,,INPATIENT,,,339.25,135.7,UNITED HEALTH,UNITED COMMERCIAL,,,,254.44,,254.44,332.47,
CANN. INTERSCREW,1680585,CDM,,,,INPATIENT,,,339.25,135.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.72,OTHER,254.44,332.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANN. INTERSCREW,1680585,CDM,,,,INPATIENT,,,339.25,135.7,MONUMENT,COMMERCIAL,,,,271.4,,254.44,332.47,
CANN. INTERSCREW,1680585,CDM,,,,INPATIENT,,,339.25,135.7,UNITED HEALTH,UNITED COMMERCIAL,,,,254.44,,254.44,332.47,
"WASHER, SPIKED",1680586,CDM,,,,INPATIENT,,,87.5,35,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.63,OTHER,65.63,85.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WASHER, SPIKED",1680586,CDM,,,,INPATIENT,,,87.5,35,MONUMENT,COMMERCIAL,,,,70,,65.63,85.75,
"WASHER, SPIKED",1680586,CDM,,,,INPATIENT,,,87.5,35,UNITED HEALTH,UNITED COMMERCIAL,,,,65.63,,65.63,85.75,
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,426.75,170.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,388.34,OTHER,320.06,418.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,426.75,170.7,MONUMENT,COMMERCIAL,,,,341.4,,320.06,418.22,
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,426.75,170.7,UNITED HEALTH,UNITED COMMERCIAL,,,,320.06,,320.06,418.22,
ANCHOR BIOKNOTLESS W/ETHIBOND,1680588,CDM,,,,INPATIENT,,,1000.75,400.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,910.68,OTHER,750.56,980.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANCHOR BIOKNOTLESS W/ETHIBOND,1680588,CDM,,,,INPATIENT,,,1000.75,400.3,MONUMENT,COMMERCIAL,,,,800.6,,750.56,980.74,
ANCHOR BIOKNOTLESS W/ETHIBOND,1680588,CDM,,,,INPATIENT,,,1000.75,400.3,UNITED HEALTH,UNITED COMMERCIAL,,,,750.56,,750.56,980.74,
"HIP, ACE SHELL 46MM",1680589,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 46MM",1680589,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 46MM",1680589,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 48MM",1680590,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 48MM",1680590,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 48MM",1680590,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 50MM",1680591,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 50MM",1680591,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 50MM",1680591,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 52MM",1680592,CDM,,,,INPATIENT,,,2742.5,1097,BLUE CROSS ANTHEM,COMMERCIAL,,,,2495.68,OTHER,2056.88,2687.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 52MM",1680592,CDM,,,,INPATIENT,,,2742.5,1097,MONUMENT,COMMERCIAL,,,,2194,,2056.88,2687.65,
"HIP, ACE SHELL 52MM",1680592,CDM,,,,INPATIENT,,,2742.5,1097,UNITED HEALTH,UNITED COMMERCIAL,,,,2056.88,,2056.88,2687.65,
"HIP, ACE SHELL 54MM",1680593,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 54MM",1680593,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 54MM",1680593,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 56MM",1680594,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 56MM",1680594,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 56MM",1680594,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 58MM",1680595,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 58MM",1680595,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 58MM",1680595,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 60MM",1680596,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 60MM",1680596,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 60MM",1680596,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 62MM",1680597,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 62MM",1680597,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 62MM",1680597,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 64MM",1680598,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 64MM",1680598,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 64MM",1680598,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 66MM",1680599,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 66MM",1680599,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 66MM",1680599,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL 68MM",1680600,CDM,,,,INPATIENT,,,2660,1064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2420.6,OTHER,1995,2606.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL 68MM",1680600,CDM,,,,INPATIENT,,,2660,1064,MONUMENT,COMMERCIAL,,,,2128,,1995,2606.8,
"HIP, ACE SHELL 68MM",1680600,CDM,,,,INPATIENT,,,2660,1064,UNITED HEALTH,UNITED COMMERCIAL,,,,1995,,1995,2606.8,
"HIP, ACE SHELL W/PEGS 42MM",1680601,CDM,,,,INPATIENT,,,2362.5,945,BLUE CROSS ANTHEM,COMMERCIAL,,,,2149.88,OTHER,1771.88,2315.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL W/PEGS 42MM",1680601,CDM,,,,INPATIENT,,,2362.5,945,MONUMENT,COMMERCIAL,,,,1890,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 42MM",1680601,CDM,,,,INPATIENT,,,2362.5,945,UNITED HEALTH,UNITED COMMERCIAL,,,,1771.88,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 45MM",1680602,CDM,,,,INPATIENT,,,2362.5,945,BLUE CROSS ANTHEM,COMMERCIAL,,,,2149.88,OTHER,1771.88,2315.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL W/PEGS 45MM",1680602,CDM,,,,INPATIENT,,,2362.5,945,MONUMENT,COMMERCIAL,,,,1890,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 45MM",1680602,CDM,,,,INPATIENT,,,2362.5,945,UNITED HEALTH,UNITED COMMERCIAL,,,,1771.88,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 48MM",1680603,CDM,,,,INPATIENT,,,2362.5,945,BLUE CROSS ANTHEM,COMMERCIAL,,,,2149.88,OTHER,1771.88,2315.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL W/PEGS 48MM",1680603,CDM,,,,INPATIENT,,,2362.5,945,MONUMENT,COMMERCIAL,,,,1890,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 48MM",1680603,CDM,,,,INPATIENT,,,2362.5,945,UNITED HEALTH,UNITED COMMERCIAL,,,,1771.88,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 51MM",1680604,CDM,,,,INPATIENT,,,2362.5,945,BLUE CROSS ANTHEM,COMMERCIAL,,,,2149.88,OTHER,1771.88,2315.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE SHELL W/PEGS 51MM",1680604,CDM,,,,INPATIENT,,,2362.5,945,MONUMENT,COMMERCIAL,,,,1890,,1771.88,2315.25,
"HIP, ACE SHELL W/PEGS 51MM",1680604,CDM,,,,INPATIENT,,,2362.5,945,UNITED HEALTH,UNITED COMMERCIAL,,,,1771.88,,1771.88,2315.25,
HIP ACE LINER 42MM,1680606,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP ACE LINER 42MM,1680606,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
HIP ACE LINER 42MM,1680606,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
HIP ACE LINER 43MM,1680607,CDM,,,,INPATIENT,,,1533,613.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1395.03,OTHER,1149.75,1502.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP ACE LINER 43MM,1680607,CDM,,,,INPATIENT,,,1533,613.2,MONUMENT,COMMERCIAL,,,,1226.4,,1149.75,1502.34,
HIP ACE LINER 43MM,1680607,CDM,,,,INPATIENT,,,1533,613.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1149.75,,1149.75,1502.34,
"HIP, ACE LINER 44MM",1680608,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE LINER 44MM",1680608,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
"HIP, ACE LINER 44MM",1680608,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
"HIP, ACE LINER 45MM",1680609,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE LINER 45MM",1680609,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
"HIP, ACE LINER 45MM",1680609,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
"HIP, ACE LINER 46MM",1680610,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE LINER 46MM",1680610,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
"HIP, ACE LINER 46MM",1680610,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
"HIP, ACE LINER 47MM",1680611,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE LINER 47MM",1680611,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
"HIP, ACE LINER 47MM",1680611,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
"HIP, ACE LINER 48MM",1680612,CDM,,,,INPATIENT,,,1487,594.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1353.17,OTHER,1115.25,1457.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, ACE LINER 48MM",1680612,CDM,,,,INPATIENT,,,1487,594.8,MONUMENT,COMMERCIAL,,,,1189.6,,1115.25,1457.26,
"HIP, ACE LINER 48MM",1680612,CDM,,,,INPATIENT,,,1487,594.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1115.25,,1115.25,1457.26,
"SCREW, HIP TIT 15MM 103530",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TIT 15MM 103530",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TIT 15MM 103530",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TIT 20MM",1680614,CDM,,,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TIT 20MM",1680614,CDM,,,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TIT 20MM",1680614,CDM,,,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TITANIUM 25MM",1680615,CDM,,,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 25MM",1680615,CDM,,,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TITANIUM 25MM",1680615,CDM,,,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TITANIUM 30MM",1680616,CDM,,,,INPATIENT,,,263.5,105.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.79,OTHER,197.63,258.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 30MM",1680616,CDM,,,,INPATIENT,,,263.5,105.4,MONUMENT,COMMERCIAL,,,,210.8,,197.63,258.23,
"SCREW, HIP TITANIUM 30MM",1680616,CDM,,,,INPATIENT,,,263.5,105.4,UNITED HEALTH,UNITED COMMERCIAL,,,,197.63,,197.63,258.23,
"SCREW, HIP TIT 35MM 103534",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TIT 35MM 103534",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TIT 35MM 103534",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TIT 40MM 103535",1680618,CDM,,,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TIT 40MM 103535",1680618,CDM,,,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TIT 40MM 103535",1680618,CDM,,,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TITANIUM 45MM",1680619,CDM,,,,INPATIENT,,,263.5,105.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.79,OTHER,197.63,258.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 45MM",1680619,CDM,,,,INPATIENT,,,263.5,105.4,MONUMENT,COMMERCIAL,,,,210.8,,197.63,258.23,
"SCREW, HIP TITANIUM 45MM",1680619,CDM,,,,INPATIENT,,,263.5,105.4,UNITED HEALTH,UNITED COMMERCIAL,,,,197.63,,197.63,258.23,
"SCREW, HIP TITANIUM 50MM",1680620,CDM,,,,INPATIENT,,,274.5,109.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.8,OTHER,205.88,269.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 50MM",1680620,CDM,,,,INPATIENT,,,274.5,109.8,MONUMENT,COMMERCIAL,,,,219.6,,205.88,269.01,
"SCREW, HIP TITANIUM 50MM",1680620,CDM,,,,INPATIENT,,,274.5,109.8,UNITED HEALTH,UNITED COMMERCIAL,,,,205.88,,205.88,269.01,
"SCREW, HIP TITANIUM 60MM",1680621,CDM,,,,INPATIENT,,,263.5,105.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.79,OTHER,197.63,258.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 60MM",1680621,CDM,,,,INPATIENT,,,263.5,105.4,MONUMENT,COMMERCIAL,,,,210.8,,197.63,258.23,
"SCREW, HIP TITANIUM 60MM",1680621,CDM,,,,INPATIENT,,,263.5,105.4,UNITED HEALTH,UNITED COMMERCIAL,,,,197.63,,197.63,258.23,
"SCREW, HIP TITANIUM 70MM",1680622,CDM,,,,INPATIENT,,,263.5,105.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,239.79,OTHER,197.63,258.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 70MM",1680622,CDM,,,,INPATIENT,,,263.5,105.4,MONUMENT,COMMERCIAL,,,,210.8,,197.63,258.23,
"SCREW, HIP TITANIUM 70MM",1680622,CDM,,,,INPATIENT,,,263.5,105.4,UNITED HEALTH,UNITED COMMERCIAL,,,,197.63,,197.63,258.23,
"HIP, Q/C DRILL BIT 20MM",1680623,CDM,,,,INPATIENT,,,229,91.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.39,OTHER,171.75,224.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, Q/C DRILL BIT 20MM",1680623,CDM,,,,INPATIENT,,,229,91.6,MONUMENT,COMMERCIAL,,,,183.2,,171.75,224.42,
"HIP, Q/C DRILL BIT 20MM",1680623,CDM,,,,INPATIENT,,,229,91.6,UNITED HEALTH,UNITED COMMERCIAL,,,,171.75,,171.75,224.42,
"HIP, Q/C DRILL BIT 30MM",1680624,CDM,,,,INPATIENT,,,240.25,96.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,218.63,OTHER,180.19,235.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, Q/C DRILL BIT 30MM",1680624,CDM,,,,INPATIENT,,,240.25,96.1,MONUMENT,COMMERCIAL,,,,192.2,,180.19,235.45,
"HIP, Q/C DRILL BIT 30MM",1680624,CDM,,,,INPATIENT,,,240.25,96.1,UNITED HEALTH,UNITED COMMERCIAL,,,,180.19,,180.19,235.45,
"HIP, Q/C DRILL BIT 40MM",1680625,CDM,,,,INPATIENT,,,172,68.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.52,OTHER,129,168.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, Q/C DRILL BIT 40MM",1680625,CDM,,,,INPATIENT,,,172,68.8,MONUMENT,COMMERCIAL,,,,137.6,,129,168.56,
"HIP, Q/C DRILL BIT 40MM",1680625,CDM,,,,INPATIENT,,,172,68.8,UNITED HEALTH,UNITED COMMERCIAL,,,,129,,129,168.56,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5510,2204,BLUE CROSS ANTHEM,COMMERCIAL,,,,5014.1,OTHER,4132.5,5399.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5510,2204,MONUMENT,COMMERCIAL,,,,4408,,4132.5,5399.8,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5510,2204,UNITED HEALTH,UNITED COMMERCIAL,,,,4132.5,,4132.5,5399.8,
"HIP, FEMORAL COMP  12-162611",1680627,CDM,,,,INPATIENT,,,3248.25,1299.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2955.91,OTHER,2436.19,3183.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL COMP  12-162611",1680627,CDM,,,,INPATIENT,,,3248.25,1299.3,MONUMENT,COMMERCIAL,,,,2598.6,,2436.19,3183.29,
"HIP, FEMORAL COMP  12-162611",1680627,CDM,,,,INPATIENT,,,3248.25,1299.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2436.19,,2436.19,3183.29,
"HIP, FEMORAL COMP 12-162613",1680628,CDM,,,,INPATIENT,,,4781,1912.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,4350.71,OTHER,3585.75,4685.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, FEMORAL COMP 12-162613",1680628,CDM,,,,INPATIENT,,,4781,1912.4,MONUMENT,COMMERCIAL,,,,3824.8,,3585.75,4685.38,
"HIP, FEMORAL COMP 12-162613",1680628,CDM,,,,INPATIENT,,,4781,1912.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3585.75,,3585.75,4685.38,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5379.5,2151.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4895.35,OTHER,4034.63,5271.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5379.5,2151.8,MONUMENT,COMMERCIAL,,,,4303.6,,4034.63,5271.91,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5379.5,2151.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4034.63,,4034.63,5271.91,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,3248.25,1299.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2955.91,OTHER,2436.19,3183.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,3248.25,1299.3,MONUMENT,COMMERCIAL,,,,2598.6,,2436.19,3183.29,
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,3248.25,1299.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2436.19,,2436.19,3183.29,
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,BLUE CROSS ANTHEM,COMMERCIAL,,,,5191.55,OTHER,4278.75,5590.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,MONUMENT,COMMERCIAL,,,,4564,,4278.75,5590.9,
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,UNITED HEALTH,UNITED COMMERCIAL,,,,4278.75,,4278.75,5590.9,
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,BLUE CROSS ANTHEM,COMMERCIAL,,,,5191.55,OTHER,4278.75,5590.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,MONUMENT,COMMERCIAL,,,,4564,,4278.75,5590.9,
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,UNITED HEALTH,UNITED COMMERCIAL,,,,4278.75,,4278.75,5590.9,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1093.37,OTHER,901.13,1177.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,MONUMENT,COMMERCIAL,,,,961.2,,901.13,1177.47,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UNITED HEALTH,UNITED COMMERCIAL,,,,901.13,,901.13,1177.47,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1803.25,721.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1640.96,OTHER,1352.44,1767.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1803.25,721.3,MONUMENT,COMMERCIAL,,,,1442.6,,1352.44,1767.19,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1803.25,721.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1352.44,,1352.44,1767.19,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1134.5,453.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1032.4,OTHER,850.88,1111.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1134.5,453.8,MONUMENT,COMMERCIAL,,,,907.6,,850.88,1111.81,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1134.5,453.8,UNITED HEALTH,UNITED COMMERCIAL,,,,850.88,,850.88,1111.81,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1748.25,699.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1590.91,OTHER,1311.19,1713.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1748.25,699.3,MONUMENT,COMMERCIAL,,,,1398.6,,1311.19,1713.29,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1748.25,699.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1311.19,,1311.19,1713.29,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1093.37,OTHER,901.13,1177.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,MONUMENT,COMMERCIAL,,,,961.2,,901.13,1177.47,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UNITED HEALTH,UNITED COMMERCIAL,,,,901.13,,901.13,1177.47,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1091.5,436.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,993.27,OTHER,818.63,1069.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1091.5,436.6,MONUMENT,COMMERCIAL,,,,873.2,,818.63,1069.67,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1091.5,436.6,UNITED HEALTH,UNITED COMMERCIAL,,,,818.63,,818.63,1069.67,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1093.37,OTHER,901.13,1177.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,MONUMENT,COMMERCIAL,,,,961.2,,901.13,1177.47,
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UNITED HEALTH,UNITED COMMERCIAL,,,,901.13,,901.13,1177.47,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,325.55,OTHER,268.31,350.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,MONUMENT,COMMERCIAL,,,,286.2,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UNITED HEALTH,UNITED COMMERCIAL,,,,268.31,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,325.55,OTHER,268.31,350.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,MONUMENT,COMMERCIAL,,,,286.2,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UNITED HEALTH,UNITED COMMERCIAL,,,,268.31,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,377,150.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,343.07,OTHER,282.75,369.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,377,150.8,MONUMENT,COMMERCIAL,,,,301.6,,282.75,369.46,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,377,150.8,UNITED HEALTH,UNITED COMMERCIAL,,,,282.75,,282.75,369.46,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,325.55,OTHER,268.31,350.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,MONUMENT,COMMERCIAL,,,,286.2,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UNITED HEALTH,UNITED COMMERCIAL,,,,268.31,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,325.55,OTHER,268.31,350.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,MONUMENT,COMMERCIAL,,,,286.2,,268.31,350.6,
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UNITED HEALTH,UNITED COMMERCIAL,,,,268.31,,268.31,350.6,
"HIP, BONE PLUG CEMENT 163005",1680646,CDM,,,,INPATIENT,,,247.75,99.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.45,OTHER,185.81,242.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, BONE PLUG CEMENT 163005",1680646,CDM,,,,INPATIENT,,,247.75,99.1,MONUMENT,COMMERCIAL,,,,198.2,,185.81,242.8,
"HIP, BONE PLUG CEMENT 163005",1680646,CDM,,,,INPATIENT,,,247.75,99.1,UNITED HEALTH,UNITED COMMERCIAL,,,,185.81,,185.81,242.8,
"HIP, BONE PLUG CEMENT 163010",1680647,CDM,,,,INPATIENT,,,289.75,115.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,263.67,OTHER,217.31,283.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, BONE PLUG CEMENT 163010",1680647,CDM,,,,INPATIENT,,,289.75,115.9,MONUMENT,COMMERCIAL,,,,231.8,,217.31,283.96,
"HIP, BONE PLUG CEMENT 163010",1680647,CDM,,,,INPATIENT,,,289.75,115.9,UNITED HEALTH,UNITED COMMERCIAL,,,,217.31,,217.31,283.96,
"HIP, BONE PLUG CEMENT 163015",1680648,CDM,,,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, BONE PLUG CEMENT 163015",1680648,CDM,,,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"HIP, BONE PLUG CEMENT 163015",1680648,CDM,,,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"HIP, BONE PLUG CEMENT 163020",1680649,CDM,,,,INPATIENT,,,301,120.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,273.91,OTHER,225.75,294.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, BONE PLUG CEMENT 163020",1680649,CDM,,,,INPATIENT,,,301,120.4,MONUMENT,COMMERCIAL,,,,240.8,,225.75,294.98,
"HIP, BONE PLUG CEMENT 163020",1680649,CDM,,,,INPATIENT,,,301,120.4,UNITED HEALTH,UNITED COMMERCIAL,,,,225.75,,225.75,294.98,
"HIP, BONE PLUG CEMENT 163025",1680650,CDM,,,,INPATIENT,,,301,120.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,273.91,OTHER,225.75,294.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"HIP, BONE PLUG CEMENT 163025",1680650,CDM,,,,INPATIENT,,,301,120.4,MONUMENT,COMMERCIAL,,,,240.8,,225.75,294.98,
"HIP, BONE PLUG CEMENT 163025",1680650,CDM,,,,INPATIENT,,,301,120.4,UNITED HEALTH,UNITED COMMERCIAL,,,,225.75,,225.75,294.98,
"KNEE, TIBIAL COMP 16 X 65",1680654,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 16 X 65",1680654,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
"KNEE, TIBIAL COMP 16 X 65",1680654,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2597.6,OTHER,2140.88,2797.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,MONUMENT,COMMERCIAL,,,,2283.6,,2140.88,2797.41,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2140.88,,2140.88,2797.41,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2597.6,OTHER,2140.88,2797.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,MONUMENT,COMMERCIAL,,,,2283.6,,2140.88,2797.41,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2140.88,,2140.88,2797.41,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2597.6,OTHER,2140.88,2797.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,MONUMENT,COMMERCIAL,,,,2283.6,,2140.88,2797.41,
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2140.88,,2140.88,2797.41,
"KNEE, TIBIAL COMP 12 X 85",1680676,CDM,,,,INPATIENT,,,4474.5,1789.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4071.8,OTHER,3355.88,4385.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 12 X 85",1680676,CDM,,,,INPATIENT,,,4474.5,1789.8,MONUMENT,COMMERCIAL,,,,3579.6,,3355.88,4385.01,
"KNEE, TIBIAL COMP 12 X 85",1680676,CDM,,,,INPATIENT,,,4474.5,1789.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3355.88,,3355.88,4385.01,
"KNEE, TIBIAL COMP 14 X 85",1680677,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 14 X 85",1680677,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
"KNEE, TIBIAL COMP 14 X 85",1680677,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
"KNEE, TIBIAL COMP 16 X 85",1680678,CDM,,,,INPATIENT,,,4260.75,1704.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.28,OTHER,3195.56,4175.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 16 X 85",1680678,CDM,,,,INPATIENT,,,4260.75,1704.3,MONUMENT,COMMERCIAL,,,,3408.6,,3195.56,4175.54,
"KNEE, TIBIAL COMP 16 X 85",1680678,CDM,,,,INPATIENT,,,4260.75,1704.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.56,,3195.56,4175.54,
"KNEE, TIBIAL COMP 20 X 85",1680679,CDM,,,,INPATIENT,,,4261.25,1704.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,3877.74,OTHER,3195.94,4176.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL COMP 20 X 85",1680679,CDM,,,,INPATIENT,,,4261.25,1704.5,MONUMENT,COMMERCIAL,,,,3409,,3195.94,4176.03,
"KNEE, TIBIAL COMP 20 X 85",1680679,CDM,,,,INPATIENT,,,4261.25,1704.5,UNITED HEALTH,UNITED COMMERCIAL,,,,3195.94,,3195.94,4176.03,
KNEE SYSTEM SPLINED 141614,1680681,CDM,,,,INPATIENT,,,5414.5,2165.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,4927.2,OTHER,4060.88,5306.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE SYSTEM SPLINED 141614,1680681,CDM,,,,INPATIENT,,,5414.5,2165.8,MONUMENT,COMMERCIAL,,,,4331.6,,4060.88,5306.21,
KNEE SYSTEM SPLINED 141614,1680681,CDM,,,,INPATIENT,,,5414.5,2165.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4060.88,,4060.88,5306.21,
SCREW CORTEX 16MM 202.816,1680682,CDM,,,,INPATIENT,,,145.5,58.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.41,OTHER,109.13,142.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SCREW CORTEX 16MM 202.816,1680682,CDM,,,,INPATIENT,,,145.5,58.2,MONUMENT,COMMERCIAL,,,,116.4,,109.13,142.59,
SCREW CORTEX 16MM 202.816,1680682,CDM,,,,INPATIENT,,,145.5,58.2,UNITED HEALTH,UNITED COMMERCIAL,,,,109.13,,109.13,142.59,
TIBIAL TRAY OFFSET  141491,1680690,CDM,,,,INPATIENT,,,2402,960.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2185.82,OTHER,1801.5,2353.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL TRAY OFFSET  141491,1680690,CDM,,,,INPATIENT,,,2402,960.8,MONUMENT,COMMERCIAL,,,,1921.6,,1801.5,2353.96,
TIBIAL TRAY OFFSET  141491,1680690,CDM,,,,INPATIENT,,,2402,960.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1801.5,,1801.5,2353.96,
LOCKING INSERT 141496,1680691,CDM,,,,INPATIENT,,,611.75,244.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,556.69,OTHER,458.81,599.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOCKING INSERT 141496,1680691,CDM,,,,INPATIENT,,,611.75,244.7,MONUMENT,COMMERCIAL,,,,489.4,,458.81,599.52,
LOCKING INSERT 141496,1680691,CDM,,,,INPATIENT,,,611.75,244.7,UNITED HEALTH,UNITED COMMERCIAL,,,,458.81,,458.81,599.52,
TIBIAL TRAY BIOMET 141483,1680692,CDM,,,,INPATIENT,,,5988.75,2395.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5449.76,OTHER,4491.56,5868.98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL TRAY BIOMET 141483,1680692,CDM,,,,INPATIENT,,,5988.75,2395.5,MONUMENT,COMMERCIAL,,,,4791,,4491.56,5868.98,
TIBIAL TRAY BIOMET 141483,1680692,CDM,,,,INPATIENT,,,5988.75,2395.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4491.56,,4491.56,5868.98,
FEMORAL 65MM W/SCREW 183324,1680693,CDM,,,,INPATIENT,,,16906,6762.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,15384.46,OTHER,12679.5,16567.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL 65MM W/SCREW 183324,1680693,CDM,,,,INPATIENT,,,16906,6762.4,MONUMENT,COMMERCIAL,,,,13524.8,,12679.5,16567.88,
FEMORAL 65MM W/SCREW 183324,1680693,CDM,,,,INPATIENT,,,16906,6762.4,UNITED HEALTH,UNITED COMMERCIAL,,,,12679.5,,12679.5,16567.88,
FEMORAL DISTAL AUGMENT 184184,1680694,CDM,,,,INPATIENT,,,2831.75,1132.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2576.89,OTHER,2123.81,2775.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL DISTAL AUGMENT 184184,1680694,CDM,,,,INPATIENT,,,2831.75,1132.7,MONUMENT,COMMERCIAL,,,,2265.4,,2123.81,2775.12,
FEMORAL DISTAL AUGMENT 184184,1680694,CDM,,,,INPATIENT,,,2831.75,1132.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2123.81,,2123.81,2775.12,
FEMORAL DISTAL AUGMENT 184204,1680695,CDM,,,,INPATIENT,,,2831.75,1132.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2576.89,OTHER,2123.81,2775.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL DISTAL AUGMENT 184204,1680695,CDM,,,,INPATIENT,,,2831.75,1132.7,MONUMENT,COMMERCIAL,,,,2265.4,,2123.81,2775.12,
FEMORAL DISTAL AUGMENT 184204,1680695,CDM,,,,INPATIENT,,,2831.75,1132.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2123.81,,2123.81,2775.12,
FEMORAL POSTERIOR AGMNT 184144,1680696,CDM,,,,INPATIENT,,,2831.75,1132.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2576.89,OTHER,2123.81,2775.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL POSTERIOR AGMNT 184144,1680696,CDM,,,,INPATIENT,,,2831.75,1132.7,MONUMENT,COMMERCIAL,,,,2265.4,,2123.81,2775.12,
FEMORAL POSTERIOR AGMNT 184144,1680696,CDM,,,,INPATIENT,,,2831.75,1132.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2123.81,,2123.81,2775.12,
FEMORALPOSTERIOR AGMNT 184164,1680697,CDM,,,,INPATIENT,,,2831.75,1132.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2576.89,OTHER,2123.81,2775.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORALPOSTERIOR AGMNT 184164,1680697,CDM,,,,INPATIENT,,,2831.75,1132.7,MONUMENT,COMMERCIAL,,,,2265.4,,2123.81,2775.12,
FEMORALPOSTERIOR AGMNT 184164,1680697,CDM,,,,INPATIENT,,,2831.75,1132.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2123.81,,2123.81,2775.12,
TISSUE FIXATION,C1776,HCPCS,278,RC,,INPATIENT,,,1675.5,670.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1524.71,OTHER,1256.63,1641.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TISSUE FIXATION,C1776,HCPCS,278,RC,,INPATIENT,,,1675.5,670.2,MONUMENT,COMMERCIAL,,,,1340.4,,1256.63,1641.99,
TISSUE FIXATION,C1776,HCPCS,278,RC,,INPATIENT,,,1675.5,670.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1256.63,,1256.63,1641.99,
DRILL BIT CALIBRATED,1680703,CDM,,,,INPATIENT,,,346.25,138.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.09,OTHER,259.69,339.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT CALIBRATED,1680703,CDM,,,,INPATIENT,,,346.25,138.5,MONUMENT,COMMERCIAL,,,,277,,259.69,339.33,
DRILL BIT CALIBRATED,1680703,CDM,,,,INPATIENT,,,346.25,138.5,UNITED HEALTH,UNITED COMMERCIAL,,,,259.69,,259.69,339.33,
MAGNUM TAPER ADAPTER 6MM,C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1181.86,OTHER,974.06,1272.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAGNUM TAPER ADAPTER 6MM,C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,MONUMENT,COMMERCIAL,,,,1039,,974.06,1272.78,
MAGNUM TAPER ADAPTER 6MM,C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,UNITED HEALTH,UNITED COMMERCIAL,,,,974.06,,974.06,1272.78,
MEDULLARY TUBE 2.5MM,C1776,HCPCS,278,RC,,INPATIENT,,,355,142,BLUE CROSS ANTHEM,COMMERCIAL,,,,323.05,OTHER,266.25,347.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MEDULLARY TUBE 2.5MM,C1776,HCPCS,278,RC,,INPATIENT,,,355,142,MONUMENT,COMMERCIAL,,,,284,,266.25,347.9,
MEDULLARY TUBE 2.5MM,C1776,HCPCS,278,RC,,INPATIENT,,,355,142,UNITED HEALTH,UNITED COMMERCIAL,,,,266.25,,266.25,347.9,
DRILL BIT 3 FLUTED 4.2MM,1680709,CDM,,,,INPATIENT,,,590,236,BLUE CROSS ANTHEM,COMMERCIAL,,,,536.9,OTHER,442.5,578.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT 3 FLUTED 4.2MM,1680709,CDM,,,,INPATIENT,,,590,236,MONUMENT,COMMERCIAL,,,,472,,442.5,578.2,
DRILL BIT 3 FLUTED 4.2MM,1680709,CDM,,,,INPATIENT,,,590,236,UNITED HEALTH,UNITED COMMERCIAL,,,,442.5,,442.5,578.2,
DRILL BIT 3 FLUTED 4.2MM 145MM,1680710,CDM,,,,INPATIENT,,,524,209.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,476.84,OTHER,393,513.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT 3 FLUTED 4.2MM 145MM,1680710,CDM,,,,INPATIENT,,,524,209.6,MONUMENT,COMMERCIAL,,,,419.2,,393,513.52,
DRILL BIT 3 FLUTED 4.2MM 145MM,1680710,CDM,,,,INPATIENT,,,524,209.6,UNITED HEALTH,UNITED COMMERCIAL,,,,393,,393,513.52,
GUIDEWIRE 3.2MM 400MM 357.399,1680712,CDM,,,,INPATIENT,,,372.5,149,BLUE CROSS ANTHEM,COMMERCIAL,,,,338.98,OTHER,279.38,365.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDEWIRE 3.2MM 400MM 357.399,1680712,CDM,,,,INPATIENT,,,372.5,149,MONUMENT,COMMERCIAL,,,,298,,279.38,365.05,
GUIDEWIRE 3.2MM 400MM 357.399,1680712,CDM,,,,INPATIENT,,,372.5,149,UNITED HEALTH,UNITED COMMERCIAL,,,,279.38,,279.38,365.05,
MINI ARC PRECISE,C1776,HCPCS,278,RC,,INPATIENT,,,3661.25,1464.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,3331.74,OTHER,2745.94,3588.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINI ARC PRECISE,C1776,HCPCS,278,RC,,INPATIENT,,,3661.25,1464.5,MONUMENT,COMMERCIAL,,,,2929,,2745.94,3588.03,
MINI ARC PRECISE,C1776,HCPCS,278,RC,,INPATIENT,,,3661.25,1464.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2745.94,,2745.94,3588.03,
DRILL BIT QC 3.5MM 110MM,1680717,CDM,,,,INPATIENT,,,297.75,119.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.95,OTHER,223.31,291.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 3.5MM 110MM,1680717,CDM,,,,INPATIENT,,,297.75,119.1,MONUMENT,COMMERCIAL,,,,238.2,,223.31,291.8,
DRILL BIT QC 3.5MM 110MM,1680717,CDM,,,,INPATIENT,,,297.75,119.1,UNITED HEALTH,UNITED COMMERCIAL,,,,223.31,,223.31,291.8,
"PLATE, TIBIAL FIXED 141233",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,BLUE CROSS ANTHEM,COMMERCIAL,,,,1686.48,OTHER,3203.25,4185.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, TIBIAL FIXED 141233",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,MONUMENT,COMMERCIAL,,,,3416.8,,3203.25,4185.58,
"PLATE, TIBIAL FIXED 141233",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UNITED HEALTH,UNITED COMMERCIAL,,,,3203.25,,3203.25,4185.58,
TIBIAL PLATE 75MM 141234,C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,BLUE CROSS ANTHEM,COMMERCIAL,,,,1686.48,OTHER,1780.22,2326.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL PLATE 75MM 141234,C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,MONUMENT,COMMERCIAL,,,,1898.9,,1780.22,2326.15,
TIBIAL PLATE 75MM 141234,C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UNITED HEALTH,UNITED COMMERCIAL,,,,1780.22,,1780.22,2326.15,
DRILL BIT QC 2.5MM 310.25,1680730,CDM,,,,INPATIENT,,,280,112,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.8,OTHER,210,274.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 2.5MM 310.25,1680730,CDM,,,,INPATIENT,,,280,112,MONUMENT,COMMERCIAL,,,,224,,210,274.4,
DRILL BIT QC 2.5MM 310.25,1680730,CDM,,,,INPATIENT,,,280,112,UNITED HEALTH,UNITED COMMERCIAL,,,,210,,210,274.4,
DRILL BIT 2.8MM 165MM,1680731,CDM,,,,INPATIENT,,,346.25,138.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.09,OTHER,259.69,339.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT 2.8MM 165MM,1680731,CDM,,,,INPATIENT,,,346.25,138.5,MONUMENT,COMMERCIAL,,,,277,,259.69,339.33,
DRILL BIT 2.8MM 165MM,1680731,CDM,,,,INPATIENT,,,346.25,138.5,UNITED HEALTH,UNITED COMMERCIAL,,,,259.69,,259.69,339.33,
WASHER 7.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,98.5,39.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.64,OTHER,73.88,96.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WASHER 7.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,98.5,39.4,MONUMENT,COMMERCIAL,,,,78.8,,73.88,96.53,
WASHER 7.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,98.5,39.4,UNITED HEALTH,UNITED COMMERCIAL,,,,73.88,,73.88,96.53,
DRILL BIT QC 2.7MM 310.67,1680733,CDM,,,,INPATIENT,,,1380.5,552.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1256.26,OTHER,1035.38,1352.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 2.7MM 310.67,1680733,CDM,,,,INPATIENT,,,1380.5,552.2,MONUMENT,COMMERCIAL,,,,1104.4,,1035.38,1352.89,
DRILL BIT QC 2.7MM 310.67,1680733,CDM,,,,INPATIENT,,,1380.5,552.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1035.38,,1035.38,1352.89,
DRILL BIT QC 2.0MM 140MM,1680735,CDM,,,,INPATIENT,,,490.5,196.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.36,OTHER,367.88,480.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 2.0MM 140MM,1680735,CDM,,,,INPATIENT,,,490.5,196.2,MONUMENT,COMMERCIAL,,,,392.4,,367.88,480.69,
DRILL BIT QC 2.0MM 140MM,1680735,CDM,,,,INPATIENT,,,490.5,196.2,UNITED HEALTH,UNITED COMMERCIAL,,,,367.88,,367.88,480.69,
CABLE 1.7X 750MM,C1776,HCPCS,278,RC,,INPATIENT,,,988.85,395.54,BLUE CROSS ANTHEM,COMMERCIAL,,,,899.85,OTHER,1110.75,1451.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CABLE 1.7X 750MM,C1776,HCPCS,278,RC,,INPATIENT,,,988.85,395.54,MONUMENT,COMMERCIAL,,,,1184.8,,1110.75,1451.38,
CABLE 1.7X 750MM,C1776,HCPCS,278,RC,,INPATIENT,,,988.85,395.54,UNITED HEALTH,UNITED COMMERCIAL,,,,1110.75,,1110.75,1451.38,
"KNEE, TIBIAL BEARING MONO LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,6776,2710.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,6166.16,OTHER,5082,6640.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING MONO LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,6776,2710.4,MONUMENT,COMMERCIAL,,,,5420.8,,5082,6640.48,
"KNEE, TIBIAL BEARING MONO LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,6776,2710.4,UNITED HEALTH,UNITED COMMERCIAL,,,,5082,,5082,6640.48,
"TIBIAL, PLATE 87MM 141237",C1776,HCPCS,278,RC,,INPATIENT,,,4271,1708.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,3886.61,OTHER,3203.25,4185.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TIBIAL, PLATE 87MM 141237",C1776,HCPCS,278,RC,,INPATIENT,,,4271,1708.4,MONUMENT,COMMERCIAL,,,,3416.8,,3203.25,4185.58,
"TIBIAL, PLATE 87MM 141237",C1776,HCPCS,278,RC,,INPATIENT,,,4271,1708.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3203.25,,3203.25,4185.58,
HEAD ENDO II 46MM 12-139016,C1776,HCPCS,278,RC,,INPATIENT,,,970.25,388.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,882.93,OTHER,727.69,950.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEAD ENDO II 46MM 12-139016,C1776,HCPCS,278,RC,,INPATIENT,,,970.25,388.1,MONUMENT,COMMERCIAL,,,,776.2,,727.69,950.85,
HEAD ENDO II 46MM 12-139016,C1776,HCPCS,278,RC,,INPATIENT,,,970.25,388.1,UNITED HEALTH,UNITED COMMERCIAL,,,,727.69,,727.69,950.85,
"TAPER ADAPTER, ENDO II 64MM",C1776,HCPCS,278,RC,,INPATIENT,,,324,129.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,294.84,OTHER,246.75,322.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TAPER ADAPTER, ENDO II 64MM",C1776,HCPCS,278,RC,,INPATIENT,,,324,129.6,MONUMENT,COMMERCIAL,,,,263.2,,246.75,322.42,
"TAPER ADAPTER, ENDO II 64MM",C1776,HCPCS,278,RC,,INPATIENT,,,324,129.6,UNITED HEALTH,UNITED COMMERCIAL,,,,246.75,,246.75,322.42,
"SUTURE, ENDOBUTTON ULTRA",1680756,CDM,,,,INPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,834.24,OTHER,687.56,898.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SUTURE, ENDOBUTTON ULTRA",1680756,CDM,,,,INPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
"SUTURE, ENDOBUTTON ULTRA",1680756,CDM,,,,INPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,,687.56,,687.56,898.42,
"TIBIAL,INTRAFIX SHEATH",C1776,HCPCS,278,RC,,INPATIENT,,,767.5,307,BLUE CROSS ANTHEM,COMMERCIAL,,,,698.43,OTHER,575.63,752.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TIBIAL,INTRAFIX SHEATH",C1776,HCPCS,278,RC,,INPATIENT,,,767.5,307,MONUMENT,COMMERCIAL,,,,614,,575.63,752.15,
"TIBIAL,INTRAFIX SHEATH",C1776,HCPCS,278,RC,,INPATIENT,,,767.5,307,UNITED HEALTH,UNITED COMMERCIAL,,,,575.63,,575.63,752.15,
"PLATE, 1/3 TUBULAR",C1713,HCPCS,278,RC,,INPATIENT,,,288.25,115.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,262.31,OTHER,216.19,282.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, 1/3 TUBULAR",C1713,HCPCS,278,RC,,INPATIENT,,,288.25,115.3,MONUMENT,COMMERCIAL,,,,230.6,,216.19,282.49,
"PLATE, 1/3 TUBULAR",C1713,HCPCS,278,RC,,INPATIENT,,,288.25,115.3,UNITED HEALTH,UNITED COMMERCIAL,,,,216.19,,216.19,282.49,
DRILL BIT QC 1.5MM,1680760,CDM,,,,INPATIENT,,,275.25,110.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,250.48,OTHER,206.44,269.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 1.5MM,1680760,CDM,,,,INPATIENT,,,275.25,110.1,MONUMENT,COMMERCIAL,,,,220.2,,206.44,269.75,
DRILL BIT QC 1.5MM,1680760,CDM,,,,INPATIENT,,,275.25,110.1,UNITED HEALTH,UNITED COMMERCIAL,,,,206.44,,206.44,269.75,
"PLATE, ONE-THIRD TUBULAR",C1776,HCPCS,278,RC,,INPATIENT,,,365.9,146.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,332.97,OTHER,456,595.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, ONE-THIRD TUBULAR",C1776,HCPCS,278,RC,,INPATIENT,,,365.9,146.36,MONUMENT,COMMERCIAL,,,,486.4,,456,595.84,
"PLATE, ONE-THIRD TUBULAR",C1776,HCPCS,278,RC,,INPATIENT,,,365.9,146.36,UNITED HEALTH,UNITED COMMERCIAL,,,,456,,456,595.84,
DRILL BIT 2.7MM,1680771,CDM,,,,INPATIENT,,,364.75,145.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,331.92,OTHER,273.56,357.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT 2.7MM,1680771,CDM,,,,INPATIENT,,,364.75,145.9,MONUMENT,COMMERCIAL,,,,291.8,,273.56,357.46,
DRILL BIT 2.7MM,1680771,CDM,,,,INPATIENT,,,364.75,145.9,UNITED HEALTH,UNITED COMMERCIAL,,,,273.56,,273.56,357.46,
PLATE 7-HOLE LCP,C1776,HCPCS,278,RC,,INPATIENT,,,347.76,139.104,BLUE CROSS ANTHEM,COMMERCIAL,,,,316.46,OTHER,433.69,566.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLATE 7-HOLE LCP,C1776,HCPCS,278,RC,,INPATIENT,,,347.76,139.104,MONUMENT,COMMERCIAL,,,,462.6,,433.69,566.69,
PLATE 7-HOLE LCP,C1776,HCPCS,278,RC,,INPATIENT,,,347.76,139.104,UNITED HEALTH,UNITED COMMERCIAL,,,,433.69,,433.69,566.69,
"SCREW, INSTRUMENTS FOR 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,110,44,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.1,OTHER,82.5,107.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, INSTRUMENTS FOR 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,110,44,MONUMENT,COMMERCIAL,,,,88,,82.5,107.8,
"SCREW, INSTRUMENTS FOR 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,110,44,UNITED HEALTH,UNITED COMMERCIAL,,,,82.5,,82.5,107.8,
"STARDRIVE, TI END CAP T40 0MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,577.4,OTHER,475.88,621.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"STARDRIVE, TI END CAP T40 0MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,MONUMENT,COMMERCIAL,,,,507.6,,475.88,621.81,
"STARDRIVE, TI END CAP T40 0MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UNITED HEALTH,UNITED COMMERCIAL,,,,475.88,,475.88,621.81,
"STARDRIVE, TI END CAP T40 15MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,577.4,OTHER,475.88,621.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"STARDRIVE, TI END CAP T40 15MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,MONUMENT,COMMERCIAL,,,,507.6,,475.88,621.81,
"STARDRIVE, TI END CAP T40 15MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UNITED HEALTH,UNITED COMMERCIAL,,,,475.88,,475.88,621.81,
"KNEE, TIBIAL CR MONO-LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,BLUE CROSS ANTHEM,COMMERCIAL,,,,3864.64,OTHER,4839.94,6324.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL CR MONO-LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,MONUMENT,COMMERCIAL,,,,5162.6,,4839.94,6324.19,
"KNEE, TIBIAL CR MONO-LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UNITED HEALTH,UNITED COMMERCIAL,,,,4839.94,,4839.94,6324.19,
"TAPER ADAPTER, MAGNUM",C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1181.86,OTHER,974.06,1272.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TAPER ADAPTER, MAGNUM",C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,MONUMENT,COMMERCIAL,,,,1039,,974.06,1272.78,
"TAPER ADAPTER, MAGNUM",C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,UNITED HEALTH,UNITED COMMERCIAL,,,,974.06,,974.06,1272.78,
FEMORAL INTER LOCK 65MM 183008,C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL INTER LOCK 65MM 183008,C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
FEMORAL INTER LOCK 65MM 183008,C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
ENDO II HEAD 42MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,610.12,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 42MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD 42MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
MODULAR HEAD COMPONENT,C1776,HCPCS,278,RC,,INPATIENT,,,1074.25,429.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,977.57,OTHER,805.69,1052.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MODULAR HEAD COMPONENT,C1776,HCPCS,278,RC,,INPATIENT,,,1074.25,429.7,MONUMENT,COMMERCIAL,,,,859.4,,805.69,1052.77,
MODULAR HEAD COMPONENT,C1776,HCPCS,278,RC,,INPATIENT,,,1074.25,429.7,UNITED HEALTH,UNITED COMMERCIAL,,,,805.69,,805.69,1052.77,
"LINER, E1 RINGLOC EP-108222",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,BLUE CROSS ANTHEM,COMMERCIAL,,,,4236.05,OTHER,3491.25,4561.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LINER, E1 RINGLOC EP-108222",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,MONUMENT,COMMERCIAL,,,,3724,,3491.25,4561.9,
"LINER, E1 RINGLOC EP-108222",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UNITED HEALTH,UNITED COMMERCIAL,,,,3491.25,,3491.25,4561.9,
CLAMP FIXATION MATERIAL 4.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1691.93,676.772,BLUE CROSS ANTHEM,COMMERCIAL,,,,1539.66,OTHER,1961.63,2563.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CLAMP FIXATION MATERIAL 4.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1691.93,676.772,MONUMENT,COMMERCIAL,,,,2092.4,,1961.63,2563.19,
CLAMP FIXATION MATERIAL 4.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1691.93,676.772,UNITED HEALTH,UNITED COMMERCIAL,,,,1961.63,,1961.63,2563.19,
"ROD, CARBON FIBER 8.0 - 200MM",C1776,HCPCS,278,RC,,INPATIENT,,,331.28,132.512,BLUE CROSS ANTHEM,COMMERCIAL,,,,301.46,OTHER,382.31,499.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"ROD, CARBON FIBER 8.0 - 200MM",C1776,HCPCS,278,RC,,INPATIENT,,,331.28,132.512,MONUMENT,COMMERCIAL,,,,407.8,,382.31,499.56,
"ROD, CARBON FIBER 8.0 - 200MM",C1776,HCPCS,278,RC,,INPATIENT,,,331.28,132.512,UNITED HEALTH,UNITED COMMERCIAL,,,,382.31,,382.31,499.56,
FIXATION NAIL 340MM (RT),C1776,HCPCS,278,RC,,INPATIENT,,,4446.75,1778.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,4046.54,OTHER,3335.06,4357.82,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FIXATION NAIL 340MM (RT),C1776,HCPCS,278,RC,,INPATIENT,,,4446.75,1778.7,MONUMENT,COMMERCIAL,,,,3557.4,,3335.06,4357.82,
FIXATION NAIL 340MM (RT),C1776,HCPCS,278,RC,,INPATIENT,,,4446.75,1778.7,UNITED HEALTH,UNITED COMMERCIAL,,,,3335.06,,3335.06,4357.82,
REAMING ROD W/BAL,C1776,HCPCS,278,RC,,INPATIENT,,,348.5,139.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,317.14,OTHER,261.38,341.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
REAMING ROD W/BAL,C1776,HCPCS,278,RC,,INPATIENT,,,348.5,139.4,MONUMENT,COMMERCIAL,,,,278.8,,261.38,341.53,
REAMING ROD W/BAL,C1776,HCPCS,278,RC,,INPATIENT,,,348.5,139.4,UNITED HEALTH,UNITED COMMERCIAL,,,,261.38,,261.38,341.53,
BLADES 11.0MM TITANIUM,C1776,HCPCS,278,RC,,INPATIENT,,,1758.5,703.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1600.24,OTHER,1318.88,1723.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADES 11.0MM TITANIUM,C1776,HCPCS,278,RC,,INPATIENT,,,1758.5,703.4,MONUMENT,COMMERCIAL,,,,1406.8,,1318.88,1723.33,
BLADES 11.0MM TITANIUM,C1776,HCPCS,278,RC,,INPATIENT,,,1758.5,703.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1318.88,,1318.88,1723.33,
"PLATE, TUBULAR W/COLLAR 10 HL",C1713,HCPCS,278,RC,,INPATIENT,,,184.28,73.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.69,OTHER,211.5,276.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, TUBULAR W/COLLAR 10 HL",C1713,HCPCS,278,RC,,INPATIENT,,,184.28,73.712,MONUMENT,COMMERCIAL,,,,225.6,,211.5,276.36,
"PLATE, TUBULAR W/COLLAR 10 HL",C1713,HCPCS,278,RC,,INPATIENT,,,184.28,73.712,UNITED HEALTH,UNITED COMMERCIAL,,,,211.5,,211.5,276.36,
ENDO 11 HEAD 49MM,C1776,HCPCS,278,RC,,INPATIENT,,,1243.75,497.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1131.81,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO 11 HEAD 49MM,C1776,HCPCS,278,RC,,INPATIENT,,,1243.75,497.5,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO 11 HEAD 49MM,C1776,HCPCS,278,RC,,INPATIENT,,,1243.75,497.5,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
MAGNUM HEAD 44MM,C1776,HCPCS,278,RC,,INPATIENT,,,3879.75,1551.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3530.57,OTHER,2909.81,3802.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAGNUM HEAD 44MM,C1776,HCPCS,278,RC,,INPATIENT,,,3879.75,1551.9,MONUMENT,COMMERCIAL,,,,3103.8,,2909.81,3802.16,
MAGNUM HEAD 44MM,C1776,HCPCS,278,RC,,INPATIENT,,,3879.75,1551.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2909.81,,2909.81,3802.16,
ENDO II HEAD 43MM,1680802,CDM,,,,INPATIENT,,,1243.75,497.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1131.81,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 43MM,1680802,CDM,,,,INPATIENT,,,1243.75,497.5,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD 43MM,1680802,CDM,,,,INPATIENT,,,1243.75,497.5,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
"SCREW, LOCKING ST 3.5MM 26MM",1680805,CDM,,,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 3.5MM 26MM",1680805,CDM,,,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 26MM",1680805,CDM,,,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 34MM",1680806,CDM,,,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 3.5MM 34MM",1680806,CDM,,,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 34MM",1680806,CDM,,,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 38MM",1680807,CDM,,,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 3.5MM 38MM",1680807,CDM,,,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 38MM",1680807,CDM,,,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 40MM",1680808,CDM,,,,INPATIENT,,,411.25,164.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.24,OTHER,308.44,403.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, LOCKING ST 3.5MM 40MM",1680808,CDM,,,,INPATIENT,,,411.25,164.5,MONUMENT,COMMERCIAL,,,,329,,308.44,403.03,
"SCREW, LOCKING ST 3.5MM 40MM",1680808,CDM,,,,INPATIENT,,,411.25,164.5,UNITED HEALTH,UNITED COMMERCIAL,,,,308.44,,308.44,403.03,
"PLATE,LCP CLAVICLE 02.112.080",1680810,CDM,,,,INPATIENT,,,1382.5,553,BLUE CROSS ANTHEM,COMMERCIAL,,,,1258.08,OTHER,1036.88,1354.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE,LCP CLAVICLE 02.112.080",1680810,CDM,,,,INPATIENT,,,1382.5,553,MONUMENT,COMMERCIAL,,,,1106,,1036.88,1354.85,
"PLATE,LCP CLAVICLE 02.112.080",1680810,CDM,,,,INPATIENT,,,1382.5,553,UNITED HEALTH,UNITED COMMERCIAL,,,,1036.88,,1036.88,1354.85,
"PLATES, CONDYLAR 8-HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3842.5,1537,BLUE CROSS ANTHEM,COMMERCIAL,,,,3496.68,OTHER,2881.88,3765.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATES, CONDYLAR 8-HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3842.5,1537,MONUMENT,COMMERCIAL,,,,3074,,2881.88,3765.65,
"PLATES, CONDYLAR 8-HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3842.5,1537,UNITED HEALTH,UNITED COMMERCIAL,,,,2881.88,,2881.88,3765.65,
ENDO II HEAD 44MM,1680893,CDM,,,,INPATIENT,,,880,352,BLUE CROSS ANTHEM,COMMERCIAL,,,,800.8,OTHER,660,862.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 44MM,1680893,CDM,,,,INPATIENT,,,880,352,MONUMENT,COMMERCIAL,,,,704,,660,862.4,
ENDO II HEAD 44MM,1680893,CDM,,,,INPATIENT,,,880,352,UNITED HEALTH,UNITED COMMERCIAL,,,,660,,660,862.4,
"KNEE, TIBIAL ANT STAB BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,2315.81,3026,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL ANT STAB BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,2470.2,,2315.81,3026,
"KNEE, TIBIAL ANT STAB BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,2315.81,,2315.81,3026,
STEINMANN PIN,C1776,HCPCS,278,RC,,INPATIENT,,,208.5,83.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,189.74,OTHER,156.38,204.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STEINMANN PIN,C1776,HCPCS,278,RC,,INPATIENT,,,208.5,83.4,MONUMENT,COMMERCIAL,,,,166.8,,156.38,204.33,
STEINMANN PIN,C1776,HCPCS,278,RC,,INPATIENT,,,208.5,83.4,UNITED HEALTH,UNITED COMMERCIAL,,,,156.38,,156.38,204.33,
COPELAND HA RSRF HD 11-114644,C1776,HCPCS,278,RC,,INPATIENT,,,8996.5,3598.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,8186.82,OTHER,6747.38,8816.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COPELAND HA RSRF HD 11-114644,C1776,HCPCS,278,RC,,INPATIENT,,,8996.5,3598.6,MONUMENT,COMMERCIAL,,,,7197.2,,6747.38,8816.57,
COPELAND HA RSRF HD 11-114644,C1776,HCPCS,278,RC,,INPATIENT,,,8996.5,3598.6,UNITED HEALTH,UNITED COMMERCIAL,,,,6747.38,,6747.38,8816.57,
"SCREW, CORTEX SP 12MM 202.872",1680898,CDM,,,,INPATIENT,,,145.5,58.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.41,OTHER,109.13,142.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX SP 12MM 202.872",1680898,CDM,,,,INPATIENT,,,145.5,58.2,MONUMENT,COMMERCIAL,,,,116.4,,109.13,142.59,
"SCREW, CORTEX SP 12MM 202.872",1680898,CDM,,,,INPATIENT,,,145.5,58.2,UNITED HEALTH,UNITED COMMERCIAL,,,,109.13,,109.13,142.59,
"PLATE, D 2.4MM 242.467 (L)",1680899,CDM,,,,INPATIENT,,,2494.25,997.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2269.77,OTHER,1870.69,2444.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, D 2.4MM 242.467 (L)",1680899,CDM,,,,INPATIENT,,,2494.25,997.7,MONUMENT,COMMERCIAL,,,,1995.4,,1870.69,2444.37,
"PLATE, D 2.4MM 242.467 (L)",1680899,CDM,,,,INPATIENT,,,2494.25,997.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1870.69,,1870.69,2444.37,
DRILL BIT QC 2.4MM 310.530,1680900,CDM,,,,INPATIENT,,,495.5,198.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.91,OTHER,371.63,485.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 2.4MM 310.530,1680900,CDM,,,,INPATIENT,,,495.5,198.2,MONUMENT,COMMERCIAL,,,,396.4,,371.63,485.59,
DRILL BIT QC 2.4MM 310.530,1680900,CDM,,,,INPATIENT,,,495.5,198.2,UNITED HEALTH,UNITED COMMERCIAL,,,,371.63,,371.63,485.59,
ENDO II HEAD 50MM 12-139024,1680903,CDM,,,,INPATIENT,,,1243.75,497.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1131.81,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 50MM 12-139024,1680903,CDM,,,,INPATIENT,,,1243.75,497.5,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD 50MM 12-139024,1680903,CDM,,,,INPATIENT,,,1243.75,497.5,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
CUP ACETABULAR 52MM PT-104052,1680904,CDM,,,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUP ACETABULAR 52MM PT-104052,1680904,CDM,,,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
CUP ACETABULAR 52MM PT-104052,1680904,CDM,,,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
"PORT, INDWELLING",C1788,HCPCS,278,RC,,INPATIENT,,,433,173.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,394.03,OTHER,324.75,424.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PORT, INDWELLING",C1788,HCPCS,278,RC,,INPATIENT,,,433,173.2,MONUMENT,COMMERCIAL,,,,346.4,,324.75,424.34,
"PORT, INDWELLING",C1788,HCPCS,278,RC,,INPATIENT,,,433,173.2,UNITED HEALTH,UNITED COMMERCIAL,,,,324.75,,324.75,424.34,
"PLATE, DISTAL RADIUS 2.4MM 7HL",C1776,HCPCS,278,RC,,INPATIENT,,,2494.25,997.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2269.77,OTHER,1870.69,2444.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DISTAL RADIUS 2.4MM 7HL",C1776,HCPCS,278,RC,,INPATIENT,,,2494.25,997.7,MONUMENT,COMMERCIAL,,,,1995.4,,1870.69,2444.37,
"PLATE, DISTAL RADIUS 2.4MM 7HL",C1776,HCPCS,278,RC,,INPATIENT,,,2494.25,997.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1870.69,,1870.69,2444.37,
"WIRE, KIRSCHNER W/TROCAR POINT",C1776,HCPCS,278,RC,,INPATIENT,,,223.02,89.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.95,OTHER,42,54.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WIRE, KIRSCHNER W/TROCAR POINT",C1776,HCPCS,278,RC,,INPATIENT,,,223.02,89.208,MONUMENT,COMMERCIAL,,,,44.8,,42,54.88,
"WIRE, KIRSCHNER W/TROCAR POINT",C1776,HCPCS,278,RC,,INPATIENT,,,223.02,89.208,UNITED HEALTH,UNITED COMMERCIAL,,,,42,,42,54.88,
DRILL BIT QC 2.0MM 100MM,1681000,CDM,,,,INPATIENT,,,315.5,126.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,287.11,OTHER,236.63,309.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 2.0MM 100MM,1681000,CDM,,,,INPATIENT,,,315.5,126.2,MONUMENT,COMMERCIAL,,,,252.4,,236.63,309.19,
DRILL BIT QC 2.0MM 100MM,1681000,CDM,,,,INPATIENT,,,315.5,126.2,UNITED HEALTH,UNITED COMMERCIAL,,,,236.63,,236.63,309.19,
DRILL BIT 1.8MM W/DEPT MARK,1681001,CDM,,,,INPATIENT,,,490.5,196.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.36,OTHER,367.88,480.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT 1.8MM W/DEPT MARK,1681001,CDM,,,,INPATIENT,,,490.5,196.2,MONUMENT,COMMERCIAL,,,,392.4,,367.88,480.69,
DRILL BIT 1.8MM W/DEPT MARK,1681001,CDM,,,,INPATIENT,,,490.5,196.2,UNITED HEALTH,UNITED COMMERCIAL,,,,367.88,,367.88,480.69,
"KNEE, TIBIAL BEARING 189080",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 189080",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARING 189080",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
ENDO II TAPER/ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,328.5,131.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,298.94,OTHER,246.38,321.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II TAPER/ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,328.5,131.4,MONUMENT,COMMERCIAL,,,,262.8,,246.38,321.93,
ENDO II TAPER/ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,328.5,131.4,UNITED HEALTH,UNITED COMMERCIAL,,,,246.38,,246.38,321.93,
ENDO II HEAD 48MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,610.12,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 48MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD 48MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
"PLATE, HUMERUS 3.5MM 3 HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3627.25,1450.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3300.8,OTHER,2720.44,3554.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, HUMERUS 3.5MM 3 HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3627.25,1450.9,MONUMENT,COMMERCIAL,,,,2901.8,,2720.44,3554.71,
"PLATE, HUMERUS 3.5MM 3 HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3627.25,1450.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2720.44,,2720.44,3554.71,
"PLATE, DISTAL RADIUS 2.4MM 3HL",C1713,HCPCS,278,RC,,INPATIENT,,,1652.62,661.048,BLUE CROSS ANTHEM,COMMERCIAL,,,,1503.88,OTHER,1808.25,2362.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DISTAL RADIUS 2.4MM 3HL",C1713,HCPCS,278,RC,,INPATIENT,,,1652.62,661.048,MONUMENT,COMMERCIAL,,,,1928.8,,1808.25,2362.78,
"PLATE, DISTAL RADIUS 2.4MM 3HL",C1713,HCPCS,278,RC,,INPATIENT,,,1652.62,661.048,UNITED HEALTH,UNITED COMMERCIAL,,,,1808.25,,1808.25,2362.78,
SHOULDER SYSTEM STD ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,429.84,171.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,391.15,OTHER,427.13,558.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHOULDER SYSTEM STD ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,429.84,171.936,MONUMENT,COMMERCIAL,,,,455.6,,427.13,558.11,
SHOULDER SYSTEM STD ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,429.84,171.936,UNITED HEALTH,UNITED COMMERCIAL,,,,427.13,,427.13,558.11,
TIBIAL PLATE 63MM,C1776,HCPCS,278,RC,,INPATIENT,,,1788.8,715.52,BLUE CROSS ANTHEM,COMMERCIAL,,,,1627.81,OTHER,1780.22,2326.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL PLATE 63MM,C1776,HCPCS,278,RC,,INPATIENT,,,1788.8,715.52,MONUMENT,COMMERCIAL,,,,1898.9,,1780.22,2326.15,
TIBIAL PLATE 63MM,C1776,HCPCS,278,RC,,INPATIENT,,,1788.8,715.52,UNITED HEALTH,UNITED COMMERCIAL,,,,1780.22,,1780.22,2326.15,
"KNEE, TIBIAL BEARNG 10 X 63MM",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1403.44,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARNG 10 X 63MM",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARNG 10 X 63MM",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
"KNEE, TIBIAL PLATE 79MM 141235",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,BLUE CROSS ANTHEM,COMMERCIAL,,,,1686.48,OTHER,1779.77,2325.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL PLATE 79MM 141235",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,MONUMENT,COMMERCIAL,,,,1898.42,,1779.77,2325.56,
"KNEE, TIBIAL PLATE 79MM 141235",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UNITED HEALTH,UNITED COMMERCIAL,,,,1779.77,,1779.77,2325.56,
"KNEE, TIBIAL BEARING 10MMX79MM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1894.84,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 10MMX79MM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
"KNEE, TIBIAL BEARING 10MMX79MM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
"PLATE, TUBULAR 1/3 W/COLLAR",C1713,HCPCS,278,RC,,INPATIENT,,,172.94,69.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,157.38,OTHER,204,266.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, TUBULAR 1/3 W/COLLAR",C1713,HCPCS,278,RC,,INPATIENT,,,172.94,69.176,MONUMENT,COMMERCIAL,,,,217.6,,204,266.56,
"PLATE, TUBULAR 1/3 W/COLLAR",C1713,HCPCS,278,RC,,INPATIENT,,,172.94,69.176,UNITED HEALTH,UNITED COMMERCIAL,,,,204,,204,266.56,
"LINER, SIZE 23 EP-108223",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,BLUE CROSS ANTHEM,COMMERCIAL,,,,4236.05,OTHER,3491.25,4561.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LINER, SIZE 23 EP-108223",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,MONUMENT,COMMERCIAL,,,,3724,,3491.25,4561.9,
"LINER, SIZE 23 EP-108223",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UNITED HEALTH,UNITED COMMERCIAL,,,,3491.25,,3491.25,4561.9,
MODULAR HEAD 36MM 11-363660,C1776,HCPCS,278,RC,,INPATIENT,,,820.8,328.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,746.93,OTHER,767.24,1002.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MODULAR HEAD 36MM 11-363660,C1776,HCPCS,278,RC,,INPATIENT,,,820.8,328.32,MONUMENT,COMMERCIAL,,,,818.38,,767.24,1002.52,
MODULAR HEAD 36MM 11-363660,C1776,HCPCS,278,RC,,INPATIENT,,,820.8,328.32,UNITED HEALTH,UNITED COMMERCIAL,,,,767.24,,767.24,1002.52,
"LINER, RINGLOC 40MM EP-108424",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,BLUE CROSS ANTHEM,COMMERCIAL,,,,4236.05,OTHER,3491.25,4561.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LINER, RINGLOC 40MM EP-108424",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,MONUMENT,COMMERCIAL,,,,3724,,3491.25,4561.9,
"LINER, RINGLOC 40MM EP-108424",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UNITED HEALTH,UNITED COMMERCIAL,,,,3491.25,,3491.25,4561.9,
MAGNUM MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,1964.48,785.792,BLUE CROSS ANTHEM,COMMERCIAL,,,,1787.68,OTHER,1473.36,1925.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAGNUM MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,1964.48,785.792,MONUMENT,COMMERCIAL,,,,1571.58,,1473.36,1925.19,
MAGNUM MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,1964.48,785.792,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.36,,1473.36,1925.19,
"PLATE, DHS-DCP HOLES 4",C1713,HCPCS,278,RC,,INPATIENT,,,1079.57,431.828,BLUE CROSS ANTHEM,COMMERCIAL,,,,982.41,OTHER,1176.19,1536.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, DHS-DCP HOLES 4",C1713,HCPCS,278,RC,,INPATIENT,,,1079.57,431.828,MONUMENT,COMMERCIAL,,,,1254.6,,1176.19,1536.89,
"PLATE, DHS-DCP HOLES 4",C1713,HCPCS,278,RC,,INPATIENT,,,1079.57,431.828,UNITED HEALTH,UNITED COMMERCIAL,,,,1176.19,,1176.19,1536.89,
MESH LF LG 10.8CM X 16.0CM,1681031,CDM,278,RC,,INPATIENT,,,536,214.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,487.76,OTHER,402,525.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MESH LF LG 10.8CM X 16.0CM,1681031,CDM,278,RC,,INPATIENT,,,536,214.4,MONUMENT,COMMERCIAL,,,,428.8,,402,525.28,
MESH LF LG 10.8CM X 16.0CM,1681031,CDM,278,RC,,INPATIENT,,,536,214.4,UNITED HEALTH,UNITED COMMERCIAL,,,,402,,402,525.28,
"SCREW, CAN WASHERLOC 50MM",C1776,HCPCS,278,RC,,INPATIENT,,,612.5,245,BLUE CROSS ANTHEM,COMMERCIAL,,,,557.38,OTHER,459.38,600.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CAN WASHERLOC 50MM",C1776,HCPCS,278,RC,,INPATIENT,,,612.5,245,MONUMENT,COMMERCIAL,,,,490,,459.38,600.25,
"SCREW, CAN WASHERLOC 50MM",C1776,HCPCS,278,RC,,INPATIENT,,,612.5,245,UNITED HEALTH,UNITED COMMERCIAL,,,,459.38,,459.38,600.25,
"MESH, DIMENSIONAL KNITTED 6X4",1681037,CDM,278,RC,,INPATIENT,,,400.75,160.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.68,OTHER,300.56,392.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"MESH, DIMENSIONAL KNITTED 6X4",1681037,CDM,278,RC,,INPATIENT,,,400.75,160.3,MONUMENT,COMMERCIAL,,,,320.6,,300.56,392.74,
"MESH, DIMENSIONAL KNITTED 6X4",1681037,CDM,278,RC,,INPATIENT,,,400.75,160.3,UNITED HEALTH,UNITED COMMERCIAL,,,,300.56,,300.56,392.74,
FEMORAL MEDIUM 154601,C1776,HCPCS,278,RC,,INPATIENT,,,8880.25,3552.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,8081.03,OTHER,6660.19,8702.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL MEDIUM 154601,C1776,HCPCS,278,RC,,INPATIENT,,,8880.25,3552.1,MONUMENT,COMMERCIAL,,,,7104.2,,6660.19,8702.65,
FEMORAL MEDIUM 154601,C1776,HCPCS,278,RC,,INPATIENT,,,8880.25,3552.1,UNITED HEALTH,UNITED COMMERCIAL,,,,6660.19,,6660.19,8702.65,
BEARING MED LF 4MM 159548,C1776,HCPCS,278,RC,,INPATIENT,,,1988.93,795.572,BLUE CROSS ANTHEM,COMMERCIAL,,,,1809.93,OTHER,2103.38,2748.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BEARING MED LF 4MM 159548,C1776,HCPCS,278,RC,,INPATIENT,,,1988.93,795.572,MONUMENT,COMMERCIAL,,,,2243.6,,2103.38,2748.41,
BEARING MED LF 4MM 159548,C1776,HCPCS,278,RC,,INPATIENT,,,1988.93,795.572,UNITED HEALTH,UNITED COMMERCIAL,,,,2103.38,,2103.38,2748.41,
ENDO II HEAD 47MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,610.12,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD 47MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD 47MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
"KNEE, TIBIAL BEARING 12MMX63MM",C1776,HCPCS,278,RC,,INPATIENT,,,2610.5,1044.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2375.56,OTHER,1957.88,2558.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEARING 12MMX63MM",C1776,HCPCS,278,RC,,INPATIENT,,,2610.5,1044.2,MONUMENT,COMMERCIAL,,,,2088.4,,1957.88,2558.29,
"KNEE, TIBIAL BEARING 12MMX63MM",C1776,HCPCS,278,RC,,INPATIENT,,,2610.5,1044.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1957.88,,1957.88,2558.29,
"TIBIAL,FIXED CRUCIATE PLATE EA",C1776,HCPCS,278,RC,,INPATIENT,,,2373.62,949.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,2159.99,OTHER,1780.22,2326.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TIBIAL,FIXED CRUCIATE PLATE EA",C1776,HCPCS,278,RC,,INPATIENT,,,2373.62,949.448,MONUMENT,COMMERCIAL,,,,1898.9,,1780.22,2326.15,
"TIBIAL,FIXED CRUCIATE PLATE EA",C1776,HCPCS,278,RC,,INPATIENT,,,2373.62,949.448,UNITED HEALTH,UNITED COMMERCIAL,,,,1780.22,,1780.22,2326.15,
VENTRALEX PATCH CIRCLE 4.3,1681147,CDM,,,,INPATIENT,,,1198.5,479.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1090.64,OTHER,898.88,1174.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VENTRALEX PATCH CIRCLE 4.3,1681147,CDM,,,,INPATIENT,,,1198.5,479.4,MONUMENT,COMMERCIAL,,,,958.8,,898.88,1174.53,
VENTRALEX PATCH CIRCLE 4.3,1681147,CDM,,,,INPATIENT,,,1198.5,479.4,UNITED HEALTH,UNITED COMMERCIAL,,,,898.88,,898.88,1174.53,
END CAP TI W/T40 5MM STARDRIVE,C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,577.4,OTHER,475.88,621.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
END CAP TI W/T40 5MM STARDRIVE,C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,MONUMENT,COMMERCIAL,,,,507.6,,475.88,621.81,
END CAP TI W/T40 5MM STARDRIVE,C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UNITED HEALTH,UNITED COMMERCIAL,,,,475.88,,475.88,621.81,
PLATE FIBULA DSTL 2.7MM 3.5MM,C1713,HCPCS,278,RC,,INPATIENT,,,1271.59,508.636,BLUE CROSS ANTHEM,COMMERCIAL,,,,1157.15,OTHER,1560.19,2038.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLATE FIBULA DSTL 2.7MM 3.5MM,C1713,HCPCS,278,RC,,INPATIENT,,,1271.59,508.636,MONUMENT,COMMERCIAL,,,,1664.2,,1560.19,2038.65,
PLATE FIBULA DSTL 2.7MM 3.5MM,C1713,HCPCS,278,RC,,INPATIENT,,,1271.59,508.636,UNITED HEALTH,UNITED COMMERCIAL,,,,1560.19,,1560.19,2038.65,
MODULAR HEAD COMP 32MM 163667,C1776,HCPCS,278,RC,,INPATIENT,,,1836.75,734.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1671.44,OTHER,1377.56,1800.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MODULAR HEAD COMP 32MM 163667,C1776,HCPCS,278,RC,,INPATIENT,,,1836.75,734.7,MONUMENT,COMMERCIAL,,,,1469.4,,1377.56,1800.02,
MODULAR HEAD COMP 32MM 163667,C1776,HCPCS,278,RC,,INPATIENT,,,1836.75,734.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1377.56,,1377.56,1800.02,
CABLE W/CRIMP 1.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1481,592.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1347.71,OTHER,1110.75,1451.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CABLE W/CRIMP 1.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1481,592.4,MONUMENT,COMMERCIAL,,,,1184.8,,1110.75,1451.38,
CABLE W/CRIMP 1.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1481,592.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1110.75,,1110.75,1451.38,
DRILL BIT QC 3.2MM 310.31,1681161,CDM,,,,INPATIENT,,,279.25,111.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.12,OTHER,209.44,273.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 3.2MM 310.31,1681161,CDM,,,,INPATIENT,,,279.25,111.7,MONUMENT,COMMERCIAL,,,,223.4,,209.44,273.67,
DRILL BIT QC 3.2MM 310.31,1681161,CDM,,,,INPATIENT,,,279.25,111.7,UNITED HEALTH,UNITED COMMERCIAL,,,,209.44,,209.44,273.67,
DRILL BIT QC 4.5MM,1681164,CDM,,,,INPATIENT,,,279.25,111.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.12,OTHER,209.44,273.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QC 4.5MM,1681164,CDM,,,,INPATIENT,,,279.25,111.7,MONUMENT,COMMERCIAL,,,,223.4,,209.44,273.67,
DRILL BIT QC 4.5MM,1681164,CDM,,,,INPATIENT,,,279.25,111.7,UNITED HEALTH,UNITED COMMERCIAL,,,,209.44,,209.44,273.67,
MOUULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,3534.25,1413.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,3216.17,OTHER,2650.69,3463.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MOUULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,3534.25,1413.7,MONUMENT,COMMERCIAL,,,,2827.4,,2650.69,3463.57,
MOUULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,3534.25,1413.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2650.69,,2650.69,3463.57,
"LINER, E1 RINGLOC ACETABULAR",C1776,HCPCS,278,RC,,INPATIENT,,,2995.75,1198.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2726.13,OTHER,2246.81,2935.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LINER, E1 RINGLOC ACETABULAR",C1776,HCPCS,278,RC,,INPATIENT,,,2995.75,1198.3,MONUMENT,COMMERCIAL,,,,2396.6,,2246.81,2935.84,
"LINER, E1 RINGLOC ACETABULAR",C1776,HCPCS,278,RC,,INPATIENT,,,2995.75,1198.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2246.81,,2246.81,2935.84,
MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,2274.5,909.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2069.8,OTHER,1705.88,2229.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,2274.5,909.8,MONUMENT,COMMERCIAL,,,,1819.6,,1705.88,2229.01,
MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,2274.5,909.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1705.88,,1705.88,2229.01,
COPELAND HA RSRF HD 11-114643,C1776,HCPCS,278,RC,,INPATIENT,,,10278.75,4111.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,9353.66,OTHER,7709.06,10073.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COPELAND HA RSRF HD 11-114643,C1776,HCPCS,278,RC,,INPATIENT,,,10278.75,4111.5,MONUMENT,COMMERCIAL,,,,8223,,7709.06,10073.18,
COPELAND HA RSRF HD 11-114643,C1776,HCPCS,278,RC,,INPATIENT,,,10278.75,4111.5,UNITED HEALTH,UNITED COMMERCIAL,,,,7709.06,,7709.06,10073.18,
CURVED BROAD LCP 4.5MM PL,C1776,HCPCS,278,RC,,INPATIENT,,,2623,1049.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2386.93,OTHER,1967.25,2570.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CURVED BROAD LCP 4.5MM PL,C1776,HCPCS,278,RC,,INPATIENT,,,2623,1049.2,MONUMENT,COMMERCIAL,,,,2098.4,,1967.25,2570.54,
CURVED BROAD LCP 4.5MM PL,C1776,HCPCS,278,RC,,INPATIENT,,,2623,1049.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1967.25,,1967.25,2570.54,
ALLODERM 6X16,1681180,CDM,,,,INPATIENT,,,8932.5,3573,BLUE CROSS ANTHEM,COMMERCIAL,,,,8128.58,OTHER,6699.38,8753.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ALLODERM 6X16,1681180,CDM,,,,INPATIENT,,,8932.5,3573,MONUMENT,COMMERCIAL,,,,7146,,6699.38,8753.85,
ALLODERM 6X16,1681180,CDM,,,,INPATIENT,,,8932.5,3573,UNITED HEALTH,UNITED COMMERCIAL,,,,6699.38,,6699.38,8753.85,
SUTURE ANCHOR 5.5MM 904922P,C1713,HCPCS,278,RC,,INPATIENT,,,912.75,365.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,830.6,OTHER,684.56,894.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUTURE ANCHOR 5.5MM 904922P,C1713,HCPCS,278,RC,,INPATIENT,,,912.75,365.1,MONUMENT,COMMERCIAL,,,,730.2,,684.56,894.5,
SUTURE ANCHOR 5.5MM 904922P,C1713,HCPCS,278,RC,,INPATIENT,,,912.75,365.1,UNITED HEALTH,UNITED COMMERCIAL,,,,684.56,,684.56,894.5,
BLADE HYPER,C1776,HCPCS,278,RC,,INPATIENT,,,423.5,169.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,385.39,OTHER,317.63,415.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADE HYPER,C1776,HCPCS,278,RC,,INPATIENT,,,423.5,169.4,MONUMENT,COMMERCIAL,,,,338.8,,317.63,415.03,
BLADE HYPER,C1776,HCPCS,278,RC,,INPATIENT,,,423.5,169.4,UNITED HEALTH,UNITED COMMERCIAL,,,,317.63,,317.63,415.03,
"KNEE, TIBIAL BEAR 10MM 189720",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,BLUE CROSS ANTHEM,COMMERCIAL,,,,3864.64,OTHER,3185.15,4161.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, TIBIAL BEAR 10MM 189720",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,MONUMENT,COMMERCIAL,,,,3397.49,,3185.15,4161.92,
"KNEE, TIBIAL BEAR 10MM 189720",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UNITED HEALTH,UNITED COMMERCIAL,,,,3185.15,,3185.15,4161.92,
"SCREW, PEEK TENODESIS 6.25X15",C1713,HCPCS,278,RC,,INPATIENT,,,867.25,346.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,789.2,OTHER,650.44,849.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, PEEK TENODESIS 6.25X15",C1713,HCPCS,278,RC,,INPATIENT,,,867.25,346.9,MONUMENT,COMMERCIAL,,,,693.8,,650.44,849.91,
"SCREW, PEEK TENODESIS 6.25X15",C1713,HCPCS,278,RC,,INPATIENT,,,867.25,346.9,UNITED HEALTH,UNITED COMMERCIAL,,,,650.44,,650.44,849.91,
LIMITED REGENEREX RINGLOC 58MM,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LIMITED REGENEREX RINGLOC 58MM,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
LIMITED REGENEREX RINGLOC 58MM,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
DRILL BIT RINGLOC 3.2MM,1681192,CDM,,,,INPATIENT,,,220.32,88.128,BLUE CROSS ANTHEM,COMMERCIAL,,,,200.49,OTHER,165.24,215.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT RINGLOC 3.2MM,1681192,CDM,,,,INPATIENT,,,220.32,88.128,MONUMENT,COMMERCIAL,,,,176.26,,165.24,215.91,
DRILL BIT RINGLOC 3.2MM,1681192,CDM,,,,INPATIENT,,,220.32,88.128,UNITED HEALTH,UNITED COMMERCIAL,,,,165.24,,165.24,215.91,
APICAL PLUG,C1776,HCPCS,278,RC,,INPATIENT,,,575.5,230.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,523.71,OTHER,431.63,563.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
APICAL PLUG,C1776,HCPCS,278,RC,,INPATIENT,,,575.5,230.2,MONUMENT,COMMERCIAL,,,,460.4,,431.63,563.99,
APICAL PLUG,C1776,HCPCS,278,RC,,INPATIENT,,,575.5,230.2,UNITED HEALTH,UNITED COMMERCIAL,,,,431.63,,431.63,563.99,
CUP RINGLOC 56MM PT-104056,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUP RINGLOC 56MM PT-104056,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
CUP RINGLOC 56MM PT-104056,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
PEEK ANCHOR 4.5MM 904840P,1681195,CDM,,,,INPATIENT,,,912.75,365.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,830.6,OTHER,684.56,894.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PEEK ANCHOR 4.5MM 904840P,1681195,CDM,,,,INPATIENT,,,912.75,365.1,MONUMENT,COMMERCIAL,,,,730.2,,684.56,894.5,
PEEK ANCHOR 4.5MM 904840P,1681195,CDM,,,,INPATIENT,,,912.75,365.1,UNITED HEALTH,UNITED COMMERCIAL,,,,684.56,,684.56,894.5,
"CUP, RINGLOC 50MM PT-116050",C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"CUP, RINGLOC 50MM PT-116050",C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
"CUP, RINGLOC 50MM PT-116050",C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
"SCREW, HIP TITANIUM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TITANIUM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"SCREW, HIP TITANIUM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,270,352.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, HIP TITANIUM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,MONUMENT,COMMERCIAL,,,,288,,270,352.8,
"SCREW, HIP TITANIUM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UNITED HEALTH,UNITED COMMERCIAL,,,,270,,270,352.8,
"PACK, OXFORD KNEE RESECTION",1681201,CDM,,,,INPATIENT,,,1909.75,763.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1737.87,OTHER,1432.31,1871.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PACK, OXFORD KNEE RESECTION",1681201,CDM,,,,INPATIENT,,,1909.75,763.9,MONUMENT,COMMERCIAL,,,,1527.8,,1432.31,1871.56,
"PACK, OXFORD KNEE RESECTION",1681201,CDM,,,,INPATIENT,,,1909.75,763.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1432.31,,1432.31,1871.56,
CARPAL TUNNEL BLADE,1681202,CDM,,,,INPATIENT,,,274.5,109.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.8,OTHER,205.88,269.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPAL TUNNEL BLADE,1681202,CDM,,,,INPATIENT,,,274.5,109.8,MONUMENT,COMMERCIAL,,,,219.6,,205.88,269.01,
CARPAL TUNNEL BLADE,1681202,CDM,,,,INPATIENT,,,274.5,109.8,UNITED HEALTH,UNITED COMMERCIAL,,,,205.88,,205.88,269.01,
DRILL CANN 2.0MM 310.221,1681207,CDM,,,,INPATIENT,,,1272.5,509,BLUE CROSS ANTHEM,COMMERCIAL,,,,1157.98,OTHER,954.38,1247.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL CANN 2.0MM 310.221,1681207,CDM,,,,INPATIENT,,,1272.5,509,MONUMENT,COMMERCIAL,,,,1018,,954.38,1247.05,
DRILL CANN 2.0MM 310.221,1681207,CDM,,,,INPATIENT,,,1272.5,509,UNITED HEALTH,UNITED COMMERCIAL,,,,954.38,,954.38,1247.05,
"SCREW, CORTEX 2.7MM 202.874",1681208,CDM,,,,INPATIENT,,,153.75,61.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.91,OTHER,115.31,150.68,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 2.7MM 202.874",1681208,CDM,,,,INPATIENT,,,153.75,61.5,MONUMENT,COMMERCIAL,,,,123,,115.31,150.68,
"SCREW, CORTEX 2.7MM 202.874",1681208,CDM,,,,INPATIENT,,,153.75,61.5,UNITED HEALTH,UNITED COMMERCIAL,,,,115.31,,115.31,150.68,
"PLATE, L 2.7MM 02.112.139(L)",1681209,CDM,,,,INPATIENT,,,2052.5,821,BLUE CROSS ANTHEM,COMMERCIAL,,,,1867.78,OTHER,1539.38,2011.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE, L 2.7MM 02.112.139(L)",1681209,CDM,,,,INPATIENT,,,2052.5,821,MONUMENT,COMMERCIAL,,,,1642,,1539.38,2011.45,
"PLATE, L 2.7MM 02.112.139(L)",1681209,CDM,,,,INPATIENT,,,2052.5,821,UNITED HEALTH,UNITED COMMERCIAL,,,,1539.38,,1539.38,2011.45,
"SCREW, CORTEX 3.5MM 204.850",1681210,CDM,,,,INPATIENT,,,83.25,33.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.76,OTHER,62.44,81.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CORTEX 3.5MM 204.850",1681210,CDM,,,,INPATIENT,,,83.25,33.3,MONUMENT,COMMERCIAL,,,,66.6,,62.44,81.59,
"SCREW, CORTEX 3.5MM 204.850",1681210,CDM,,,,INPATIENT,,,83.25,33.3,UNITED HEALTH,UNITED COMMERCIAL,,,,62.44,,62.44,81.59,
SAFETY KNIFE BC378235,1681211,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SAFETY KNIFE BC378235,1681211,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
SAFETY KNIFE BC378235,1681211,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
"SCREW, CANN TI 4.0MM 407.646",1681212,CDM,,,,INPATIENT,,,613,245.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,557.83,OTHER,459.75,600.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN TI 4.0MM 407.646",1681212,CDM,,,,INPATIENT,,,613,245.2,MONUMENT,COMMERCIAL,,,,490.4,,459.75,600.74,
"SCREW, CANN TI 4.0MM 407.646",1681212,CDM,,,,INPATIENT,,,613,245.2,UNITED HEALTH,UNITED COMMERCIAL,,,,459.75,,459.75,600.74,
ENDO II HEAD   12-139014,1681213,CDM,,,,INPATIENT,,,1243.75,497.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1131.81,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD   12-139014,1681213,CDM,,,,INPATIENT,,,1243.75,497.5,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD   12-139014,1681213,CDM,,,,INPATIENT,,,1243.75,497.5,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
TIBIAL BEARING 10X71 103535,1681214,CDM,,,,INPATIENT,,,5525,2210,BLUE CROSS ANTHEM,COMMERCIAL,,,,5027.75,OTHER,4143.75,5414.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL BEARING 10X71 103535,1681214,CDM,,,,INPATIENT,,,5525,2210,MONUMENT,COMMERCIAL,,,,4420,,4143.75,5414.5,
TIBIAL BEARING 10X71 103535,1681214,CDM,,,,INPATIENT,,,5525,2210,UNITED HEALTH,UNITED COMMERCIAL,,,,4143.75,,4143.75,5414.5,
KNEE SYSTEM BIOMET 141616,1681215,CDM,,,,INPATIENT,,,3551.5,1420.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3231.87,OTHER,2663.63,3480.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE SYSTEM BIOMET 141616,1681215,CDM,,,,INPATIENT,,,3551.5,1420.6,MONUMENT,COMMERCIAL,,,,2841.2,,2663.63,3480.47,
KNEE SYSTEM BIOMET 141616,1681215,CDM,,,,INPATIENT,,,3551.5,1420.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2663.63,,2663.63,3480.47,
"KNEE, FEMORAL 72.5MM 183013",1681216,CDM,278,RC,,INPATIENT,,,3653.1,1461.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,3324.32,OTHER,3442.5,4498.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, FEMORAL 72.5MM 183013",1681216,CDM,278,RC,,INPATIENT,,,3653.1,1461.24,MONUMENT,COMMERCIAL,,,,3672,,3442.5,4498.2,
"KNEE, FEMORAL 72.5MM 183013",1681216,CDM,278,RC,,INPATIENT,,,3653.1,1461.24,UNITED HEALTH,UNITED COMMERCIAL,,,,3442.5,,3442.5,4498.2,
"PLATE,DHS 38MM 4HOLE 281.040",1681217,CDM,,,,INPATIENT,,,1661.5,664.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1511.97,OTHER,1246.13,1628.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PLATE,DHS 38MM 4HOLE 281.040",1681217,CDM,,,,INPATIENT,,,1661.5,664.6,MONUMENT,COMMERCIAL,,,,1329.2,,1246.13,1628.27,
"PLATE,DHS 38MM 4HOLE 281.040",1681217,CDM,,,,INPATIENT,,,1661.5,664.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1246.13,,1246.13,1628.27,
CUP RINGLOC 25MM PT-104060,1681218,CDM,,,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUP RINGLOC 25MM PT-104060,1681218,CDM,,,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
CUP RINGLOC 25MM PT-104060,1681218,CDM,,,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
"LINER, RINGLOC 44MM EP-108625",1681219,CDM,,,,INPATIENT,,,7179.75,2871.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,6533.57,OTHER,5384.81,7036.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LINER, RINGLOC 44MM EP-108625",1681219,CDM,,,,INPATIENT,,,7179.75,2871.9,MONUMENT,COMMERCIAL,,,,5743.8,,5384.81,7036.16,
"LINER, RINGLOC 44MM EP-108625",1681219,CDM,,,,INPATIENT,,,7179.75,2871.9,UNITED HEALTH,UNITED COMMERCIAL,,,,5384.81,,5384.81,7036.16,
FEMORAL TAPERLOC 18.5 103216,1681220,CDM,,,,INPATIENT,,,8781.5,3512.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,7991.17,OTHER,6586.13,8605.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL TAPERLOC 18.5 103216,1681220,CDM,,,,INPATIENT,,,8781.5,3512.6,MONUMENT,COMMERCIAL,,,,7025.2,,6586.13,8605.87,
FEMORAL TAPERLOC 18.5 103216,1681220,CDM,,,,INPATIENT,,,8781.5,3512.6,UNITED HEALTH,UNITED COMMERCIAL,,,,6586.13,,6586.13,8605.87,
FEMORAL TAPERLOC 20.0 103210,1681221,CDM,,,,INPATIENT,,,6016.25,2406.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5474.79,OTHER,4512.19,5895.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL TAPERLOC 20.0 103210,1681221,CDM,,,,INPATIENT,,,6016.25,2406.5,MONUMENT,COMMERCIAL,,,,4813,,4512.19,5895.93,
FEMORAL TAPERLOC 20.0 103210,1681221,CDM,,,,INPATIENT,,,6016.25,2406.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4512.19,,4512.19,5895.93,
KNEE SYSTEM OXFORD 154721,1681222,CDM,,,,INPATIENT,,,5998.75,2399.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5458.86,OTHER,4499.06,5878.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE SYSTEM OXFORD 154721,1681222,CDM,,,,INPATIENT,,,5998.75,2399.5,MONUMENT,COMMERCIAL,,,,4799,,4499.06,5878.78,
KNEE SYSTEM OXFORD 154721,1681222,CDM,,,,INPATIENT,,,5998.75,2399.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4499.06,,4499.06,5878.78,
KNEE SYSTEM OXFORD 159577,1681223,CDM,,,,INPATIENT,,,2804.5,1121.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2552.1,OTHER,2103.38,2748.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE SYSTEM OXFORD 159577,1681223,CDM,,,,INPATIENT,,,2804.5,1121.8,MONUMENT,COMMERCIAL,,,,2243.6,,2103.38,2748.41,
KNEE SYSTEM OXFORD 159577,1681223,CDM,,,,INPATIENT,,,2804.5,1121.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2103.38,,2103.38,2748.41,
BLADES TIT HELICAL 456.301,1681224,CDM,,,,INPATIENT,,,1973,789.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1795.43,OTHER,1479.75,1933.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADES TIT HELICAL 456.301,1681224,CDM,,,,INPATIENT,,,1973,789.2,MONUMENT,COMMERCIAL,,,,1578.4,,1479.75,1933.54,
BLADES TIT HELICAL 456.301,1681224,CDM,,,,INPATIENT,,,1973,789.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1479.75,,1479.75,1933.54,
ENDO II HEAD  12-139014,1681225,CDM,,,,INPATIENT,,,1243.75,497.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1131.81,OTHER,932.81,1218.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO II HEAD  12-139014,1681225,CDM,,,,INPATIENT,,,1243.75,497.5,MONUMENT,COMMERCIAL,,,,995,,932.81,1218.88,
ENDO II HEAD  12-139014,1681225,CDM,,,,INPATIENT,,,1243.75,497.5,UNITED HEALTH,UNITED COMMERCIAL,,,,932.81,,932.81,1218.88,
TIBAL TRAY BIOMET OFFSET,1681226,CDM,,,,INPATIENT,,,611.75,244.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,556.69,OTHER,458.81,599.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBAL TRAY BIOMET OFFSET,1681226,CDM,,,,INPATIENT,,,611.75,244.7,MONUMENT,COMMERCIAL,,,,489.4,,458.81,599.52,
TIBAL TRAY BIOMET OFFSET,1681226,CDM,,,,INPATIENT,,,611.75,244.7,UNITED HEALTH,UNITED COMMERCIAL,,,,458.81,,458.81,599.52,
KNEE SYSTEM TRAY PAR 154723,1681227,CDM,,,,INPATIENT,,,5998.75,2399.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5458.86,OTHER,4499.06,5878.78,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE SYSTEM TRAY PAR 154723,1681227,CDM,,,,INPATIENT,,,5998.75,2399.5,MONUMENT,COMMERCIAL,,,,4799,,4499.06,5878.78,
KNEE SYSTEM TRAY PAR 154723,1681227,CDM,,,,INPATIENT,,,5998.75,2399.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4499.06,,4499.06,5878.78,
KNEE FEMORAL PEGGED 161469,1681228,CDM,,,,INPATIENT,,,5194.89,2077.956,BLUE CROSS ANTHEM,COMMERCIAL,,,,4727.35,OTHER,3896.17,5090.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE FEMORAL PEGGED 161469,1681228,CDM,,,,INPATIENT,,,5194.89,2077.956,MONUMENT,COMMERCIAL,,,,4155.91,,3896.17,5090.99,
KNEE FEMORAL PEGGED 161469,1681228,CDM,,,,INPATIENT,,,5194.89,2077.956,UNITED HEALTH,UNITED COMMERCIAL,,,,3896.17,,3896.17,5090.99,
KNEE MENISCAL BEARING 159578,1681230,CDM,,,,INPATIENT,,,2804.5,1121.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2552.1,OTHER,2103.38,2748.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KNEE MENISCAL BEARING 159578,1681230,CDM,,,,INPATIENT,,,2804.5,1121.8,MONUMENT,COMMERCIAL,,,,2243.6,,2103.38,2748.41,
KNEE MENISCAL BEARING 159578,1681230,CDM,,,,INPATIENT,,,2804.5,1121.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2103.38,,2103.38,2748.41,
SHOULDER CUFF,1681232,CDM,,,,INPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,159.93,OTHER,131.81,172.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHOULDER CUFF,1681232,CDM,,,,INPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
SHOULDER CUFF,1681232,CDM,,,,INPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,,131.81,,131.81,172.24,
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,INPATIENT,,,2315.72,926.288,BLUE CROSS ANTHEM,COMMERCIAL,,,,2107.31,OTHER,1736.8,2269.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,INPATIENT,,,2315.72,926.288,MONUMENT,COMMERCIAL,,,,1852.6,,1736.8,2269.4,
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,INPATIENT,,,2315.72,926.288,UNITED HEALTH,UNITED COMMERCIAL,,,,1736.8,,1736.8,2269.4,
MESH (IMPLANTABLE),C1781,HCPCS,278,RC,,INPATIENT,,,2738.44,1095.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,2491.98,OTHER,2053.8,2683.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MESH (IMPLANTABLE),C1781,HCPCS,278,RC,,INPATIENT,,,2738.44,1095.376,MONUMENT,COMMERCIAL,,,,2190.8,,2053.8,2683.7,
MESH (IMPLANTABLE),C1781,HCPCS,278,RC,,INPATIENT,,,2738.44,1095.376,UNITED HEALTH,UNITED COMMERCIAL,,,,2053.8,,2053.8,2683.7,
"LEAD, NEUROSTIMULATOR",C1778,HCPCS,278,RC,,INPATIENT,,,9708.61,3883.444,BLUE CROSS ANTHEM,COMMERCIAL,,,,8834.84,OTHER,7281.5,9514.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"LEAD, NEUROSTIMULATOR",C1778,HCPCS,278,RC,,INPATIENT,,,9708.61,3883.444,MONUMENT,COMMERCIAL,,,,7766.9,,7281.5,9514.4,
"LEAD, NEUROSTIMULATOR",C1778,HCPCS,278,RC,,INPATIENT,,,9708.61,3883.444,UNITED HEALTH,UNITED COMMERCIAL,,,,7281.5,,7281.5,9514.4,
TISSUE LOCALIZATION EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,545.42,218.168,BLUE CROSS ANTHEM,COMMERCIAL,,,,496.33,OTHER,409.1,534.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TISSUE LOCALIZATION EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,545.42,218.168,MONUMENT,COMMERCIAL,,,,436.3,,409.1,534.5,
TISSUE LOCALIZATION EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,545.42,218.168,UNITED HEALTH,UNITED COMMERCIAL,,,,409.1,,409.1,534.5,
"STENT, NON-COR, TEM W/O DEL",C2617,HCPCS,278,RC,,INPATIENT,,,941.08,376.432,BLUE CROSS ANTHEM,COMMERCIAL,,,,856.38,OTHER,705.8,922.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"STENT, NON-COR, TEM W/O DEL",C2617,HCPCS,278,RC,,INPATIENT,,,941.08,376.432,MONUMENT,COMMERCIAL,,,,752.9,,705.8,922.3,
"STENT, NON-COR, TEM W/O DEL",C2617,HCPCS,278,RC,,INPATIENT,,,941.08,376.432,UNITED HEALTH,UNITED COMMERCIAL,,,,705.8,,705.8,922.3,
GENERATOR NEURO RECHG BAT SY,C1820,HCPCS,278,RC,,INPATIENT,,,42327.52,16931.008,BLUE CROSS ANTHEM,COMMERCIAL,,,,38518.04,OTHER,31745.6,41481,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GENERATOR NEURO RECHG BAT SY,C1820,HCPCS,278,RC,,INPATIENT,,,42327.52,16931.008,MONUMENT,COMMERCIAL,,,,33862,,31745.6,41481,
GENERATOR NEURO RECHG BAT SY,C1820,HCPCS,278,RC,,INPATIENT,,,42327.52,16931.008,UNITED HEALTH,UNITED COMMERCIAL,,,,31745.6,,31745.6,41481,
"PATIENT PROGR, NEUROSTIM",C1787,HCPCS,278,RC,,INPATIENT,,,4370.67,1748.268,BLUE CROSS ANTHEM,COMMERCIAL,,,,3977.31,OTHER,3278,4283.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PATIENT PROGR, NEUROSTIM",C1787,HCPCS,278,RC,,INPATIENT,,,4370.67,1748.268,MONUMENT,COMMERCIAL,,,,3496.5,,3278,4283.3,
"PATIENT PROGR, NEUROSTIM",C1787,HCPCS,278,RC,,INPATIENT,,,4370.67,1748.268,UNITED HEALTH,UNITED COMMERCIAL,,,,3278,,3278,4283.3,
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3689.82,OTHER,3041.06,3973.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,MONUMENT,COMMERCIAL,,,,3243.8,,3041.06,3973.66,
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3041.06,,3041.06,3973.66,
APOGEE SYSTEM W/INTEXEN LP,1684010,CDM,,,,INPATIENT,,,6369.75,2547.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,5796.47,OTHER,4777.31,6242.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
APOGEE SYSTEM W/INTEXEN LP,1684010,CDM,,,,INPATIENT,,,6369.75,2547.9,MONUMENT,COMMERCIAL,,,,5095.8,,4777.31,6242.36,
APOGEE SYSTEM W/INTEXEN LP,1684010,CDM,,,,INPATIENT,,,6369.75,2547.9,UNITED HEALTH,UNITED COMMERCIAL,,,,4777.31,,4777.31,6242.36,
MONARC + SUBFASCIAL HAMMOCK,1684020,CDM,,,,INPATIENT,,,4054.75,1621.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3689.82,OTHER,3041.06,3973.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MONARC + SUBFASCIAL HAMMOCK,1684020,CDM,,,,INPATIENT,,,4054.75,1621.9,MONUMENT,COMMERCIAL,,,,3243.8,,3041.06,3973.66,
MONARC + SUBFASCIAL HAMMOCK,1684020,CDM,,,,INPATIENT,,,4054.75,1621.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3041.06,,3041.06,3973.66,
PERIGEE SYSTEM W/INTEXEN LP,1684030,CDM,,,,INPATIENT,,,7041.75,2816.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,6407.99,OTHER,5281.31,6900.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PERIGEE SYSTEM W/INTEXEN LP,1684030,CDM,,,,INPATIENT,,,7041.75,2816.7,MONUMENT,COMMERCIAL,,,,5633.4,,5281.31,6900.92,
PERIGEE SYSTEM W/INTEXEN LP,1684030,CDM,,,,INPATIENT,,,7041.75,2816.7,UNITED HEALTH,UNITED COMMERCIAL,,,,5281.31,,5281.31,6900.92,
"SCREW, TITANIUM CANN 48MM",1684037,CDM,,,,INPATIENT,,,613,245.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,557.83,OTHER,459.75,600.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, TITANIUM CANN 48MM",1684037,CDM,,,,INPATIENT,,,613,245.2,MONUMENT,COMMERCIAL,,,,490.4,,459.75,600.74,
"SCREW, TITANIUM CANN 48MM",1684037,CDM,,,,INPATIENT,,,613,245.2,UNITED HEALTH,UNITED COMMERCIAL,,,,459.75,,459.75,600.74,
CUP RINGLOC 52MM PT-116052,1684038,CDM,,,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUP RINGLOC 52MM PT-116052,1684038,CDM,,,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
CUP RINGLOC 52MM PT-116052,1684038,CDM,,,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
ENDO TAPER/ADAPTER 139247,1684043,CDM,,,,INPATIENT,,,329,131.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.39,OTHER,246.75,322.42,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDO TAPER/ADAPTER 139247,1684043,CDM,,,,INPATIENT,,,329,131.6,MONUMENT,COMMERCIAL,,,,263.2,,246.75,322.42,
ENDO TAPER/ADAPTER 139247,1684043,CDM,,,,INPATIENT,,,329,131.6,UNITED HEALTH,UNITED COMMERCIAL,,,,246.75,,246.75,322.42,
"SCREW, CANN 20MM 245842",1684044,CDM,,,,INPATIENT,,,846.25,338.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,770.09,OTHER,634.69,829.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN 20MM 245842",1684044,CDM,,,,INPATIENT,,,846.25,338.5,MONUMENT,COMMERCIAL,,,,677,,634.69,829.33,
"SCREW, CANN 20MM 245842",1684044,CDM,,,,INPATIENT,,,846.25,338.5,UNITED HEALTH,UNITED COMMERCIAL,,,,634.69,,634.69,829.33,
"SCREW, CANN 16MM 3213-065-0805",1684045,CDM,,,,INPATIENT,,,912.75,365.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,830.6,OTHER,684.56,894.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"SCREW, CANN 16MM 3213-065-0805",1684045,CDM,,,,INPATIENT,,,912.75,365.1,MONUMENT,COMMERCIAL,,,,730.2,,684.56,894.5,
"SCREW, CANN 16MM 3213-065-0805",1684045,CDM,,,,INPATIENT,,,912.75,365.1,UNITED HEALTH,UNITED COMMERCIAL,,,,684.56,,684.56,894.5,
THREAD TIP GUIDE 3.2MM,1684046,CDM,,,,INPATIENT,,,82.75,33.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.3,OTHER,62.06,81.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
THREAD TIP GUIDE 3.2MM,1684046,CDM,,,,INPATIENT,,,82.75,33.1,MONUMENT,COMMERCIAL,,,,66.2,,62.06,81.1,
THREAD TIP GUIDE 3.2MM,1684046,CDM,,,,INPATIENT,,,82.75,33.1,UNITED HEALTH,UNITED COMMERCIAL,,,,62.06,,62.06,81.1,
FEMORAL VANGUARD CR 183033,1684047,CDM,,,,INPATIENT,,,4589.01,1835.604,BLUE CROSS ANTHEM,COMMERCIAL,,,,4176,OTHER,3441.76,4497.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FEMORAL VANGUARD CR 183033,1684047,CDM,,,,INPATIENT,,,4589.01,1835.604,MONUMENT,COMMERCIAL,,,,3671.21,,3441.76,4497.23,
FEMORAL VANGUARD CR 183033,1684047,CDM,,,,INPATIENT,,,4589.01,1835.604,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.76,,3441.76,4497.23,
TIBIAL BEARING 12X79 183462,1684048,CDM,,,,INPATIENT,,,2967.5,1187,BLUE CROSS ANTHEM,COMMERCIAL,,,,2700.43,OTHER,2225.63,2908.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL BEARING 12X79 183462,1684048,CDM,,,,INPATIENT,,,2967.5,1187,MONUMENT,COMMERCIAL,,,,2374,,2225.63,2908.15,
TIBIAL BEARING 12X79 183462,1684048,CDM,,,,INPATIENT,,,2967.5,1187,UNITED HEALTH,UNITED COMMERCIAL,,,,2225.63,,2225.63,2908.15,
CUP RINGLOC 54MM PT-104054,1684049,CDM,,,,INPATIENT,,,5939,2375.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,5404.49,OTHER,4454.25,5820.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUP RINGLOC 54MM PT-104054,1684049,CDM,,,,INPATIENT,,,5939,2375.6,MONUMENT,COMMERCIAL,,,,4751.2,,4454.25,5820.22,
CUP RINGLOC 54MM PT-104054,1684049,CDM,,,,INPATIENT,,,5939,2375.6,UNITED HEALTH,UNITED COMMERCIAL,,,,4454.25,,4454.25,5820.22,
MODULAR HEAD 36MM 11-363661,1684050,CDM,,,,INPATIENT,,,3134.75,1253.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2852.62,OTHER,2351.06,3072.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MODULAR HEAD 36MM 11-363661,1684050,CDM,,,,INPATIENT,,,3134.75,1253.9,MONUMENT,COMMERCIAL,,,,2507.8,,2351.06,3072.06,
MODULAR HEAD 36MM 11-363661,1684050,CDM,,,,INPATIENT,,,3134.75,1253.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2351.06,,2351.06,3072.06,
VANGRD RT INTRLCK 60MM 183004,1684051,CDM,,,,INPATIENT,,,4589,1835.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,4175.99,OTHER,3441.75,4497.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VANGRD RT INTRLCK 60MM 183004,1684051,CDM,,,,INPATIENT,,,4589,1835.6,MONUMENT,COMMERCIAL,,,,3671.2,,3441.75,4497.22,
VANGRD RT INTRLCK 60MM 183004,1684051,CDM,,,,INPATIENT,,,4589,1835.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3441.75,,3441.75,4497.22,
TIBIAL BEARING 12X67 189042,1684052,CDM,,,,INPATIENT,,,2082.24,832.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,1894.84,OTHER,1561.68,2040.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TIBIAL BEARING 12X67 189042,1684052,CDM,,,,INPATIENT,,,2082.24,832.896,MONUMENT,COMMERCIAL,,,,1665.79,,1561.68,2040.6,
TIBIAL BEARING 12X67 189042,1684052,CDM,,,,INPATIENT,,,2082.24,832.896,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.68,,1561.68,2040.6,
POWER PORT TITANIUM SM,C1788,HCPCS,278,RC,,INPATIENT,,,561.6,224.64,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.06,OTHER,982.69,1284.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POWER PORT TITANIUM SM,C1788,HCPCS,278,RC,,INPATIENT,,,561.6,224.64,MONUMENT,COMMERCIAL,,,,1048.2,,982.69,1284.05,
POWER PORT TITANIUM SM,C1788,HCPCS,278,RC,,INPATIENT,,,561.6,224.64,UNITED HEALTH,UNITED COMMERCIAL,,,,982.69,,982.69,1284.05,
POWER PORT MRI DEVICE 8FR,C1788,HCPCS,278,RC,,INPATIENT,,,540,216,BLUE CROSS ANTHEM,COMMERCIAL,,,,491.4,OTHER,982.69,1284.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POWER PORT MRI DEVICE 8FR,C1788,HCPCS,278,RC,,INPATIENT,,,540,216,MONUMENT,COMMERCIAL,,,,1048.2,,982.69,1284.05,
POWER PORT MRI DEVICE 8FR,C1788,HCPCS,278,RC,,INPATIENT,,,540,216,UNITED HEALTH,UNITED COMMERCIAL,,,,982.69,,982.69,1284.05,
GUIDE WIRE,C1769,HCPCS,278,RC,,INPATIENT,,,307.87,123.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.16,OTHER,230.9,301.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GUIDE WIRE,C1769,HCPCS,278,RC,,INPATIENT,,,307.87,123.148,MONUMENT,COMMERCIAL,,,,246.3,,230.9,301.7,
GUIDE WIRE,C1769,HCPCS,278,RC,,INPATIENT,,,307.87,123.148,UNITED HEALTH,UNITED COMMERCIAL,,,,230.9,,230.9,301.7,
WASHER 6.5 /CANCELLOUS SCREW,1690001,CDM,,,,INPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.88,OTHER,90.56,118.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WASHER 6.5 /CANCELLOUS SCREW,1690001,CDM,,,,INPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
WASHER 6.5 /CANCELLOUS SCREW,1690001,CDM,,,,INPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,,90.56,,90.56,118.34,
NURSERY SPECIAL CARE,1790010,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NURSERY SPECIAL CARE,1790010,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
NURSERY SPECIAL CARE,1790010,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
BLOOD TRANS SER 4-8 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1159.8,OTHER,1087.3,1420.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANS SER 4-8 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,MONUMENT,COMMERCIAL,,,,1159.8,,1087.3,1420.8,
US LUNG/MEDIASTINUM FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,2680.75,1072.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,2010.56,2627.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD TRANS SER 2-4 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,999.8,OTHER,937.3,1224.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANS SER 2-4 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,MONUMENT,COMMERCIAL,,,,999.8,,937.3,1224.8,
FNA BX W/US GDN 1ST LES OTHER,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1499.4,OTHER,1323,1728.7,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA ADD'L SEQ THERA DGN,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH EA ADD'L SEQ THERA DGN,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
US LIVER FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1323,1728.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV CONCURRENTLY INFUSED,96368,CPT,450,RC,,OUTPATIENT,,,216,86.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,172.8,OTHER,162,211.68,PERCENT OF CHARGES BASED ON HCPCS CODE
IV CONCURRENTLY INFUSED,96368,CPT,450,RC,,OUTPATIENT,,,216,86.4,MONUMENT,COMMERCIAL,,,,172.8,,162,211.68,
FNA ADDITIONAL LESION,10006,CPT,402,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
IV INFUSED SEQ EA ADD'L,96367,CPT,450,RC,,OUTPATIENT,,,156,62.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.8,OTHER,117,152.88,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSED SEQ EA ADD'L,96367,CPT,450,RC,,OUTPATIENT,,,156,62.4,MONUMENT,COMMERCIAL,,,,124.8,,117,152.88,
CT FNA W/IMAGE GUIDANCE,10009,CPT,350,RC,,OUTPATIENT,,,3220.25,1288.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2415.19,3155.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEMO INJ SQ IM NONHORMONAL,96401,CPT,331,RC,,OUTPATIENT,,,271,108.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,216.8,OTHER,203.25,265.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMO INJ SQ IM NONHORMONAL,96401,CPT,331,RC,,OUTPATIENT,,,271,108.4,MONUMENT,COMMERCIAL,,,,216.8,,203.25,265.58,
CT PANCREAS FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3179.75,1271.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2384.81,3116.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEMO INJ SQ IM HORMONAL AGENT,96402,CPT,331,RC,,OUTPATIENT,,,272,108.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.6,OTHER,204,266.56,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMO INJ SQ IM HORMONAL AGENT,96402,CPT,331,RC,,OUTPATIENT,,,272,108.8,MONUMENT,COMMERCIAL,,,,217.6,,204,266.56,
CT LUNG FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3360,1344,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2520,3292.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION ON BODY INJECTOR,96377,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.8,OTHER,121.69,159.01,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION ON BODY INJECTOR,96377,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,MONUMENT,COMMERCIAL,,,,129.8,,121.69,159.01,
FNA BX W/CT GDN EA ADDL,10010,CPT,320,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL I,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,270.94,354.03,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH INTL THER/DIAG LVL I,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,289,,270.94,354.03,
FNA W/O IMAGE,10021,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UNITED HEALTH,UNITED COMMERCIAL,,,,664.275,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL II,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,219.94,287.39,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH INTL THER/DIAG LVL II,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,234.6,,219.94,287.39,
CT FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1007.63,1316.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV PUSH INTL THER/DIAG LVL III,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,229.31,299.64,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH INTL THER/DIAG LVL III,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,244.6,,229.31,299.64,
FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1141.975,OTHER,1007.63,1316.63,PERCENT OF TOTAL BILLED CHARGES
OBS IV INFUS > 16 MINS INITIAL,96365,CPT,260,RC,,INPATIENT,,,475.75,190.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,432.93,OTHER,356.81,466.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV INFUS > 16 MINS INITIAL,96365,CPT,260,RC,,INPATIENT,,,475.75,190.3,MONUMENT,COMMERCIAL,,,,380.6,,356.81,466.24,
OBS IV INFUS > 16 MINS INITIAL,96365,CPT,260,RC,,INPATIENT,,,475.75,190.3,UNITED HEALTH,UNITED COMMERCIAL,,,,356.81,,356.81,466.24,
OBS IV INFUS EA ADD'L HR,96366,CPT,450,RC,,INPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.41,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV INFUS EA ADD'L HR,96366,CPT,450,RC,,INPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
OBS IV INFUS EA ADD'L HR,96366,CPT,450,RC,,INPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
OBS IV PUSH (FIRST MED),96374,CPT,450,RC,,INPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,369.11,OTHER,164.06,214.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV PUSH (FIRST MED),96374,CPT,450,RC,,INPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
OBS IV PUSH (FIRST MED),96374,CPT,450,RC,,INPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,164.06,,164.06,214.38,
OBS IV PUSH NEW MED ADDON,96375,CPT,450,RC,,INPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.06,OTHER,164.06,214.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV PUSH NEW MED ADDON,96375,CPT,450,RC,,INPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
OBS IV PUSH NEW MED ADDON,96375,CPT,450,RC,,INPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,164.06,,164.06,214.38,
OBS IV PUSH SAME MED ADDON,96376,CPT,260,RC,,INPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.06,OTHER,164.06,214.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV PUSH SAME MED ADDON,96376,CPT,260,RC,,INPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
OBS IV PUSH SAME MED ADDON,96376,CPT,260,RC,,INPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,164.06,,164.06,214.38,
OBS IM/SQ INJ,96372,CPT,260,RC,,INPATIENT,,,190.5,76.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.36,OTHER,142.88,186.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IM/SQ INJ,96372,CPT,260,RC,,INPATIENT,,,190.5,76.2,MONUMENT,COMMERCIAL,,,,152.4,,142.88,186.69,
OBS IM/SQ INJ,96372,CPT,260,RC,,INPATIENT,,,190.5,76.2,UNITED HEALTH,UNITED COMMERCIAL,,,,142.88,,142.88,186.69,
OBS IV HYDRATION (INITIAL),96360,CPT,450,RC,,INPATIENT,,,448,179.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,407.68,OTHER,336,439.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV HYDRATION (INITIAL),96360,CPT,450,RC,,INPATIENT,,,448,179.2,MONUMENT,COMMERCIAL,,,,358.4,,336,439.04,
OBS IV HYDRATION (INITIAL),96360,CPT,450,RC,,INPATIENT,,,448,179.2,UNITED HEALTH,UNITED COMMERCIAL,,,,336,,336,439.04,
OBS SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,INPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.13,OTHER,103.13,134.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,INPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
OBS SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,INPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,103.13,,103.13,134.75,
OBS IV HYDRATION ADD'L HR,96361,CPT,450,RC,,INPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.38,OTHER,88.5,115.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IV HYDRATION ADD'L HR,96361,CPT,450,RC,,INPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
OBS IV HYDRATION ADD'L HR,96361,CPT,450,RC,,INPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,,88.5,,88.5,115.64,
BAMLANIVIMAB,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,BLUE CROSS ANTHEM,COMMERCIAL,,,,298.22,OTHER,245.8,321.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAMLANIVIMAB,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,MONUMENT,COMMERCIAL,,,,262.2,,245.8,321.2,
BAMLANIVIMAB,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,UNITED HEALTH,UNITED COMMERCIAL,,,,245.8,,245.8,321.2,
BAMLANIVIMAB MS,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,BLUE CROSS ANTHEM,COMMERCIAL,,,,298.22,OTHER,245.8,321.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAMLANIVIMAB MS,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,MONUMENT,COMMERCIAL,,,,262.2,,245.8,321.2,
BAMLANIVIMAB MS,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,UNITED HEALTH,UNITED COMMERCIAL,,,,245.8,,245.8,321.2,
REGENERON,M0243,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,BLUE CROSS ANTHEM,COMMERCIAL,,,,425.1,OTHER,350.4,457.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
REGENERON,M0243,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,MONUMENT,COMMERCIAL,,,,373.7,,350.4,457.8,
REGENERON,M0243,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UNITED HEALTH,UNITED COMMERCIAL,,,,350.4,,350.4,457.8,
REGENERON MS,M0243,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,BLUE CROSS ANTHEM,COMMERCIAL,,,,424.89,OTHER,350.2,457.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
REGENERON MS,M0243,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,MONUMENT,COMMERCIAL,,,,373.5,,350.2,457.6,
REGENERON MS,M0243,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,UNITED HEALTH,UNITED COMMERCIAL,,,,350.2,,350.2,457.6,
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,BLUE CROSS ANTHEM,COMMERCIAL,,,,425.1,OTHER,350.4,457.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,MONUMENT,COMMERCIAL,,,,373.7,,350.4,457.8,
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UNITED HEALTH,UNITED COMMERCIAL,,,,350.4,,350.4,457.8,
BAMLAN AND ETESEV INFUSION MS,M0245,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,BLUE CROSS ANTHEM,COMMERCIAL,,,,424.89,OTHER,350.2,457.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAMLAN AND ETESEV INFUSION MS,M0245,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,MONUMENT,COMMERCIAL,,,,373.5,,350.2,457.6,
BAMLAN AND ETESEV INFUSION MS,M0245,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,UNITED HEALTH,UNITED COMMERCIAL,,,,350.2,,350.2,457.6,
SOTROVIMAB INFUSION,M0247,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,BLUE CROSS ANTHEM,COMMERCIAL,,,,425.1,OTHER,350.4,457.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SOTROVIMAB INFUSION,M0247,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,MONUMENT,COMMERCIAL,,,,373.7,,350.4,457.8,
SOTROVIMAB INFUSION,M0247,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UNITED HEALTH,UNITED COMMERCIAL,,,,350.4,,350.4,457.8,
SOTROVIMAB INFUSION MS,M0247,HCPCS,771,RC,,INPATIENT,,,897.92,359.168,BLUE CROSS ANTHEM,COMMERCIAL,,,,817.11,OTHER,673.4,880,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SOTROVIMAB INFUSION MS,M0247,HCPCS,771,RC,,INPATIENT,,,897.92,359.168,MONUMENT,COMMERCIAL,,,,718.3,,673.4,880,
SOTROVIMAB INFUSION MS,M0247,HCPCS,771,RC,,INPATIENT,,,897.92,359.168,UNITED HEALTH,UNITED COMMERCIAL,,,,673.4,,673.4,880,
"TIXAGEV AND CILGAV, INJ",M0220,HCPCS,771,RC,,INPATIENT,,,156.17,62.468,BLUE CROSS ANTHEM,COMMERCIAL,,,,142.11,OTHER,117.1,153,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"TIXAGEV AND CILGAV, INJ",M0220,HCPCS,771,RC,,INPATIENT,,,156.17,62.468,MONUMENT,COMMERCIAL,,,,124.9,,117.1,153,
"TIXAGEV AND CILGAV, INJ",M0220,HCPCS,771,RC,,INPATIENT,,,156.17,62.468,UNITED HEALTH,UNITED COMMERCIAL,,,,117.1,,117.1,153,
BEBTELOVIMAB INJECTION,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,BLUE CROSS ANTHEM,COMMERCIAL,,,,330.96,OTHER,272.8,356.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BEBTELOVIMAB INJECTION,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,MONUMENT,COMMERCIAL,,,,291,,272.8,356.4,
BEBTELOVIMAB INJECTION,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,UNITED HEALTH,UNITED COMMERCIAL,,,,272.8,,272.8,356.4,
BEBTELOVIMAB INJECTION MS,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,BLUE CROSS ANTHEM,COMMERCIAL,,,,330.96,OTHER,272.8,356.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BEBTELOVIMAB INJECTION MS,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,MONUMENT,COMMERCIAL,,,,291,,272.8,356.4,
BEBTELOVIMAB INJECTION MS,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,UNITED HEALTH,UNITED COMMERCIAL,,,,272.8,,272.8,356.4,
IMMUNIZATION ADMIN,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,108,141.1,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNIZATION ADMIN,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.1,
AXILLA MARKER PLACEMENT,10035,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,929.8,1214.9,PERCENT OF TOTAL BILLED CHARGES
IMMUNIZATION ADMIN EACH ADD,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.4,OTHER,68.8,89.9,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNIZATION ADMIN EACH ADD,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,MONUMENT,COMMERCIAL,,,,73.4,,68.8,89.9,
ACNE SURGERY,10040,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 1-2 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,919.8,OTHER,862.3,1126.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANS SER 1-2 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,MONUMENT,COMMERCIAL,,,,919.8,,862.3,1126.8,
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
CONCURRENT ADMIN OF CHEMO,96549,CPT,261,RC,,OUTPATIENT,,,301.75,120.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,241.4,OTHER,226.31,295.72,PERCENT OF CHARGES BASED ON HCPCS CODE
CONCURRENT ADMIN OF CHEMO,96549,CPT,261,RC,,OUTPATIENT,,,301.75,120.7,MONUMENT,COMMERCIAL,,,,241.4,,226.31,295.72,
INCIS/DRAIN ABCESS COMP/MULT,10061,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 0-1 HOUR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.8,OTHER,787.3,1028.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANS SER 0-1 HOUR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,MONUMENT,COMMERCIAL,,,,839.8,,787.3,1028.8,
INCISION & DRAINAGE PILONIDAL,10080,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
TRAY DRESSING,2700010,CDM,,,,INPATIENT,,,30.25,12.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.53,OTHER,22.69,29.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY DRESSING,2700010,CDM,,,,INPATIENT,,,30.25,12.1,MONUMENT,COMMERCIAL,,,,24.2,,22.69,29.65,
TRAY DRESSING,2700010,CDM,,,,INPATIENT,,,30.25,12.1,UNITED HEALTH,UNITED COMMERCIAL,,,,22.69,,22.69,29.65,
SAFE EXAM,2700012,CDM,,,,INPATIENT,,,389,155.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,353.99,OTHER,291.75,381.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SAFE EXAM,2700012,CDM,,,,INPATIENT,,,389,155.6,MONUMENT,COMMERCIAL,,,,311.2,,291.75,381.22,
SAFE EXAM,2700012,CDM,,,,INPATIENT,,,389,155.6,UNITED HEALTH,UNITED COMMERCIAL,,,,291.75,,291.75,381.22,
EVIDENCE COLLECTION,2700014,CDM,,,,INPATIENT,,,389,155.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,353.99,OTHER,291.75,381.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EVIDENCE COLLECTION,2700014,CDM,,,,INPATIENT,,,389,155.6,MONUMENT,COMMERCIAL,,,,311.2,,291.75,381.22,
EVIDENCE COLLECTION,2700014,CDM,,,,INPATIENT,,,389,155.6,UNITED HEALTH,UNITED COMMERCIAL,,,,291.75,,291.75,381.22,
ADAPTER REMOTE RES SPIKE,2700020,CDM,,,,INPATIENT,,,155.75,62.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.73,OTHER,116.81,152.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADAPTER REMOTE RES SPIKE,2700020,CDM,,,,INPATIENT,,,155.75,62.3,MONUMENT,COMMERCIAL,,,,124.6,,116.81,152.64,
ADAPTER REMOTE RES SPIKE,2700020,CDM,,,,INPATIENT,,,155.75,62.3,UNITED HEALTH,UNITED COMMERCIAL,,,,116.81,,116.81,152.64,
AERO CHAMBER,2700030,CDM,,,,INPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.61,OTHER,49.13,64.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AERO CHAMBER,2700030,CDM,,,,INPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
AERO CHAMBER,2700030,CDM,,,,INPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,49.13,,49.13,64.19,
BAG BILE REG,2700040,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG BILE REG,2700040,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
BAG BILE REG,2700040,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
CROSSFLOW OUTFLOW TUBING,2700060,CDM,,,,INPATIENT,,,147.75,59.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.45,OTHER,110.81,144.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CROSSFLOW OUTFLOW TUBING,2700060,CDM,,,,INPATIENT,,,147.75,59.1,MONUMENT,COMMERCIAL,,,,118.2,,110.81,144.8,
CROSSFLOW OUTFLOW TUBING,2700060,CDM,,,,INPATIENT,,,147.75,59.1,UNITED HEALTH,UNITED COMMERCIAL,,,,110.81,,110.81,144.8,
ARM SLING LG,2700070,CDM,,,,INPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.32,OTHER,39,50.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ARM SLING LG,2700070,CDM,,,,INPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
ARM SLING LG,2700070,CDM,,,,INPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,,39,,39,50.96,
ARM SLING MD,2700080,CDM,,,,INPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.08,OTHER,30.56,39.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ARM SLING MD,2700080,CDM,,,,INPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
ARM SLING MD,2700080,CDM,,,,INPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,,30.56,,30.56,39.94,
ARM SLING SM,2700090,CDM,,,,INPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.08,OTHER,30.56,39.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ARM SLING SM,2700090,CDM,,,,INPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
ARM SLING SM,2700090,CDM,,,,INPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,,30.56,,30.56,39.94,
LOWER BODY WARMER BLANKET,2700092,CDM,,,,INPATIENT,,,27.25,10.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.8,OTHER,20.44,26.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOWER BODY WARMER BLANKET,2700092,CDM,,,,INPATIENT,,,27.25,10.9,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
LOWER BODY WARMER BLANKET,2700092,CDM,,,,INPATIENT,,,27.25,10.9,UNITED HEALTH,UNITED COMMERCIAL,,,,20.44,,20.44,26.71,
ATHLETIC SUPPORTER MD,2700100,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ATHLETIC SUPPORTER MD,2700100,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
ATHLETIC SUPPORTER MD,2700100,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
ATHLETIC SUPPORTER SM,2700110,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ATHLETIC SUPPORTER SM,2700110,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
ATHLETIC SUPPORTER SM,2700110,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
ORTHO SLING ARM CHILD W/PAD,2700120,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SLING ARM CHILD W/PAD,2700120,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
ORTHO SLING ARM CHILD W/PAD,2700120,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
BAG RESUS W/MASK ADULT,2700130,CDM,,,,INPATIENT,,,103.25,41.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.96,OTHER,77.44,101.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG RESUS W/MASK ADULT,2700130,CDM,,,,INPATIENT,,,103.25,41.3,MONUMENT,COMMERCIAL,,,,82.6,,77.44,101.19,
BAG RESUS W/MASK ADULT,2700130,CDM,,,,INPATIENT,,,103.25,41.3,UNITED HEALTH,UNITED COMMERCIAL,,,,77.44,,77.44,101.19,
BAG RESUS W/MASK CHILD,2700140,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG RESUS W/MASK CHILD,2700140,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
BAG RESUS W/MASK CHILD,2700140,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
BANDAGE ESMARK W/O LINER,2700170,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BANDAGE ESMARK W/O LINER,2700170,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
BANDAGE ESMARK W/O LINER,2700170,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
BITE PROOF BITE BLOCK,2700180,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BITE PROOF BITE BLOCK,2700180,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
BITE PROOF BITE BLOCK,2700180,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
BITE BLOCK DISPOSIBLE,2700200,CDM,,,,INPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.71,OTHER,25.31,33.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BITE BLOCK DISPOSIBLE,2700200,CDM,,,,INPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
BITE BLOCK DISPOSIBLE,2700200,CDM,,,,INPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,,25.31,,25.31,33.08,
FLUTTER VALVE (BLUE),2700211,CDM,,,,INPATIENT,,,135.5,54.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.31,OTHER,101.63,132.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FLUTTER VALVE (BLUE),2700211,CDM,,,,INPATIENT,,,135.5,54.2,MONUMENT,COMMERCIAL,,,,108.4,,101.63,132.79,
FLUTTER VALVE (BLUE),2700211,CDM,,,,INPATIENT,,,135.5,54.2,UNITED HEALTH,UNITED COMMERCIAL,,,,101.63,,101.63,132.79,
ORTHO BOOT CAST XLG OPEN,2700240,CDM,,,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO BOOT CAST XLG OPEN,2700240,CDM,,,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ORTHO BOOT CAST XLG OPEN,2700240,CDM,,,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
CUFF CRYO KNEE MED W/COOLER,2700242,CDM,,,,INPATIENT,,,170.75,68.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,155.38,OTHER,128.06,167.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CUFF CRYO KNEE MED W/COOLER,2700242,CDM,,,,INPATIENT,,,170.75,68.3,MONUMENT,COMMERCIAL,,,,136.6,,128.06,167.34,
CUFF CRYO KNEE MED W/COOLER,2700242,CDM,,,,INPATIENT,,,170.75,68.3,UNITED HEALTH,UNITED COMMERCIAL,,,,128.06,,128.06,167.34,
BRACHIAL PLEXUS ANES TRAY,2700270,CDM,,,,INPATIENT,,,267.75,107.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,243.65,OTHER,200.81,262.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BRACHIAL PLEXUS ANES TRAY,2700270,CDM,,,,INPATIENT,,,267.75,107.1,MONUMENT,COMMERCIAL,,,,214.2,,200.81,262.4,
BRACHIAL PLEXUS ANES TRAY,2700270,CDM,,,,INPATIENT,,,267.75,107.1,UNITED HEALTH,UNITED COMMERCIAL,,,,200.81,,200.81,262.4,
KOPANS NEEDLE 20G 5CM,2700300,CDM,,,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KOPANS NEEDLE 20G 5CM,2700300,CDM,,,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
KOPANS NEEDLE 20G 5CM,2700300,CDM,,,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
KOPANS NEEDLE 20G 7CM,2700301,CDM,,,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KOPANS NEEDLE 20G 7CM,2700301,CDM,,,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
KOPANS NEEDLE 20G 7CM,2700301,CDM,,,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
KOPANS NEEDLE 20G 9CM,2700302,CDM,,,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KOPANS NEEDLE 20G 9CM,2700302,CDM,,,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
KOPANS NEEDLE 20G 9CM,2700302,CDM,,,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
KOPANS NEEDLE 20G 15CM,2700303,CDM,,,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KOPANS NEEDLE 20G 15CM,2700303,CDM,,,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
KOPANS NEEDLE 20G 15CM,2700303,CDM,,,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
HOMER MAMMOLOK 20G 5CM,2700304,CDM,,,,INPATIENT,,,118.75,47.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.06,OTHER,89.06,116.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HOMER MAMMOLOK 20G 5CM,2700304,CDM,,,,INPATIENT,,,118.75,47.5,MONUMENT,COMMERCIAL,,,,95,,89.06,116.38,
HOMER MAMMOLOK 20G 5CM,2700304,CDM,,,,INPATIENT,,,118.75,47.5,UNITED HEALTH,UNITED COMMERCIAL,,,,89.06,,89.06,116.38,
HOMER MAMMOLOR 20G 7.5CM,2700305,CDM,,,,INPATIENT,,,126.75,50.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.34,OTHER,95.06,124.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HOMER MAMMOLOR 20G 7.5CM,2700305,CDM,,,,INPATIENT,,,126.75,50.7,MONUMENT,COMMERCIAL,,,,101.4,,95.06,124.22,
HOMER MAMMOLOR 20G 7.5CM,2700305,CDM,,,,INPATIENT,,,126.75,50.7,UNITED HEALTH,UNITED COMMERCIAL,,,,95.06,,95.06,124.22,
HOMER MAMMOLOK 20G 10CM,2700306,CDM,,,,INPATIENT,,,126.75,50.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.34,OTHER,95.06,124.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HOMER MAMMOLOK 20G 10CM,2700306,CDM,,,,INPATIENT,,,126.75,50.7,MONUMENT,COMMERCIAL,,,,101.4,,95.06,124.22,
HOMER MAMMOLOK 20G 10CM,2700306,CDM,,,,INPATIENT,,,126.75,50.7,UNITED HEALTH,UNITED COMMERCIAL,,,,95.06,,95.06,124.22,
HOMER MAMMOLOK 20G 12.5CM,2700307,CDM,,,,INPATIENT,,,118.75,47.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.06,OTHER,89.06,116.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HOMER MAMMOLOK 20G 12.5CM,2700307,CDM,,,,INPATIENT,,,118.75,47.5,MONUMENT,COMMERCIAL,,,,95,,89.06,116.38,
HOMER MAMMOLOK 20G 12.5CM,2700307,CDM,,,,INPATIENT,,,118.75,47.5,UNITED HEALTH,UNITED COMMERCIAL,,,,89.06,,89.06,116.38,
GALACTOGRAPHY INFUSION UNIT,2700308,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GALACTOGRAPHY INFUSION UNIT,2700308,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
GALACTOGRAPHY INFUSION UNIT,2700308,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
GALACTOGRAPHY KIT DGK002X,2700309,CDM,,,,INPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.13,OTHER,71.81,93.84,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GALACTOGRAPHY KIT DGK002X,2700309,CDM,,,,INPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
GALACTOGRAPHY KIT DGK002X,2700309,CDM,,,,INPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,,71.81,,71.81,93.84,
YUEH CENTESIS NEEDLE 9646,2700310,CDM,,,,INPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.77,OTHER,70.69,92.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
YUEH CENTESIS NEEDLE 9646,2700310,CDM,,,,INPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
YUEH CENTESIS NEEDLE 9646,2700310,CDM,,,,INPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,,70.69,,70.69,92.37,
TRAY CENTRAL VEIN CATH,2700500,CDM,,,,INPATIENT,,,132,52.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.12,OTHER,99,129.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY CENTRAL VEIN CATH,2700500,CDM,,,,INPATIENT,,,132,52.8,MONUMENT,COMMERCIAL,,,,105.6,,99,129.36,
TRAY CENTRAL VEIN CATH,2700500,CDM,,,,INPATIENT,,,132,52.8,UNITED HEALTH,UNITED COMMERCIAL,,,,99,,99,129.36,
TRAY CENTRAL LINE,2700501,CDM,,,,INPATIENT,,,300,120,BLUE CROSS ANTHEM,COMMERCIAL,,,,273,OTHER,225,294,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY CENTRAL LINE,2700501,CDM,,,,INPATIENT,,,300,120,MONUMENT,COMMERCIAL,,,,240,,225,294,
TRAY CENTRAL LINE,2700501,CDM,,,,INPATIENT,,,300,120,UNITED HEALTH,UNITED COMMERCIAL,,,,225,,225,294,
BAG CLOSED URINARY DRAIN,2700630,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG CLOSED URINARY DRAIN,2700630,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
BAG CLOSED URINARY DRAIN,2700630,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
CONSTAVAC PVC BLOOD KIT,2700720,CDM,,,,INPATIENT,,,851.25,340.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,774.64,OTHER,638.44,834.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CONSTAVAC PVC BLOOD KIT,2700720,CDM,,,,INPATIENT,,,851.25,340.5,MONUMENT,COMMERCIAL,,,,681,,638.44,834.23,
CONSTAVAC PVC BLOOD KIT,2700720,CDM,,,,INPATIENT,,,851.25,340.5,UNITED HEALTH,UNITED COMMERCIAL,,,,638.44,,638.44,834.23,
WOUND VAC,2701000,CDM,,,,INPATIENT,,,899.5,359.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,818.55,OTHER,674.63,881.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WOUND VAC,2701000,CDM,,,,INPATIENT,,,899.5,359.8,MONUMENT,COMMERCIAL,,,,719.6,,674.63,881.51,
WOUND VAC,2701000,CDM,,,,INPATIENT,,,899.5,359.8,UNITED HEALTH,UNITED COMMERCIAL,,,,674.63,,674.63,881.51,
BLADDER FOLEY TRAY 18FR,2701210,CDM,,,,INPATIENT,,,111.25,44.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.24,OTHER,83.44,109.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADDER FOLEY TRAY 18FR,2701210,CDM,,,,INPATIENT,,,111.25,44.5,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
BLADDER FOLEY TRAY 18FR,2701210,CDM,,,,INPATIENT,,,111.25,44.5,UNITED HEALTH,UNITED COMMERCIAL,,,,83.44,,83.44,109.03,
BLADDER FOLEY TRAY 16FR,2701230,CDM,,,,INPATIENT,,,111.25,44.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.24,OTHER,83.44,109.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADDER FOLEY TRAY 16FR,2701230,CDM,,,,INPATIENT,,,111.25,44.5,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
BLADDER FOLEY TRAY 16FR,2701230,CDM,,,,INPATIENT,,,111.25,44.5,UNITED HEALTH,UNITED COMMERCIAL,,,,83.44,,83.44,109.03,
HIP SPICA MEDIUM,2701310,CDM,,,,INPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.13,OTHER,103.13,134.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SPICA MEDIUM,2701310,CDM,,,,INPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
HIP SPICA MEDIUM,2701310,CDM,,,,INPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,103.13,,103.13,134.75,
HIP SPICA LG,2701320,CDM,,,,INPATIENT,,,142.75,57.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.9,OTHER,107.06,139.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SPICA LG,2701320,CDM,,,,INPATIENT,,,142.75,57.1,MONUMENT,COMMERCIAL,,,,114.2,,107.06,139.9,
HIP SPICA LG,2701320,CDM,,,,INPATIENT,,,142.75,57.1,UNITED HEALTH,UNITED COMMERCIAL,,,,107.06,,107.06,139.9,
HIP SPICA XLG,2701330,CDM,,,,INPATIENT,,,142.75,57.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.9,OTHER,107.06,139.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIP SPICA XLG,2701330,CDM,,,,INPATIENT,,,142.75,57.1,MONUMENT,COMMERCIAL,,,,114.2,,107.06,139.9,
HIP SPICA XLG,2701330,CDM,,,,INPATIENT,,,142.75,57.1,UNITED HEALTH,UNITED COMMERCIAL,,,,107.06,,107.06,139.9,
HUMID VENT PED.,2701340,CDM,,,,INPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.32,OTHER,39,50.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HUMID VENT PED.,2701340,CDM,,,,INPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
HUMID VENT PED.,2701340,CDM,,,,INPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,,39,,39,50.96,
PREFIL HUMIDIFER 650ML,2701360,CDM,,,,INPATIENT,,,27.25,10.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.8,OTHER,20.44,26.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PREFIL HUMIDIFER 650ML,2701360,CDM,,,,INPATIENT,,,27.25,10.9,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
PREFIL HUMIDIFER 650ML,2701360,CDM,,,,INPATIENT,,,27.25,10.9,UNITED HEALTH,UNITED COMMERCIAL,,,,20.44,,20.44,26.71,
IMMOB   SHOULDER MD,2701370,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMOB   SHOULDER MD,2701370,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
IMMOB   SHOULDER MD,2701370,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
IMMOB   SHOULDER SM,2701380,CDM,,,,INPATIENT,,,38.5,15.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.04,OTHER,28.88,37.73,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMOB   SHOULDER SM,2701380,CDM,,,,INPATIENT,,,38.5,15.4,MONUMENT,COMMERCIAL,,,,30.8,,28.88,37.73,
IMMOB   SHOULDER SM,2701380,CDM,,,,INPATIENT,,,38.5,15.4,UNITED HEALTH,UNITED COMMERCIAL,,,,28.88,,28.88,37.73,
IMMOB   SHOULDER XLG,2701390,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMOB   SHOULDER XLG,2701390,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
IMMOB   SHOULDER XLG,2701390,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
IMMOB  SHOULDER LG,2701400,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMOB  SHOULDER LG,2701400,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
IMMOB  SHOULDER LG,2701400,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
IMMOB  SHOULDER XXLG,2701410,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMOB  SHOULDER XXLG,2701410,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
IMMOB  SHOULDER XXLG,2701410,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
BARRIER CREAM,2701420,CDM,,,,INPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43,OTHER,35.44,46.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BARRIER CREAM,2701420,CDM,,,,INPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
BARRIER CREAM,2701420,CDM,,,,INPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,,35.44,,35.44,46.31,
PERCUTAN INTROD KIT,2701430,CDM,,,,INPATIENT,,,314.75,125.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.42,OTHER,236.06,308.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PERCUTAN INTROD KIT,2701430,CDM,,,,INPATIENT,,,314.75,125.9,MONUMENT,COMMERCIAL,,,,251.8,,236.06,308.46,
PERCUTAN INTROD KIT,2701430,CDM,,,,INPATIENT,,,314.75,125.9,UNITED HEALTH,UNITED COMMERCIAL,,,,236.06,,236.06,308.46,
IV CATH EXT. SET,2701460,CDM,,,,INPATIENT,,,22.75,9.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.7,OTHER,17.06,22.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV CATH EXT. SET,2701460,CDM,,,,INPATIENT,,,22.75,9.1,MONUMENT,COMMERCIAL,,,,18.2,,17.06,22.3,
IV CATH EXT. SET,2701460,CDM,,,,INPATIENT,,,22.75,9.1,UNITED HEALTH,UNITED COMMERCIAL,,,,17.06,,17.06,22.3,
IV WARMING SET HOTLINE,2701470,CDM,,,,INPATIENT,,,93.75,37.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.31,OTHER,70.31,91.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV WARMING SET HOTLINE,2701470,CDM,,,,INPATIENT,,,93.75,37.5,MONUMENT,COMMERCIAL,,,,75,,70.31,91.88,
IV WARMING SET HOTLINE,2701470,CDM,,,,INPATIENT,,,93.75,37.5,UNITED HEALTH,UNITED COMMERCIAL,,,,70.31,,70.31,91.88,
POUCH CADD PUMP DISP,2701500,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POUCH CADD PUMP DISP,2701500,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
POUCH CADD PUMP DISP,2701500,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
"KNEE BRACE 20 SMALL""",2701540,CDM,,,,INPATIENT,,,168,67.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.88,OTHER,126,164.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE BRACE 20 SMALL""",2701540,CDM,,,,INPATIENT,,,168,67.2,MONUMENT,COMMERCIAL,,,,134.4,,126,164.64,
"KNEE BRACE 20 SMALL""",2701540,CDM,,,,INPATIENT,,,168,67.2,UNITED HEALTH,UNITED COMMERCIAL,,,,126,,126,164.64,
"KNEE BRACE 22 MEDIUM""",2701550,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE BRACE 22 MEDIUM""",2701550,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
"KNEE BRACE 22 MEDIUM""",2701550,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
"KNEE BRACE 18 X-SMALL""",2701560,CDM,,,,INPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.35,OTHER,59.63,77.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE BRACE 18 X-SMALL""",2701560,CDM,,,,INPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
"KNEE BRACE 18 X-SMALL""",2701560,CDM,,,,INPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,,59.63,,59.63,77.91,
"KNEE BRACE 24 LARGE""",L1830,HCPCS,274,RC,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE BRACE 24 LARGE""",L1830,HCPCS,274,RC,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
"KNEE BRACE 24 LARGE""",L1830,HCPCS,274,RC,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
"KNEE, BRACE HINGED LONG",2701572,CDM,,,,INPATIENT,,,308.75,123.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.96,OTHER,231.56,302.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, BRACE HINGED LONG",2701572,CDM,,,,INPATIENT,,,308.75,123.5,MONUMENT,COMMERCIAL,,,,247,,231.56,302.58,
"KNEE, BRACE HINGED LONG",2701572,CDM,,,,INPATIENT,,,308.75,123.5,UNITED HEALTH,UNITED COMMERCIAL,,,,231.56,,231.56,302.58,
"KNEE, BRACE HINGED SHORT",L1833,HCPCS,274,RC,,INPATIENT,,,299.75,119.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,272.77,OTHER,224.81,293.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"KNEE, BRACE HINGED SHORT",L1833,HCPCS,274,RC,,INPATIENT,,,299.75,119.9,MONUMENT,COMMERCIAL,,,,239.8,,224.81,293.76,
"KNEE, BRACE HINGED SHORT",L1833,HCPCS,274,RC,,INPATIENT,,,299.75,119.9,UNITED HEALTH,UNITED COMMERCIAL,,,,224.81,,224.81,293.76,
WRIST HOLDER,2701590,CDM,,,,INPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.37,OTHER,40.69,53.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WRIST HOLDER,2701590,CDM,,,,INPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
WRIST HOLDER,2701590,CDM,,,,INPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,40.69,,40.69,53.17,
RESERVOIR SUCTION 100CC,2701610,CDM,,,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RESERVOIR SUCTION 100CC,2701610,CDM,,,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
RESERVOIR SUCTION 100CC,2701610,CDM,,,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
SAL. SUMP ANTI-REFLUX ADDPT,2701620,CDM,,,,INPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.47,OTHER,52.31,68.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SAL. SUMP ANTI-REFLUX ADDPT,2701620,CDM,,,,INPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
SAL. SUMP ANTI-REFLUX ADDPT,2701620,CDM,,,,INPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,,52.31,,52.31,68.36,
MASK SEAL EASY,2701630,CDM,,,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MASK SEAL EASY,2701630,CDM,,,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
MASK SEAL EASY,2701630,CDM,,,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
PRESS. MONIT. KIT W/TRAN,2701640,CDM,,,,INPATIENT,,,130.5,52.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.76,OTHER,97.88,127.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PRESS. MONIT. KIT W/TRAN,2701640,CDM,,,,INPATIENT,,,130.5,52.2,MONUMENT,COMMERCIAL,,,,104.4,,97.88,127.89,
PRESS. MONIT. KIT W/TRAN,2701640,CDM,,,,INPATIENT,,,130.5,52.2,UNITED HEALTH,UNITED COMMERCIAL,,,,97.88,,97.88,127.89,
OPTIVAC KIT DOUBLE MIX SYSTEM,2701650,CDM,,,,INPATIENT,,,189,75.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,171.99,OTHER,141.75,185.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OPTIVAC KIT DOUBLE MIX SYSTEM,2701650,CDM,,,,INPATIENT,,,189,75.6,MONUMENT,COMMERCIAL,,,,151.2,,141.75,185.22,
OPTIVAC KIT DOUBLE MIX SYSTEM,2701650,CDM,,,,INPATIENT,,,189,75.6,UNITED HEALTH,UNITED COMMERCIAL,,,,141.75,,141.75,185.22,
MIX EVAC II,2701660,CDM,,,,INPATIENT,,,398.25,159.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,362.41,OTHER,298.69,390.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MIX EVAC II,2701660,CDM,,,,INPATIENT,,,398.25,159.3,MONUMENT,COMMERCIAL,,,,318.6,,298.69,390.29,
MIX EVAC II,2701660,CDM,,,,INPATIENT,,,398.25,159.3,UNITED HEALTH,UNITED COMMERCIAL,,,,298.69,,298.69,390.29,
KIT MULTIMED BDL LUMEN 7FR,2701670,CDM,,,,INPATIENT,,,264.75,105.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,240.92,OTHER,198.56,259.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KIT MULTIMED BDL LUMEN 7FR,2701670,CDM,,,,INPATIENT,,,264.75,105.9,MONUMENT,COMMERCIAL,,,,211.8,,198.56,259.46,
KIT MULTIMED BDL LUMEN 7FR,2701670,CDM,,,,INPATIENT,,,264.75,105.9,UNITED HEALTH,UNITED COMMERCIAL,,,,198.56,,198.56,259.46,
NASOGASTRIC LEVIN TUBE 18,2701710,CDM,,,,INPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.71,OTHER,25.31,33.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NASOGASTRIC LEVIN TUBE 18,2701710,CDM,,,,INPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
NASOGASTRIC LEVIN TUBE 18,2701710,CDM,,,,INPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,,25.31,,25.31,33.08,
NEEDLE  BIOPSY 20MM DISP,2701720,CDM,,,,INPATIENT,,,258.75,103.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,235.46,OTHER,194.06,253.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEEDLE  BIOPSY 20MM DISP,2701720,CDM,,,,INPATIENT,,,258.75,103.5,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
NEEDLE  BIOPSY 20MM DISP,2701720,CDM,,,,INPATIENT,,,258.75,103.5,UNITED HEALTH,UNITED COMMERCIAL,,,,194.06,,194.06,253.58,
NOSE PROBE,2701750,CDM,,,,INPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.16,OTHER,57,74.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NOSE PROBE,2701750,CDM,,,,INPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
NOSE PROBE,2701750,CDM,,,,INPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,,57,,57,74.48,
ESOPHAGEAL STETH 18FR,2701760,CDM,,,,INPATIENT,,,613.5,245.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,558.29,OTHER,460.13,601.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ESOPHAGEAL STETH 18FR,2701760,CDM,,,,INPATIENT,,,613.5,245.4,MONUMENT,COMMERCIAL,,,,490.8,,460.13,601.23,
ESOPHAGEAL STETH 18FR,2701760,CDM,,,,INPATIENT,,,613.5,245.4,UNITED HEALTH,UNITED COMMERCIAL,,,,460.13,,460.13,601.23,
ESOPHAGEAL STETH 12FR,2701770,CDM,,,,INPATIENT,,,1193.25,477.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1085.86,OTHER,894.94,1169.39,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ESOPHAGEAL STETH 12FR,2701770,CDM,,,,INPATIENT,,,1193.25,477.3,MONUMENT,COMMERCIAL,,,,954.6,,894.94,1169.39,
ESOPHAGEAL STETH 12FR,2701770,CDM,,,,INPATIENT,,,1193.25,477.3,UNITED HEALTH,UNITED COMMERCIAL,,,,894.94,,894.94,1169.39,
OPTHAMIC BURR,2701800,CDM,,,,INPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.31,OTHER,66.19,86.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OPTHAMIC BURR,2701800,CDM,,,,INPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
OPTHAMIC BURR,2701800,CDM,,,,INPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,66.19,,66.19,86.49,
POST OP SHOES LADIES LG,2701810,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POST OP SHOES LADIES LG,2701810,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
POST OP SHOES LADIES LG,2701810,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
POST OP SHOES MEN LG,2701820,CDM,,,,INPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.51,OTHER,81.19,106.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POST OP SHOES MEN LG,2701820,CDM,,,,INPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
POST OP SHOES MEN LG,2701820,CDM,,,,INPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,,81.19,,81.19,106.09,
POST OP SHOES LADIES MED,2701830,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POST OP SHOES LADIES MED,2701830,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
POST OP SHOES LADIES MED,2701830,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
POST OP SHOES MEN MD,2701850,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POST OP SHOES MEN MD,2701850,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
POST OP SHOES MEN MD,2701850,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
MICRODRIP NON VENT,2701860,CDM,,,,INPATIENT,,,22.75,9.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.7,OTHER,17.06,22.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MICRODRIP NON VENT,2701860,CDM,,,,INPATIENT,,,22.75,9.1,MONUMENT,COMMERCIAL,,,,18.2,,17.06,22.3,
MICRODRIP NON VENT,2701860,CDM,,,,INPATIENT,,,22.75,9.1,UNITED HEALTH,UNITED COMMERCIAL,,,,17.06,,17.06,22.3,
MICRO CURVED SCISSOR,2701861,CDM,,,,INPATIENT,,,736.5,294.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,670.22,OTHER,552.38,721.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MICRO CURVED SCISSOR,2701861,CDM,,,,INPATIENT,,,736.5,294.6,MONUMENT,COMMERCIAL,,,,589.2,,552.38,721.77,
MICRO CURVED SCISSOR,2701861,CDM,,,,INPATIENT,,,736.5,294.6,UNITED HEALTH,UNITED COMMERCIAL,,,,552.38,,552.38,721.77,
CURVED SCISSOR,2701862,CDM,,,,INPATIENT,,,557.75,223.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,507.55,OTHER,418.31,546.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CURVED SCISSOR,2701862,CDM,,,,INPATIENT,,,557.75,223.1,MONUMENT,COMMERCIAL,,,,446.2,,418.31,546.6,
CURVED SCISSOR,2701862,CDM,,,,INPATIENT,,,557.75,223.1,UNITED HEALTH,UNITED COMMERCIAL,,,,418.31,,418.31,546.6,
KIT PERITIONEAL LAVAGE,2701880,CDM,,,,INPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.28,OTHER,151.88,198.45,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
KIT PERITIONEAL LAVAGE,2701880,CDM,,,,INPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
KIT PERITIONEAL LAVAGE,2701880,CDM,,,,INPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,,151.88,,151.88,198.45,
TRAY PERCUTANEOUS,2701890,CDM,,,,INPATIENT,,,251.75,100.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.09,OTHER,188.81,246.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAY PERCUTANEOUS,2701890,CDM,,,,INPATIENT,,,251.75,100.7,MONUMENT,COMMERCIAL,,,,201.4,,188.81,246.72,
TRAY PERCUTANEOUS,2701890,CDM,,,,INPATIENT,,,251.75,100.7,UNITED HEALTH,UNITED COMMERCIAL,,,,188.81,,188.81,246.72,
ATRIUM SINGLE CHEST DRAIN,2701900,CDM,,,,INPATIENT,,,236,94.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.76,OTHER,177,231.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ATRIUM SINGLE CHEST DRAIN,2701900,CDM,,,,INPATIENT,,,236,94.4,MONUMENT,COMMERCIAL,,,,188.8,,177,231.28,
ATRIUM SINGLE CHEST DRAIN,2701900,CDM,,,,INPATIENT,,,236,94.4,UNITED HEALTH,UNITED COMMERCIAL,,,,177,,177,231.28,
SPLINT SAM,2701920,CDM,,,,INPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.48,OTHER,60.56,79.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT SAM,2701920,CDM,,,,INPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
SPLINT SAM,2701920,CDM,,,,INPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,,60.56,,60.56,79.14,
STYLETE SHERI-SLIP 10FR,2701930,CDM,,,,INPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.18,OTHER,33.94,44.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STYLETE SHERI-SLIP 10FR,2701930,CDM,,,,INPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
STYLETE SHERI-SLIP 10FR,2701930,CDM,,,,INPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,,33.94,,33.94,44.35,
SKIN TEMP SENSOR,2701940,CDM,,,,INPATIENT,,,20.75,8.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.88,OTHER,15.56,20.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SKIN TEMP SENSOR,2701940,CDM,,,,INPATIENT,,,20.75,8.3,MONUMENT,COMMERCIAL,,,,16.6,,15.56,20.34,
SKIN TEMP SENSOR,2701940,CDM,,,,INPATIENT,,,20.75,8.3,UNITED HEALTH,UNITED COMMERCIAL,,,,15.56,,15.56,20.34,
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
SPLINT ONE STEP 2 X 10,2701960,CDM,271,RC,,INPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.28,OTHER,45.56,59.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 2 X 10,2701960,CDM,271,RC,,INPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
SPLINT ONE STEP 2 X 10,2701960,CDM,271,RC,,INPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,,45.56,,45.56,59.54,
SPLINT ONE STEP 3 X 35,2701970,CDM,,,,INPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.62,OTHER,96.94,126.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 3 X 35,2701970,CDM,,,,INPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
SPLINT ONE STEP 3 X 35,2701970,CDM,,,,INPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,,96.94,,96.94,126.67,
SPLINT ONE STEP 5 X 45,2701980,CDM,,,,INPATIENT,,,177.5,71,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.53,OTHER,133.13,173.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 5 X 45,2701980,CDM,,,,INPATIENT,,,177.5,71,MONUMENT,COMMERCIAL,,,,142,,133.13,173.95,
SPLINT ONE STEP 5 X 45,2701980,CDM,,,,INPATIENT,,,177.5,71,UNITED HEALTH,UNITED COMMERCIAL,,,,133.13,,133.13,173.95,
SPLINT ONE STEP 5 X 30,2701990,CDM,,,,INPATIENT,,,152.25,60.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,138.55,OTHER,114.19,149.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 5 X 30,2701990,CDM,,,,INPATIENT,,,152.25,60.9,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
SPLINT ONE STEP 5 X 30,2701990,CDM,,,,INPATIENT,,,152.25,60.9,UNITED HEALTH,UNITED COMMERCIAL,,,,114.19,,114.19,149.21,
SPLINT ONE STEP 4 X 15,2702000,CDM,271,RC,,INPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.36,OTHER,67.88,88.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT ONE STEP 4 X 15,2702000,CDM,271,RC,,INPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
SPLINT ONE STEP 4 X 15,2702000,CDM,271,RC,,INPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,,67.88,,67.88,88.69,
SPLINT WRIST XSM-XLG LT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.51,OTHER,81.19,106.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT WRIST XSM-XLG LT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
SPLINT WRIST XSM-XLG LT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,,81.19,,81.19,106.09,
SPLINT WRIST XSM-XLG RT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.51,OTHER,81.19,106.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPLINT WRIST XSM-XLG RT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
SPLINT WRIST XSM-XLG RT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,,81.19,,81.19,106.09,
STERI CATH CLOSED SUCTION,2702030,CDM,,,,INPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.75,OTHER,89.63,117.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERI CATH CLOSED SUCTION,2702030,CDM,,,,INPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
STERI CATH CLOSED SUCTION,2702030,CDM,,,,INPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,,89.63,,89.63,117.11,
SUCTION CANNISTER BLUE,2702090,CDM,,,,INPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.93,OTHER,17.25,22.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUCTION CANNISTER BLUE,2702090,CDM,,,,INPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.25,22.54,
SUCTION CANNISTER BLUE,2702090,CDM,,,,INPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,,17.25,,17.25,22.54,
SUCTION DELEE INFANT 10FR,2702100,CDM,,,,INPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.3,OTHER,18.38,24.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUCTION DELEE INFANT 10FR,2702100,CDM,,,,INPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
SUCTION DELEE INFANT 10FR,2702100,CDM,,,,INPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.38,,18.38,24.01,
SURGILAV PLUS HANDPIECE,2702110,CDM,,,,INPATIENT,,,362,144.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,329.42,OTHER,271.5,354.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SURGILAV PLUS HANDPIECE,2702110,CDM,,,,INPATIENT,,,362,144.8,MONUMENT,COMMERCIAL,,,,289.6,,271.5,354.76,
SURGILAV PLUS HANDPIECE,2702110,CDM,,,,INPATIENT,,,362,144.8,UNITED HEALTH,UNITED COMMERCIAL,,,,271.5,,271.5,354.76,
SURGIVAC EVACUATOR KIT,2702120,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SURGIVAC EVACUATOR KIT,2702120,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
SURGIVAC EVACUATOR KIT,2702120,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
EXTENSTION T CONNECTOR,2702140,CDM,,,,INPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.08,OTHER,30.56,39.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXTENSTION T CONNECTOR,2702140,CDM,,,,INPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
EXTENSTION T CONNECTOR,2702140,CDM,,,,INPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,,30.56,,30.56,39.94,
COLOSTOMY WOUND KIT,2702150,CDM,,,,INPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.75,OTHER,89.63,117.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COLOSTOMY WOUND KIT,2702150,CDM,,,,INPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
COLOSTOMY WOUND KIT,2702150,CDM,,,,INPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,,89.63,,89.63,117.11,
CROUP TENT CANOPY,2702280,CDM,,,,INPATIENT,,,103.25,41.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.96,OTHER,77.44,101.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CROUP TENT CANOPY,2702280,CDM,,,,INPATIENT,,,103.25,41.3,MONUMENT,COMMERCIAL,,,,82.6,,77.44,101.19,
CROUP TENT CANOPY,2702280,CDM,,,,INPATIENT,,,103.25,41.3,UNITED HEALTH,UNITED COMMERCIAL,,,,77.44,,77.44,101.19,
CATH TROCAR 20FR,2702290,CDM,,,,INPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.53,OTHER,101.81,133.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATH TROCAR 20FR,2702290,CDM,,,,INPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
CATH TROCAR 20FR,2702290,CDM,,,,INPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,,101.81,,101.81,133.04,
INFLOW CASSETTE TUBING,2702320,CDM,,,,INPATIENT,,,150.25,60.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.73,OTHER,112.69,147.25,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INFLOW CASSETTE TUBING,2702320,CDM,,,,INPATIENT,,,150.25,60.1,MONUMENT,COMMERCIAL,,,,120.2,,112.69,147.25,
INFLOW CASSETTE TUBING,2702320,CDM,,,,INPATIENT,,,150.25,60.1,UNITED HEALTH,UNITED COMMERCIAL,,,,112.69,,112.69,147.25,
URI-METER DRAIN BAG,2702330,CDM,,,,INPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.97,OTHER,85.69,111.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
URI-METER DRAIN BAG,2702330,CDM,,,,INPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
URI-METER DRAIN BAG,2702330,CDM,,,,INPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,,85.69,,85.69,111.97,
FLEXIBLE WAF. 2-3/4,2702360,CDM,,,,INPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.61,OTHER,49.13,64.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FLEXIBLE WAF. 2-3/4,2702360,CDM,,,,INPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
FLEXIBLE WAF. 2-3/4,2702360,CDM,,,,INPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,49.13,,49.13,64.19,
TROCAR V2,2702370,CDM,,,,INPATIENT,,,727.5,291,BLUE CROSS ANTHEM,COMMERCIAL,,,,662.03,OTHER,545.63,712.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR V2,2702370,CDM,,,,INPATIENT,,,727.5,291,MONUMENT,COMMERCIAL,,,,582,,545.63,712.95,
TROCAR V2,2702370,CDM,,,,INPATIENT,,,727.5,291,UNITED HEALTH,UNITED COMMERCIAL,,,,545.63,,545.63,712.95,
TROCAR 12MM W/REDUCER,2702380,CDM,,,,INPATIENT,,,637,254.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,579.67,OTHER,477.75,624.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR 12MM W/REDUCER,2702380,CDM,,,,INPATIENT,,,637,254.8,MONUMENT,COMMERCIAL,,,,509.6,,477.75,624.26,
TROCAR 12MM W/REDUCER,2702380,CDM,,,,INPATIENT,,,637,254.8,UNITED HEALTH,UNITED COMMERCIAL,,,,477.75,,477.75,624.26,
TROCAR VERSASTEP 12MM,2702390,CDM,,,,INPATIENT,,,514.25,205.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,467.97,OTHER,385.69,503.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR VERSASTEP 12MM,2702390,CDM,,,,INPATIENT,,,514.25,205.7,MONUMENT,COMMERCIAL,,,,411.4,,385.69,503.97,
TROCAR VERSASTEP 12MM,2702390,CDM,,,,INPATIENT,,,514.25,205.7,UNITED HEALTH,UNITED COMMERCIAL,,,,385.69,,385.69,503.97,
PROBE GUIDE LATERAL,2704000,CDM,,,,INPATIENT,,,53.5,21.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.69,OTHER,40.13,52.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROBE GUIDE LATERAL,2704000,CDM,,,,INPATIENT,,,53.5,21.4,MONUMENT,COMMERCIAL,,,,42.8,,40.13,52.43,
PROBE GUIDE LATERAL,2704000,CDM,,,,INPATIENT,,,53.5,21.4,UNITED HEALTH,UNITED COMMERCIAL,,,,40.13,,40.13,52.43,
VACUUM SET,2704001,CDM,,,,INPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.67,OTHER,67.31,87.96,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VACUUM SET,2704001,CDM,,,,INPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
VACUUM SET,2704001,CDM,,,,INPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,,67.31,,67.31,87.96,
BIOPSY SITE IDENTIFIER 11G2,2704002,CDM,,,,INPATIENT,,,388.5,155.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,353.54,OTHER,291.38,380.73,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOPSY SITE IDENTIFIER 11G2,2704002,CDM,,,,INPATIENT,,,388.5,155.4,MONUMENT,COMMERCIAL,,,,310.8,,291.38,380.73,
BIOPSY SITE IDENTIFIER 11G2,2704002,CDM,,,,INPATIENT,,,388.5,155.4,UNITED HEALTH,UNITED COMMERCIAL,,,,291.38,,291.38,380.73,
STEREOTACTIC PROBE,2704003,CDM,,,,INPATIENT,,,854.25,341.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,777.37,OTHER,640.69,837.17,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STEREOTACTIC PROBE,2704003,CDM,,,,INPATIENT,,,854.25,341.7,MONUMENT,COMMERCIAL,,,,683.4,,640.69,837.17,
STEREOTACTIC PROBE,2704003,CDM,,,,INPATIENT,,,854.25,341.7,UNITED HEALTH,UNITED COMMERCIAL,,,,640.69,,640.69,837.17,
BIOPSY SITE IDENTIFIER 11G,2704004,CDM,,,,INPATIENT,,,369.5,147.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,336.25,OTHER,277.13,362.11,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOPSY SITE IDENTIFIER 11G,2704004,CDM,,,,INPATIENT,,,369.5,147.8,MONUMENT,COMMERCIAL,,,,295.6,,277.13,362.11,
BIOPSY SITE IDENTIFIER 11G,2704004,CDM,,,,INPATIENT,,,369.5,147.8,UNITED HEALTH,UNITED COMMERCIAL,,,,277.13,,277.13,362.11,
PROBE GUIDE FRONTAL,2704005,CDM,,,,INPATIENT,,,49.5,19.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.05,OTHER,37.13,48.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROBE GUIDE FRONTAL,2704005,CDM,,,,INPATIENT,,,49.5,19.8,MONUMENT,COMMERCIAL,,,,39.6,,37.13,48.51,
PROBE GUIDE FRONTAL,2704005,CDM,,,,INPATIENT,,,49.5,19.8,UNITED HEALTH,UNITED COMMERCIAL,,,,37.13,,37.13,48.51,
WALKER SHORT SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER SHORT SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER SHORT SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER SHORT MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER SHORT MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER SHORT MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER SHORT LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER SHORT LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER SHORT LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
SHAVER BLADE TOMCAT 4.0MM,2704030,CDM,,,,INPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.7,OTHER,167.06,218.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHAVER BLADE TOMCAT 4.0MM,2704030,CDM,,,,INPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
SHAVER BLADE TOMCAT 4.0MM,2704030,CDM,,,,INPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,167.06,,167.06,218.3,
SHAVER BLADE TOMCAT 5.5MM,2704031,CDM,,,,INPATIENT,,,201.75,80.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,183.59,OTHER,151.31,197.72,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHAVER BLADE TOMCAT 5.5MM,2704031,CDM,,,,INPATIENT,,,201.75,80.7,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
SHAVER BLADE TOMCAT 5.5MM,2704031,CDM,,,,INPATIENT,,,201.75,80.7,UNITED HEALTH,UNITED COMMERCIAL,,,,151.31,,151.31,197.72,
ENDOPATH TROCAR 12X100,2704032,CDM,,,,INPATIENT,,,166.25,66.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,151.29,OTHER,124.69,162.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOPATH TROCAR 12X100,2704032,CDM,,,,INPATIENT,,,166.25,66.5,MONUMENT,COMMERCIAL,,,,133,,124.69,162.93,
ENDOPATH TROCAR 12X100,2704032,CDM,,,,INPATIENT,,,166.25,66.5,UNITED HEALTH,UNITED COMMERCIAL,,,,124.69,,124.69,162.93,
DRILL BIT TWIST 2.0,2704033,CDM,,,,INPATIENT,,,456.75,182.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,415.64,OTHER,342.56,447.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT TWIST 2.0,2704033,CDM,,,,INPATIENT,,,456.75,182.7,MONUMENT,COMMERCIAL,,,,365.4,,342.56,447.62,
DRILL BIT TWIST 2.0,2704033,CDM,,,,INPATIENT,,,456.75,182.7,UNITED HEALTH,UNITED COMMERCIAL,,,,342.56,,342.56,447.62,
MULTI CLIP APPLIER SM 9 3/8,2704034,CDM,,,,INPATIENT,,,235.75,94.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.53,OTHER,176.81,231.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MULTI CLIP APPLIER SM 9 3/8,2704034,CDM,,,,INPATIENT,,,235.75,94.3,MONUMENT,COMMERCIAL,,,,188.6,,176.81,231.04,
MULTI CLIP APPLIER SM 9 3/8,2704034,CDM,,,,INPATIENT,,,235.75,94.3,UNITED HEALTH,UNITED COMMERCIAL,,,,176.81,,176.81,231.04,
MULTIPLE CLIP APPLIER 9 3/8,2704035,CDM,,,,INPATIENT,,,237.25,94.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,215.9,OTHER,177.94,232.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MULTIPLE CLIP APPLIER 9 3/8,2704035,CDM,,,,INPATIENT,,,237.25,94.9,MONUMENT,COMMERCIAL,,,,189.8,,177.94,232.51,
MULTIPLE CLIP APPLIER 9 3/8,2704035,CDM,,,,INPATIENT,,,237.25,94.9,UNITED HEALTH,UNITED COMMERCIAL,,,,177.94,,177.94,232.51,
TROCAR VERSAPORT,2705000,CDM,,,,INPATIENT,,,356.5,142.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.42,OTHER,267.38,349.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR VERSAPORT,2705000,CDM,,,,INPATIENT,,,356.5,142.6,MONUMENT,COMMERCIAL,,,,285.2,,267.38,349.37,
TROCAR VERSAPORT,2705000,CDM,,,,INPATIENT,,,356.5,142.6,UNITED HEALTH,UNITED COMMERCIAL,,,,267.38,,267.38,349.37,
BLADELESS TROCAR XCEL 5MM,2705001,CDM,,,,INPATIENT,,,180.5,72.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,164.26,OTHER,135.38,176.89,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BLADELESS TROCAR XCEL 5MM,2705001,CDM,,,,INPATIENT,,,180.5,72.2,MONUMENT,COMMERCIAL,,,,144.4,,135.38,176.89,
BLADELESS TROCAR XCEL 5MM,2705001,CDM,,,,INPATIENT,,,180.5,72.2,UNITED HEALTH,UNITED COMMERCIAL,,,,135.38,,135.38,176.89,
TROCAR CANNULA W/SLEEVE,2705002,CDM,,,,INPATIENT,,,102.25,40.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.05,OTHER,76.69,100.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR CANNULA W/SLEEVE,2705002,CDM,,,,INPATIENT,,,102.25,40.9,MONUMENT,COMMERCIAL,,,,81.8,,76.69,100.21,
TROCAR CANNULA W/SLEEVE,2705002,CDM,,,,INPATIENT,,,102.25,40.9,UNITED HEALTH,UNITED COMMERCIAL,,,,76.69,,76.69,100.21,
SCISSORS CURVED W/UNIPOLAR,2705003,CDM,,,,INPATIENT,,,272.25,108.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,247.75,OTHER,204.19,266.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SCISSORS CURVED W/UNIPOLAR,2705003,CDM,,,,INPATIENT,,,272.25,108.9,MONUMENT,COMMERCIAL,,,,217.8,,204.19,266.81,
SCISSORS CURVED W/UNIPOLAR,2705003,CDM,,,,INPATIENT,,,272.25,108.9,UNITED HEALTH,UNITED COMMERCIAL,,,,204.19,,204.19,266.81,
WALKER SHORT XS,2705004,CDM,,,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER SHORT XS,2705004,CDM,,,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER SHORT XS,2705004,CDM,,,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER SHORT XL,2705005,CDM,,,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER SHORT XL,2705005,CDM,,,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER SHORT XL,2705005,CDM,,,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER STD SIZE XS,2705006,CDM,,,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER STD SIZE XS,2705006,CDM,,,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER STD SIZE XS,2705006,CDM,,,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER STD SIZE SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER STD SIZE SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER STD SIZE SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER STD SIZE MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER STD SIZE MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER STD SIZE MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER STD SIZE LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER STD SIZE LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER STD SIZE LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
WALKER STD SIZE XL,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WALKER STD SIZE XL,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
WALKER STD SIZE XL,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
TROCAR BLUNT TIP 12MM,2705011,CDM,,,,INPATIENT,,,278.75,111.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,253.66,OTHER,209.06,273.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TROCAR BLUNT TIP 12MM,2705011,CDM,,,,INPATIENT,,,278.75,111.5,MONUMENT,COMMERCIAL,,,,223,,209.06,273.18,
TROCAR BLUNT TIP 12MM,2705011,CDM,,,,INPATIENT,,,278.75,111.5,UNITED HEALTH,UNITED COMMERCIAL,,,,209.06,,209.06,273.18,
HARMONIC FOCUS CURVED SHEARS,2705012,CDM,,,,INPATIENT,,,1772.75,709.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1329.56,1737.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HARMONIC FOCUS CURVED SHEARS,2705012,CDM,,,,INPATIENT,,,1772.75,709.1,MONUMENT,COMMERCIAL,,,,1418.2,,1329.56,1737.3,
HARMONIC FOCUS CURVED SHEARS,2705012,CDM,,,,INPATIENT,,,1772.75,709.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1329.56,,1329.56,1737.3,
CANNULA UNIVERSAL SET 5.5MM,2705013,CDM,,,,INPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANNULA UNIVERSAL SET 5.5MM,2705013,CDM,,,,INPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
CANNULA UNIVERSAL SET 5.5MM,2705013,CDM,,,,INPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
BUR ROUND 8 FLUTES 5.5MM,2705014,CDM,,,,INPATIENT,,,203.75,81.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.41,OTHER,152.81,199.68,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BUR ROUND 8 FLUTES 5.5MM,2705014,CDM,,,,INPATIENT,,,203.75,81.5,MONUMENT,COMMERCIAL,,,,163,,152.81,199.68,
BUR ROUND 8 FLUTES 5.5MM,2705014,CDM,,,,INPATIENT,,,203.75,81.5,UNITED HEALTH,UNITED COMMERCIAL,,,,152.81,,152.81,199.68,
OSCILLATING SAW BLADE,2705015,CDM,,,,INPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.26,OTHER,99.94,130.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OSCILLATING SAW BLADE,2705015,CDM,,,,INPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
OSCILLATING SAW BLADE,2705015,CDM,,,,INPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,,99.94,,99.94,130.59,
SAW BLADE OSCILLATING,2705016,CDM,,,,INPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.86,OTHER,109.5,143.08,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SAW BLADE OSCILLATING,2705016,CDM,,,,INPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
SAW BLADE OSCILLATING,2705016,CDM,,,,INPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,,109.5,,109.5,143.08,
SHAVER BUR TAN 5.5MM,2705017,CDM,,,,INPATIENT,,,235,94,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.85,OTHER,176.25,230.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHAVER BUR TAN 5.5MM,2705017,CDM,,,,INPATIENT,,,235,94,MONUMENT,COMMERCIAL,,,,188,,176.25,230.3,
SHAVER BUR TAN 5.5MM,2705017,CDM,,,,INPATIENT,,,235,94,UNITED HEALTH,UNITED COMMERCIAL,,,,176.25,,176.25,230.3,
RASP LG TEARCROSS CUT 7X14,2705018,CDM,,,,INPATIENT,,,355.25,142.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,323.28,OTHER,266.44,348.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RASP LG TEARCROSS CUT 7X14,2705018,CDM,,,,INPATIENT,,,355.25,142.1,MONUMENT,COMMERCIAL,,,,284.2,,266.44,348.15,
RASP LG TEARCROSS CUT 7X14,2705018,CDM,,,,INPATIENT,,,355.25,142.1,UNITED HEALTH,UNITED COMMERCIAL,,,,266.44,,266.44,348.15,
DRILL BIT COUPLING 3.2X145,2705019,CDM,,,,INPATIENT,,,279.5,111.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.35,OTHER,209.63,273.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT COUPLING 3.2X145,2705019,CDM,,,,INPATIENT,,,279.5,111.8,MONUMENT,COMMERCIAL,,,,223.6,,209.63,273.91,
DRILL BIT COUPLING 3.2X145,2705019,CDM,,,,INPATIENT,,,279.5,111.8,UNITED HEALTH,UNITED COMMERCIAL,,,,209.63,,209.63,273.91,
TAP FOR 3.5MM CORTEX SCREW,2705020,CDM,,,,INPATIENT,,,360.75,144.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,328.28,OTHER,270.56,353.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TAP FOR 3.5MM CORTEX SCREW,2705020,CDM,,,,INPATIENT,,,360.75,144.3,MONUMENT,COMMERCIAL,,,,288.6,,270.56,353.54,
TAP FOR 3.5MM CORTEX SCREW,2705020,CDM,,,,INPATIENT,,,360.75,144.3,UNITED HEALTH,UNITED COMMERCIAL,,,,270.56,,270.56,353.54,
LIGASURE IMPACT TISSUE FUSION,2705021,CDM,,,,INPATIENT,,,1893.75,757.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.31,OTHER,1420.31,1855.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LIGASURE IMPACT TISSUE FUSION,2705021,CDM,,,,INPATIENT,,,1893.75,757.5,MONUMENT,COMMERCIAL,,,,1515,,1420.31,1855.88,
LIGASURE IMPACT TISSUE FUSION,2705021,CDM,,,,INPATIENT,,,1893.75,757.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1420.31,,1420.31,1855.88,
MULTICLIP APPLIER 11 1/2 LNGTH,2705022,CDM,,,,INPATIENT,,,237.25,94.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,215.9,OTHER,177.94,232.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MULTICLIP APPLIER 11 1/2 LNGTH,2705022,CDM,,,,INPATIENT,,,237.25,94.9,MONUMENT,COMMERCIAL,,,,189.8,,177.94,232.51,
MULTICLIP APPLIER 11 1/2 LNGTH,2705022,CDM,,,,INPATIENT,,,237.25,94.9,UNITED HEALTH,UNITED COMMERCIAL,,,,177.94,,177.94,232.51,
HARMONIC ACE PISTOL GRIP TORQ,2705023,CDM,,,,INPATIENT,,,1432.75,573.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1303.8,OTHER,1074.56,1404.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HARMONIC ACE PISTOL GRIP TORQ,2705023,CDM,,,,INPATIENT,,,1432.75,573.1,MONUMENT,COMMERCIAL,,,,1146.2,,1074.56,1404.1,
HARMONIC ACE PISTOL GRIP TORQ,2705023,CDM,,,,INPATIENT,,,1432.75,573.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1074.56,,1074.56,1404.1,
MULTI CLIP APPLIER SM,2705024,CDM,,,,INPATIENT,,,235.75,94.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,214.53,OTHER,176.81,231.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MULTI CLIP APPLIER SM,2705024,CDM,,,,INPATIENT,,,235.75,94.3,MONUMENT,COMMERCIAL,,,,188.6,,176.81,231.04,
MULTI CLIP APPLIER SM,2705024,CDM,,,,INPATIENT,,,235.75,94.3,UNITED HEALTH,UNITED COMMERCIAL,,,,176.81,,176.81,231.04,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,282.75,113.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,257.3,OTHER,212.06,277.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,282.75,113.1,MONUMENT,COMMERCIAL,,,,226.2,,212.06,277.1,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,282.75,113.1,UNITED HEALTH,UNITED COMMERCIAL,,,,212.06,,212.06,277.1,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,293.75,117.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,267.31,OTHER,220.31,287.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,293.75,117.5,MONUMENT,COMMERCIAL,,,,235,,220.31,287.88,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,293.75,117.5,UNITED HEALTH,UNITED COMMERCIAL,,,,220.31,,220.31,287.88,
DRILL BIT CANNULATED,2705027,CDM,,,,INPATIENT,,,1392.25,556.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1266.95,OTHER,1044.19,1364.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT CANNULATED,2705027,CDM,,,,INPATIENT,,,1392.25,556.9,MONUMENT,COMMERCIAL,,,,1113.8,,1044.19,1364.41,
DRILL BIT CANNULATED,2705027,CDM,,,,INPATIENT,,,1392.25,556.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1044.19,,1044.19,1364.41,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,452.75,181.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,412,OTHER,339.56,443.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,452.75,181.1,MONUMENT,COMMERCIAL,,,,362.2,,339.56,443.7,
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,452.75,181.1,UNITED HEALTH,UNITED COMMERCIAL,,,,339.56,,339.56,443.7,
SAGITTAL SAW BLADE,2705029,CDM,,,,INPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.26,OTHER,99.94,130.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SAGITTAL SAW BLADE,2705029,CDM,,,,INPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
SAGITTAL SAW BLADE,2705029,CDM,,,,INPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,,99.94,,99.94,130.59,
TRU-CLOSE SUCTION DRAIN,2705032,CDM,,,,INPATIENT,,,109.25,43.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.42,OTHER,81.94,107.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRU-CLOSE SUCTION DRAIN,2705032,CDM,,,,INPATIENT,,,109.25,43.7,MONUMENT,COMMERCIAL,,,,87.4,,81.94,107.07,
TRU-CLOSE SUCTION DRAIN,2705032,CDM,,,,INPATIENT,,,109.25,43.7,UNITED HEALTH,UNITED COMMERCIAL,,,,81.94,,81.94,107.07,
REFROBACIN CEMENT,2705034,CDM,,,,INPATIENT,,,529.2,211.68,BLUE CROSS ANTHEM,COMMERCIAL,,,,481.57,OTHER,396.9,518.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
REFROBACIN CEMENT,2705034,CDM,,,,INPATIENT,,,529.2,211.68,MONUMENT,COMMERCIAL,,,,423.36,,396.9,518.62,
REFROBACIN CEMENT,2705034,CDM,,,,INPATIENT,,,529.2,211.68,UNITED HEALTH,UNITED COMMERCIAL,,,,396.9,,396.9,518.62,
CPAP MASK,2710010,CDM,,,,INPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.13,OTHER,103.13,134.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CPAP MASK,2710010,CDM,,,,INPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
CPAP MASK,2710010,CDM,,,,INPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,103.13,,103.13,134.75,
CPAP VALVE,2710020,CDM,,,,INPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.44,OTHER,63,82.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CPAP VALVE,2710020,CDM,,,,INPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
CPAP VALVE,2710020,CDM,,,,INPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,,63,,63,82.32,
OXYHOOD DAILY (NSY),2710025,CDM,,,,INPATIENT,,,204.5,81.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,186.1,OTHER,153.38,200.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OXYHOOD DAILY (NSY),2710025,CDM,,,,INPATIENT,,,204.5,81.8,MONUMENT,COMMERCIAL,,,,163.6,,153.38,200.41,
OXYHOOD DAILY (NSY),2710025,CDM,,,,INPATIENT,,,204.5,81.8,UNITED HEALTH,UNITED COMMERCIAL,,,,153.38,,153.38,200.41,
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.3,OTHER,22.5,29.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,,22.5,,22.5,29.4,
OXYHOOD DAILY,2710050,CDM,,,,INPATIENT,,,204.5,81.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,186.1,OTHER,153.38,200.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OXYHOOD DAILY,2710050,CDM,,,,INPATIENT,,,204.5,81.8,MONUMENT,COMMERCIAL,,,,163.6,,153.38,200.41,
OXYHOOD DAILY,2710050,CDM,,,,INPATIENT,,,204.5,81.8,UNITED HEALTH,UNITED COMMERCIAL,,,,153.38,,153.38,200.41,
CLIP APPLIER LIGACLIP 10X28.9,2720010,CDM,,,,INPATIENT,,,210.5,84.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,191.56,OTHER,157.88,206.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CLIP APPLIER LIGACLIP 10X28.9,2720010,CDM,,,,INPATIENT,,,210.5,84.2,MONUMENT,COMMERCIAL,,,,168.4,,157.88,206.29,
CLIP APPLIER LIGACLIP 10X28.9,2720010,CDM,,,,INPATIENT,,,210.5,84.2,UNITED HEALTH,UNITED COMMERCIAL,,,,157.88,,157.88,206.29,
SHLDR ORTHOTIC SHLDR CAP DESN,L3671,HCPCS,274,RC,,INPATIENT,,,1089,435.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,990.99,OTHER,816.75,1067.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SHLDR ORTHOTIC SHLDR CAP DESN,L3671,HCPCS,274,RC,,INPATIENT,,,1089,435.6,MONUMENT,COMMERCIAL,,,,871.2,,816.75,1067.22,
SHLDR ORTHOTIC SHLDR CAP DESN,L3671,HCPCS,274,RC,,INPATIENT,,,1089,435.6,UNITED HEALTH,UNITED COMMERCIAL,,,,816.75,,816.75,1067.22,
ELBOW ORTHOTIC W/O JOINTS CUST,L3702,HCPCS,274,RC,,INPATIENT,,,694,277.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.54,OTHER,280.5,366.52,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELBOW ORTHOTIC W/O JOINTS CUST,L3702,HCPCS,274,RC,,INPATIENT,,,694,277.6,MONUMENT,COMMERCIAL,,,,299.2,,280.5,366.52,
ELBOW ORTHOTIC W/O JOINTS CUST,L3702,HCPCS,274,RC,,INPATIENT,,,694,277.6,UNITED HEALTH,UNITED COMMERCIAL,,,,280.5,,280.5,366.52,
ELB ORTH W/ADJ LOCK JNT PRFAB,L3760,HCPCS,274,RC,,INPATIENT,,,691.75,276.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,629.49,OTHER,518.81,677.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELB ORTH W/ADJ LOCK JNT PRFAB,L3760,HCPCS,274,RC,,INPATIENT,,,691.75,276.7,MONUMENT,COMMERCIAL,,,,553.4,,518.81,677.92,
ELB ORTH W/ADJ LOCK JNT PRFAB,L3760,HCPCS,274,RC,,INPATIENT,,,691.75,276.7,UNITED HEALTH,UNITED COMMERCIAL,,,,518.81,,518.81,677.92,
EWHO RIGID W/O JNTS CF,L3763,HCPCS,274,RC,,INPATIENT,,,1562,624.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1421.42,OTHER,1171.5,1530.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EWHO RIGID W/O JNTS CF,L3763,HCPCS,274,RC,,INPATIENT,,,1562,624.8,MONUMENT,COMMERCIAL,,,,1249.6,,1171.5,1530.8,
EWHO RIGID W/O JNTS CF,L3763,HCPCS,274,RC,,INPATIENT,,,1562,624.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1171.5,,1171.5,1530.8,
EWHFO RIGID W/O JOINTS CUSTOM,L3765,HCPCS,274,RC,,INPATIENT,,,1616.25,646.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1470.79,OTHER,1212.19,1583.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EWHFO RIGID W/O JOINTS CUSTOM,L3765,HCPCS,274,RC,,INPATIENT,,,1616.25,646.5,MONUMENT,COMMERCIAL,,,,1293,,1212.19,1583.93,
EWHFO RIGID W/O JOINTS CUSTOM,L3765,HCPCS,274,RC,,INPATIENT,,,1616.25,646.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1212.19,,1212.19,1583.93,
WHFO CUSTOM FABRICATED INCL,L3806,HCPCS,274,RC,,INPATIENT,,,1165.68,466.272,BLUE CROSS ANTHEM,COMMERCIAL,,,,1060.77,OTHER,422.81,552.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WHFO CUSTOM FABRICATED INCL,L3806,HCPCS,274,RC,,INPATIENT,,,1165.68,466.272,MONUMENT,COMMERCIAL,,,,451,,422.81,552.48,
WHFO CUSTOM FABRICATED INCL,L3806,HCPCS,274,RC,,INPATIENT,,,1165.68,466.272,UNITED HEALTH,UNITED COMMERCIAL,,,,422.81,,422.81,552.48,
"WHFO, RIGID W/O JOINTS",L3808,HCPCS,274,RC,,INPATIENT,,,850,340,BLUE CROSS ANTHEM,COMMERCIAL,,,,773.5,OTHER,637.5,833,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"WHFO, RIGID W/O JOINTS",L3808,HCPCS,274,RC,,INPATIENT,,,850,340,MONUMENT,COMMERCIAL,,,,680,,637.5,833,
"WHFO, RIGID W/O JOINTS",L3808,HCPCS,274,RC,,INPATIENT,,,850,340,UNITED HEALTH,UNITED COMMERCIAL,,,,637.5,,637.5,833,
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,INPATIENT,,,485.38,194.152,BLUE CROSS ANTHEM,COMMERCIAL,,,,441.7,OTHER,364,475.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,INPATIENT,,,485.38,194.152,MONUMENT,COMMERCIAL,,,,388.3,,364,475.7,
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,INPATIENT,,,485.38,194.152,UNITED HEALTH,UNITED COMMERCIAL,,,,364,,364,475.7,
WHFO DYN FLEXOR HINGE WRST/FIN,L3900,HCPCS,274,RC,,INPATIENT,,,1831,732.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1666.21,OTHER,1373.25,1794.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WHFO DYN FLEXOR HINGE WRST/FIN,L3900,HCPCS,274,RC,,INPATIENT,,,1831,732.4,MONUMENT,COMMERCIAL,,,,1464.8,,1373.25,1794.38,
WHFO DYN FLEXOR HINGE WRST/FIN,L3900,HCPCS,274,RC,,INPATIENT,,,1831,732.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1373.25,,1373.25,1794.38,
WHO INCL 1/MORE NONTORSION JOI,L3905,HCPCS,274,RC,,INPATIENT,,,1267.5,507,BLUE CROSS ANTHEM,COMMERCIAL,,,,1153.43,OTHER,950.63,1242.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WHO INCL 1/MORE NONTORSION JOI,L3905,HCPCS,274,RC,,INPATIENT,,,1267.5,507,MONUMENT,COMMERCIAL,,,,1014,,950.63,1242.15,
WHO INCL 1/MORE NONTORSION JOI,L3905,HCPCS,274,RC,,INPATIENT,,,1267.5,507,UNITED HEALTH,UNITED COMMERCIAL,,,,950.63,,950.63,1242.15,
WHO W/O JOINTS CF,L3906,HCPCS,274,RC,,INPATIENT,,,998,399.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,908.18,OTHER,748.5,978,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WHO W/O JOINTS CF,L3906,HCPCS,274,RC,,INPATIENT,,,998,399.2,MONUMENT,COMMERCIAL,,,,798.4,,748.5,978,
WHO W/O JOINTS CF,L3906,HCPCS,274,RC,,INPATIENT,,,998,399.2,UNITED HEALTH,UNITED COMMERCIAL,,,,748.5,,748.5,978,
HFO W/O JOINTS CF,L3913,HCPCS,274,RC,,INPATIENT,,,684,273.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,622.44,OTHER,513,670.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HFO W/O JOINTS CF,L3913,HCPCS,274,RC,,INPATIENT,,,684,273.6,MONUMENT,COMMERCIAL,,,,547.2,,513,670.3,
HFO W/O JOINTS CF,L3913,HCPCS,274,RC,,INPATIENT,,,684,273.6,UNITED HEALTH,UNITED COMMERCIAL,,,,513,,513,670.3,
HFO INCL 1/MORE NONTORSION JOI,L3921,HCPCS,274,RC,,INPATIENT,,,366,146.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,333.06,OTHER,274.5,358.68,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HFO INCL 1/MORE NONTORSION JOI,L3921,HCPCS,274,RC,,INPATIENT,,,366,146.4,MONUMENT,COMMERCIAL,,,,292.8,,274.5,358.68,
HFO INCL 1/MORE NONTORSION JOI,L3921,HCPCS,274,RC,,INPATIENT,,,366,146.4,UNITED HEALTH,UNITED COMMERCIAL,,,,274.5,,274.5,358.68,
HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,274,RC,,INPATIENT,,,276.78,110.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,251.87,OTHER,207.6,271.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,274,RC,,INPATIENT,,,276.78,110.712,MONUMENT,COMMERCIAL,,,,221.4,,207.6,271.2,
HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,274,RC,,INPATIENT,,,276.78,110.712,UNITED HEALTH,UNITED COMMERCIAL,,,,207.6,,207.6,271.2,
FO W/O JOINTS CF,L3933,HCPCS,274,RC,,INPATIENT,,,490,196,BLUE CROSS ANTHEM,COMMERCIAL,,,,445.9,OTHER,367.5,480.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FO W/O JOINTS CF,L3933,HCPCS,274,RC,,INPATIENT,,,490,196,MONUMENT,COMMERCIAL,,,,392,,367.5,480.2,
FO W/O JOINTS CF,L3933,HCPCS,274,RC,,INPATIENT,,,490,196,UNITED HEALTH,UNITED COMMERCIAL,,,,367.5,,367.5,480.2,
FINGER ORTHOTIC NONTORSION JOI,L3935,HCPCS,274,RC,,INPATIENT,,,267.75,107.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,243.65,OTHER,200.81,262.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FINGER ORTHOTIC NONTORSION JOI,L3935,HCPCS,274,RC,,INPATIENT,,,267.75,107.1,MONUMENT,COMMERCIAL,,,,214.2,,200.81,262.4,
FINGER ORTHOTIC NONTORSION JOI,L3935,HCPCS,274,RC,,INPATIENT,,,267.75,107.1,UNITED HEALTH,UNITED COMMERCIAL,,,,200.81,,200.81,262.4,
SEWHO ABDJUCTION POSITIONING,L3967,HCPCS,274,RC,,INPATIENT,,,668,267.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,607.88,OTHER,501,654.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEWHO ABDJUCTION POSITIONING,L3967,HCPCS,274,RC,,INPATIENT,,,668,267.2,MONUMENT,COMMERCIAL,,,,534.4,,501,654.64,
SEWHO ABDJUCTION POSITIONING,L3967,HCPCS,274,RC,,INPATIENT,,,668,267.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501,,501,654.64,
TISSUE LOCALIZATION-EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,720,288,BLUE CROSS ANTHEM,COMMERCIAL,,,,655.2,OTHER,540,705.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TISSUE LOCALIZATION-EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,720,288,MONUMENT,COMMERCIAL,,,,576,,540,705.6,
TISSUE LOCALIZATION-EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,720,288,UNITED HEALTH,UNITED COMMERCIAL,,,,540,,540,705.6,
BULKAMID URETHRAL BULKING SYST,L8603,HCPCS,278,RC,,INPATIENT,,,1871.1,748.44,BLUE CROSS ANTHEM,COMMERCIAL,,,,1702.7,OTHER,1403.3,1833.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BULKAMID URETHRAL BULKING SYST,L8603,HCPCS,278,RC,,INPATIENT,,,1871.1,748.44,MONUMENT,COMMERCIAL,,,,1496.9,,1403.3,1833.7,
BULKAMID URETHRAL BULKING SYST,L8603,HCPCS,278,RC,,INPATIENT,,,1871.1,748.44,UNITED HEALTH,UNITED COMMERCIAL,,,,1403.3,,1403.3,1833.7,
MATTRESS V-CUE HILL-ROM,2790024,CDM,,,,INPATIENT,,,118.5,47.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.84,OTHER,88.88,116.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MATTRESS V-CUE HILL-ROM,2790024,CDM,,,,INPATIENT,,,118.5,47.4,MONUMENT,COMMERCIAL,,,,94.8,,88.88,116.13,
MATTRESS V-CUE HILL-ROM,2790024,CDM,,,,INPATIENT,,,118.5,47.4,UNITED HEALTH,UNITED COMMERCIAL,,,,88.88,,88.88,116.13,
VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
REM FOREIGN BODY SUB-Q SIMPLE,10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
CHROMOGRANIN A,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.8,OTHER,140.44,183.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOGRANIN A,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,MONUMENT,COMMERCIAL,,,,149.8,,140.44,183.51,
"REMOVE FOREIGN BODY, SIM",10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
ANA REFLEX TITER,86039,CPT,300,RC,,OUTPATIENT,,,90.75,36.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.6,OTHER,68.06,88.94,PERCENT OF CHARGES BASED ON HCPCS CODE
ANA REFLEX TITER,86039,CPT,300,RC,,OUTPATIENT,,,90.75,36.3,MONUMENT,COMMERCIAL,,,,72.6,,68.06,88.94,
INC/REMOVAL FOREIGN BODY;COMPL,10121,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UNITED HEALTH,UNITED COMMERCIAL,,,,896.325,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION REFLEX SERUM,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,BLUE CROSS ANTHEM,COMMERCIAL,,,,174,OTHER,163.13,213.15,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOFIXATION REFLEX SERUM,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,MONUMENT,COMMERCIAL,,,,174,,163.13,213.15,
HEMATOMA/SEROMA/FLUID DRAIN,10140,CPT,402,RC,,OUTPATIENT,,,427.5,171,UNITED HEALTH,UNITED COMMERCIAL,,,,363.375,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
HEMOCHROMATOSIS HFE GENE,81256,CPT,300,RC,,OUTPATIENT,,,545.75,218.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,436.6,OTHER,409.31,534.84,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOCHROMATOSIS HFE GENE,81256,CPT,300,RC,,OUTPATIENT,,,545.75,218.3,MONUMENT,COMMERCIAL,,,,436.6,,409.31,534.84,
INCISION AND DRAINAGE,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1072.0625,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNDFIXATION REFLEX URINE,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,179.4,OTHER,168.19,219.77,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNDFIXATION REFLEX URINE,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,MONUMENT,COMMERCIAL,,,,179.4,,168.19,219.77,
INCISION AND DRAINAGE HEMOTOMA,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1072.0625,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
WARFARIN RESPONSE GENOTYPE,0030U,HCPCS,300,RC,,INPATIENT,,,821.83,328.732,BLUE CROSS ANTHEM,COMMERCIAL,,,,747.87,OTHER,616.4,805.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WARFARIN RESPONSE GENOTYPE,0030U,HCPCS,300,RC,,INPATIENT,,,821.83,328.732,MONUMENT,COMMERCIAL,,,,657.5,,616.4,805.4,
WARFARIN RESPONSE GENOTYPE,0030U,HCPCS,300,RC,,INPATIENT,,,821.83,328.732,UNITED HEALTH,UNITED COMMERCIAL,,,,616.4,,616.4,805.4,
MEDPRO C (STUDENTS),3000015,CDM,,,,INPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.85,OTHER,26.25,34.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MEDPRO C (STUDENTS),3000015,CDM,,,,INPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
MEDPRO C (STUDENTS),3000015,CDM,,,,INPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,,26.25,,26.25,34.3,
VENOUS PH ONLY,82800,CPT,300,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
VENOUS PH ONLY,82800,CPT,300,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
ALUMINUM SERUM,82108,CPT,300,RC,,OUTPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.2,OTHER,38.63,50.47,PERCENT OF CHARGES BASED ON HCPCS CODE
ALUMINUM SERUM,82108,CPT,300,RC,,OUTPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
US CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,320.63,418.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEALTH FAIR PSA SCREENING,3000020,CDM,,,,INPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.85,OTHER,26.25,34.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR PSA SCREENING,3000020,CDM,,,,INPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
HEALTH FAIR PSA SCREENING,3000020,CDM,,,,INPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,,26.25,,26.25,34.3,
HEALTH FAIR FSH,3000021,CDM,,,,INPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.85,OTHER,26.25,34.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR FSH,3000021,CDM,,,,INPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
HEALTH FAIR FSH,3000021,CDM,,,,INPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,,26.25,,26.25,34.3,
HEALTH FAIR A1C,3000022,CDM,,,,INPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.95,OTHER,33.75,44.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR A1C,3000022,CDM,,,,INPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.75,44.1,
HEALTH FAIR A1C,3000022,CDM,,,,INPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,,33.75,,33.75,44.1,
HEALTH FAIR CBC,3000023,CDM,,,,INPATIENT,,,25,10,BLUE CROSS ANTHEM,COMMERCIAL,,,,22.75,OTHER,18.75,24.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR CBC,3000023,CDM,,,,INPATIENT,,,25,10,MONUMENT,COMMERCIAL,,,,20,,18.75,24.5,
HEALTH FAIR CBC,3000023,CDM,,,,INPATIENT,,,25,10,UNITED HEALTH,UNITED COMMERCIAL,,,,18.75,,18.75,24.5,
DMEA ABO,3000024,CDM,,,,INPATIENT,,,13.5,5.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.29,OTHER,10.13,13.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DMEA ABO,3000024,CDM,,,,INPATIENT,,,13.5,5.4,MONUMENT,COMMERCIAL,,,,10.8,,10.13,13.23,
DMEA ABO,3000024,CDM,,,,INPATIENT,,,13.5,5.4,UNITED HEALTH,UNITED COMMERCIAL,,,,10.13,,10.13,13.23,
DMEA RH,3000025,CDM,,,,INPATIENT,,,13.5,5.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.29,OTHER,10.13,13.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DMEA RH,3000025,CDM,,,,INPATIENT,,,13.5,5.4,MONUMENT,COMMERCIAL,,,,10.8,,10.13,13.23,
DMEA RH,3000025,CDM,,,,INPATIENT,,,13.5,5.4,UNITED HEALTH,UNITED COMMERCIAL,,,,10.13,,10.13,13.23,
DES-GAMMA CARBOXY PROTHROMBIN,83951,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,241.8,OTHER,226.69,296.21,PERCENT OF CHARGES BASED ON HCPCS CODE
DES-GAMMA CARBOXY PROTHROMBIN,83951,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,MONUMENT,COMMERCIAL,,,,241.8,,226.69,296.21,
PUNCTURE ASPIRATE ABCESS SMPL,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
MSHG GENE FULL ANALYSIS,81298,CPT,300,RC,,OUTPATIENT,,,1499.5,599.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1199.6,OTHER,1124.63,1469.51,PERCENT OF CHARGES BASED ON HCPCS CODE
MSHG GENE FULL ANALYSIS,81298,CPT,300,RC,,OUTPATIENT,,,1499.5,599.8,MONUMENT,COMMERCIAL,,,,1199.6,,1124.63,1469.51,
PUNCTURE DRAINAGE OF LESION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,251.25,328.3,PERCENT OF TOTAL BILLED CHARGES
SPECIMEN COLLECTION CAPILLARY,36416,CPT,300,RC,,OUTPATIENT,,,6.25,2.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5,OTHER,4.69,6.13,PERCENT OF CHARGES BASED ON HCPCS CODE
SPECIMEN COLLECTION CAPILLARY,36416,CPT,300,RC,,OUTPATIENT,,,6.25,2.5,MONUMENT,COMMERCIAL,,,,5,,4.69,6.13,
DBRDMT SKIN UP TO 10% OF BODY,11000,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANSFER RBC,82657,CPT,300,RC,,OUTPATIENT,,,479.75,191.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,383.8,OTHER,359.81,470.16,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOPURINE METHYLTRANSFER RBC,82657,CPT,300,RC,,OUTPATIENT,,,479.75,191.9,MONUMENT,COMMERCIAL,,,,383.8,,359.81,470.16,
DEBRIDEMENT OPEN FX SUBQ ONLY,11010,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2802.025,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY  RBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY  RBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
DEBRIDEMENT SKIN SUBQ TISSUE,11011,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2802.025,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY WBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY WBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
DEBRIDEMENT SUBQ TISSUE 20 SQ,11042,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,UNITED HEALTH,UNITED COMMERCIAL,,,,791.775,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L WBC,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L WBC,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
DEB BONE 20 SQ CM OR LESS,11044,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,UNITED HEALTH,UNITED COMMERCIAL,,,,791.775,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATE&ID BY HIGH RESOLTN,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATE&ID BY HIGH RESOLTN,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
US SKIN LESION BIOPSY,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,323.44,422.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L WBC,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L WBC,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
BIOPSY SKIN LESION,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,UNITED HEALTH,UNITED COMMERCIAL,,,,366.5625,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,83909,CPT,300,RC,,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEP ID BY HIGH RESOLUTION,83909,CPT,300,RC,,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
INCISIONAL BIOPSY SINGLE LESN,11106,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,BLUE CROSS ANTHEM,COMMERCIAL,,,,22,OTHER,20.63,26.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,MONUMENT,COMMERCIAL,,,,22,,20.63,26.95,
REMOVAL OF SKIN TAGS UP TO 15,11200,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,8390959,CPT,300,RC,59,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEP ID BY HIGH RESOLUTION,8390959,CPT,300,RC,59,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
EXC TR-EXT B9+MART 0.6-ICM,11401,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
DRUGS OF ABUSE SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,293.5,117.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,234.8,OTHER,220.13,287.63,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUGS OF ABUSE SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,293.5,117.4,MONUMENT,COMMERCIAL,,,,234.8,,220.13,287.63,
FLUID EXC H-F-NK-SP B9+MARG,11422,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 1,80301,CPT,301,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DRUG ABUSE SURVEY  URINE 1,80301,CPT,301,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 2,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 2,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 2,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 3,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 3,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 3,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 4,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 4,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 4,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 5,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 5,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 5,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 6,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 6,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 6,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 7,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 7,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 7,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 8,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.35,OTHER,28.31,37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z DRUG ABUSE SURVEY  URINE 8,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
Z DRUG ABUSE SURVEY  URINE 8,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,,28.31,,28.31,37,
FLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,138.5,55.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,110.8,OTHER,103.88,135.73,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,138.5,55.4,MONUMENT,COMMERCIAL,,,,110.8,,103.88,135.73,
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,450,RC,,OUTPATIENT,,,605,242,UNITED HEALTH,UNITED COMMERCIAL,,,,514.25,OTHER,453.8,592.9,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.776,OTHER,91.7,119.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,MONUMENT,COMMERCIAL,,,,97.8,,91.7,119.8,
EXC MALIGN LESION INCL MARGINS,11606,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.776,OTHER,91.7,119.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,MONUMENT,COMMERCIAL,,,,97.8,,91.7,119.8,
TRIMMING OF FINGER/TOE NAIL(S),11719,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,,94.299,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
VASO INTESTINAL POLYPETIDE,84586,CPT,300,RC,,OUTPATIENT,,,245,98,BLUE CROSS ANTHEM,COMMERCIAL,,,,196,OTHER,183.75,240.1,PERCENT OF CHARGES BASED ON HCPCS CODE
VASO INTESTINAL POLYPETIDE,84586,CPT,300,RC,,OUTPATIENT,,,245,98,MONUMENT,COMMERCIAL,,,,196,,183.75,240.1,
DEBRIDEMENT NAIL 1-5,11720,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,,94.299,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE BY PCR,87476,CPT,300,RC,,OUTPATIENT,,,509,203.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,407.2,OTHER,381.75,498.82,PERCENT OF CHARGES BASED ON HCPCS CODE
LYME DISEASE BY PCR,87476,CPT,300,RC,,OUTPATIENT,,,509,203.6,MONUMENT,COMMERCIAL,,,,407.2,,381.75,498.82,
AVULSION OF NAIL PLATE SINGLE,11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
INSITU HYBRIDIZATION AUTO,88367,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,320.06,418.22,PERCENT OF CHARGES BASED ON HCPCS CODE
INSITU HYBRIDIZATION AUTO,88367,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,341.4,,320.06,418.22,
"REMOVAL OF NAIL PLATE, SINGLE",11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,189.75,247.94,PERCENT OF TOTAL BILLED CHARGES
TUMOR IMMUNOHISTOCHEM,88361,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,112.5,147,PERCENT OF CHARGES BASED ON HCPCS CODE
TUMOR IMMUNOHISTOCHEM,88361,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
REMOVE NAIL PLATE ADD-ON,11732,CPT,450,RC,,OUTPATIENT,,,255,102,UNITED HEALTH,UNITED COMMERCIAL,,,,216.75,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C RESISTANCE V  PLASMA,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.4,OTHER,150.38,196.49,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN C RESISTANCE V  PLASMA,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,MONUMENT,COMMERCIAL,,,,160.4,,150.38,196.49,
EVACUATION SUBUNGAL HEMOTOMA,11740,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,161.25,210.7,PERCENT OF TOTAL BILLED CHARGES
PROTEIN S ACTIVITY,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.6,OTHER,176.81,231.04,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN S ACTIVITY,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,MONUMENT,COMMERCIAL,,,,188.6,,176.81,231.04,
EXCISION OF NAIL PERM RM,11750,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UNITED HEALTH,UNITED COMMERCIAL,,,,896.325,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
CHROM ANALY CT 5 CELLS 1 KARY,88261,CPT,300,RC,,OUTPATIENT,,,1072.75,429.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,858.2,OTHER,804.56,1051.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROM ANALY CT 5 CELLS 1 KARY,88261,CPT,300,RC,,OUTPATIENT,,,1072.75,429.1,MONUMENT,COMMERCIAL,,,,858.2,,804.56,1051.3,
REPAIR OF NAIL BED,11760,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
GONADOTROPIN RELEASING HORMONE,83727,CPT,300,RC,,OUTPATIENT,,,529.75,211.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,423.8,OTHER,397.31,519.16,PERCENT OF CHARGES BASED ON HCPCS CODE
GONADOTROPIN RELEASING HORMONE,83727,CPT,300,RC,,OUTPATIENT,,,529.75,211.9,MONUMENT,COMMERCIAL,,,,423.8,,397.31,519.16,
WEDGE EXCISION OF SKIN OF NAIL,11765,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UNITED HEALTH,UNITED COMMERCIAL,,,,664.275,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
MYH GENETIC MOLECUALR ANALYSIS,81401,CPT,300,RC,,OUTPATIENT,,,398,159.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,318.4,OTHER,298.5,390.04,PERCENT OF CHARGES BASED ON HCPCS CODE
MYH GENETIC MOLECUALR ANALYSIS,81401,CPT,300,RC,,OUTPATIENT,,,398,159.2,MONUMENT,COMMERCIAL,,,,318.4,,298.5,390.04,
REMOVE PILONIDAL CYST SIMPLE,11770,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UNITED HEALTH,UNITED COMMERCIAL,,,,664.275,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN LIKE IMMUNOREACTIVITY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
TRYPSIN LIKE IMMUNOREACTIVITY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
SIMPLE REPAIR 2.5 CM OR LESS,12001,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN FECAL,84488,CPT,300,RC,,OUTPATIENT,,,157.25,62.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.8,OTHER,117.94,154.11,PERCENT OF CHARGES BASED ON HCPCS CODE
TRYPSIN FECAL,84488,CPT,300,RC,,OUTPATIENT,,,157.25,62.9,MONUMENT,COMMERCIAL,,,,125.8,,117.94,154.11,
RPR SF WOUND TR 2.5CM/<,12001,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,172.5,225.4,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
SIMPLE REPAIR 2.6CM TO 7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE ISOLATE NUCLEIC,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
RPR SF WOUND TRNK 2.6-7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,210.75,275.38,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,88386,CPT,310,RC,,OUTPATIENT,,,735,294,BLUE CROSS ANTHEM,COMMERCIAL,,,,588,OTHER,551.25,720.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ARRAY BASED EVAL MULT PROBES,88386,CPT,310,RC,,OUTPATIENT,,,735,294,MONUMENT,COMMERCIAL,,,,588,,551.25,720.3,
SIMPLE REPAIR 7.6-12.5 CM,12004,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,BLUE CROSS ANTHEM,COMMERCIAL,,,,588,OTHER,551.25,720.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,MONUMENT,COMMERCIAL,,,,588,,551.25,720.3,
SIMPLE REPAIR 12.6 TO 20 CM,12005,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,BLUE CROSS ANTHEM,COMMERCIAL,,,,588,OTHER,551.25,720.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,MONUMENT,COMMERCIAL,,,,588,,551.25,720.3,
SIMPLE REPAIR 20.1 TO 30 CM,12006,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,BLUE CROSS ANTHEM,COMMERCIAL,,,,588,OTHER,551.25,720.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,MONUMENT,COMMERCIAL,,,,588,,551.25,720.3,
SIMPLE REPAIR > 30CM,12007,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR FACE <2.5CM,12011,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
RPR SF WOUND FA 2.5 CM/<,12011,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,211.5,276.36,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR FACE 2.6 - 5.0CM,12013,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR FACE 5.1-7.5CM,12014,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
RPR SF WOUNDS FA 5.1-7.5 CM,12014,CPT,450,RC,,OUTPATIENT,,,365,146,UNITED HEALTH,UNITED COMMERCIAL,,,,310.25,OTHER,273.75,357.7,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR 7.6-12.5CM,12015,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR 12.6-20.0,12016,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SIMPLE REPAIR 20.1-30.0CM,12017,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
5-HIAA ASSAY,83497,CPT,300,RC,,OUTPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.2,OTHER,167.06,218.3,PERCENT OF CHARGES BASED ON HCPCS CODE
5-HIAA ASSAY,83497,CPT,300,RC,,OUTPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
SIMPLE REPAIR OVER 30CM,12018,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,UNITED HEALTH,UNITED COMMERCIAL,,,,815.3625,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,OUTPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.2,OTHER,34.88,45.57,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,OUTPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
TRMT OF SUPERFICIAL WND SIMPLE,12020,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CARBOHYDRATE DEF TRANSFERRIN,82373,CPT,300,RC,,OUTPATIENT,,,101.25,40.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,81,OTHER,75.94,99.23,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBOHYDRATE DEF TRANSFERRIN,82373,CPT,300,RC,,OUTPATIENT,,,101.25,40.5,MONUMENT,COMMERCIAL,,,,81,,75.94,99.23,
INTERMED REPAIR > 2.5 CM,12031,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.2,OTHER,34.88,45.57,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
INTERMED REPAIR 2.6-7.5CM,12032,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
AUTOIMMUNE INNER EAR 68KD,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,228.4,OTHER,214.13,279.79,PERCENT OF CHARGES BASED ON HCPCS CODE
AUTOIMMUNE INNER EAR 68KD,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,MONUMENT,COMMERCIAL,,,,228.4,,214.13,279.79,
INTERMED REPAIR 7.6-12.5CM,12034,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
COLLAPSIN RESPONSE MP 5 IGG,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,228.4,OTHER,214.13,279.79,PERCENT OF CHARGES BASED ON HCPCS CODE
COLLAPSIN RESPONSE MP 5 IGG,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,MONUMENT,COMMERCIAL,,,,228.4,,214.13,279.79,
INTERMED REPAIR 12.6-20.0CM,12035,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
ACH R GANGLIONIC NEURONAL ANTI,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
ACH R GANGLIONIC NEURONAL ANTI,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
INTERMED REPAIR 20.1-30.0CM,12036,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
PROTOPORPHYRINS FRAC ERYTHRO,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTOPORPHYRINS FRAC ERYTHRO,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
INTERMED REPAIR OVER 30.0 CM,12037,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,UNITED HEALTH,UNITED COMMERCIAL,,,,2906.1415,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PHENOBARBITAL,80184,CPT,300,RC,,OUTPATIENT,,,52.5,21,BLUE CROSS ANTHEM,COMMERCIAL,,,,42,OTHER,39.4,51.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF PHENOBARBITAL,80184,CPT,300,RC,,OUTPATIENT,,,52.5,21,MONUMENT,COMMERCIAL,,,,42,,39.4,51.5,
INTER REPAIR GENITAL 2.5 CM<,12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
P GALACTOSE 1 PHOSPHATE,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.632,OTHER,12.56,16.42,PERCENT OF CHARGES BASED ON HCPCS CODE
P GALACTOSE 1 PHOSPHATE,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,MONUMENT,COMMERCIAL,,,,13.4,,12.56,16.42,
"LAYER CLOSURE OF WOUNDS, HAND",12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,464.25,606.62,PERCENT OF TOTAL BILLED CHARGES
P CF IMMUNOASSAY,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.632,OTHER,25.5,33.32,PERCENT OF CHARGES BASED ON HCPCS CODE
P CF IMMUNOASSAY,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,MONUMENT,COMMERCIAL,,,,27.2,,25.5,33.32,
INTER REPAIR GENITIAL 2.6-7.5,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
ZINC PROTOPORPHYRINS,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
ZINC PROTOPORPHYRINS,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
INTERMED REPAIR 2.6-7.5CM,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
P MS-MS EXPANDED SCREEN,83788,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
P MS-MS EXPANDED SCREEN,83788,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
INTERMED REPAIR 7.6-12.5CM,12044,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,83788,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MASS SPECTOMETRY,83788,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
INTERMED REPAIR 12.6-20.0CM,12045,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,8378859,CPT,300,RC,59,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MASS SPECTOMETRY,8378859,CPT,300,RC,59,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
REPAIR INTERMED 20.1-30.0CM,12046,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
NUCLEOTIDASE-5,83915,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEOTIDASE-5,83915,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
INTERMED REPAIR OVER 30.0 CM,12047,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,UNITED HEALTH,UNITED COMMERCIAL,,,,2906.1415,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
INTERMED REPAIR < 2.5CM FACE,12051,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
UPD GLUCURONOSYLTRANSFERASE,81350,CPT,300,RC,,OUTPATIENT,,,1251.25,500.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1001,OTHER,938.44,1226.23,PERCENT OF CHARGES BASED ON HCPCS CODE
UPD GLUCURONOSYLTRANSFERASE,81350,CPT,300,RC,,OUTPATIENT,,,1251.25,500.5,MONUMENT,COMMERCIAL,,,,1001,,938.44,1226.23,
INTERMED REPAIR 2.5-5.0CM,12052,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
INTERMED REPAIR 5.1-7.5CM,12053,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
INTERMED REPAIR 7.6-12.5CM,12054,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS  FRACTIONATED,82542,CPT,301,RC,,OUTPATIENT,,,136,54.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.8,OTHER,102,133.28,PERCENT OF CHARGES BASED ON HCPCS CODE
PORPHYRINS  FRACTIONATED,82542,CPT,301,RC,,OUTPATIENT,,,136,54.4,MONUMENT,COMMERCIAL,,,,108.8,,102,133.28,
INTERMED REPAIR 12.6-20.0CM,12055,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,277.88,363.09,PERCENT OF TOTAL BILLED CHARGES
ZIPRASIDONE,G0480,HCPCS,300,RC,,BOTH,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ZIPRASIDONE,G0480,HCPCS,300,RC,,BOTH,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
ZIPRASIDONE,G0480,HCPCS,300,RC,,BOTH,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
PORPHYRINS  TOTAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
PORPHYRINS  TOTAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
INTERMED REPAIR 20.1-30.0CM,12056,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
COENZYME Q10,82542,CPT,301,RC,,OUTPATIENT,,,289.5,115.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,231.6,OTHER,217.13,283.71,PERCENT OF CHARGES BASED ON HCPCS CODE
COENZYME Q10,82542,CPT,301,RC,,OUTPATIENT,,,289.5,115.8,MONUMENT,COMMERCIAL,,,,231.6,,217.13,283.71,
INTERMED REPAIR OVER 30.0CM,12057,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2710.65,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALOPRAM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ESCITALOPRAM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
COMPLEX REPAIR 1.1-2.5CM,13100,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
COMPLEX REPAIR 2.6-7.5CM,13101,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
ANTI-HMGCR AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,256,102.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.8,OTHER,192,250.88,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI-HMGCR AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,256,102.4,MONUMENT,COMMERCIAL,,,,204.8,,192,250.88,
COMPLEX REPAIR EACH ADD 5.0CM,13102,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UNITED HEALTH,UNITED COMMERCIAL,,,,171.0625,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
COMPLEX REPAIR 1.1-2.5CM,13120,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
BRCA1/BRACA2 FULL GENE ANALYSI,81162,CPT,300,RC,,OUTPATIENT,,,3649.76,1459.904,BLUE CROSS ANTHEM,COMMERCIAL,,,,2919.808,OTHER,1546.31,2020.52,PERCENT OF CHARGES BASED ON HCPCS CODE
BRCA1/BRACA2 FULL GENE ANALYSI,81162,CPT,300,RC,,OUTPATIENT,,,3649.76,1459.904,MONUMENT,COMMERCIAL,,,,1649.4,,1546.31,2020.52,
COMPLEX REPAIRED SCALP/EXTREMI,13121,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
COMPLEX REPAIR EACH ADD 5.0 CM,13122,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UNITED HEALTH,UNITED COMMERCIAL,,,,171.0625,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
INHIBIN B,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
INHIBIN B,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
COMPLEX REPAIR 1.1-2.5CM,13131,CPT,450,RC,,OUTPATIENT,,,985.75,394.3,UNITED HEALTH,UNITED COMMERCIAL,,,,837.8875,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
COMPLEX REPAIR 2.6-7.5CM,13132,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
17-HYDROXYCORTICOSTEROIDS,83491,CPT,301,RC,,OUTPATIENT,,,166,66.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.8,OTHER,124.5,162.68,PERCENT OF CHARGES BASED ON HCPCS CODE
17-HYDROXYCORTICOSTEROIDS,83491,CPT,301,RC,,OUTPATIENT,,,166,66.4,MONUMENT,COMMERCIAL,,,,132.8,,124.5,162.68,
COMPLEX REPAIR EACH ADD 5.0CM,13133,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UNITED HEALTH,UNITED COMMERCIAL,,,,171.0625,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
COMPLEX REPAIR > 1.0CM,13150,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2710.65,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
ZIKAVIRUS IGM,86790,CPT,300,RC,,OUTPATIENT,,,220.5,88.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,176.4,OTHER,165.38,216.09,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIKAVIRUS IGM,86790,CPT,300,RC,,OUTPATIENT,,,220.5,88.2,MONUMENT,COMMERCIAL,,,,176.4,,165.38,216.09,
COMPLEX REPAIR 1.1-2.5CM,13151,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,87300,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LEGIONELLA SMEAR,87300,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
COMPLEX REPAIR 2.6-7.5CM,13152,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,8730091,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LEGIONELLA SMEAR,8730091,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
COMPLEX REPAIR EACH ADD 5CM,13153,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UNITED HEALTH,UNITED COMMERCIAL,,,,171.0625,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
REMOVE SUTURES SAME SURGEON,15850,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UNITED HEALTH,UNITED COMMERCIAL,,,,888.0375,OTHER,146.06,190.86,PERCENT OF TOTAL BILLED CHARGES
MICROSATELLITE INSTABILITY,81301,CPT,312,RC,,OUTPATIENT,,,697.12,278.848,BLUE CROSS ANTHEM,COMMERCIAL,,,,557.696,OTHER,304.13,397.39,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROSATELLITE INSTABILITY,81301,CPT,312,RC,,OUTPATIENT,,,697.12,278.848,MONUMENT,COMMERCIAL,,,,324.4,,304.13,397.39,
TRT 1ST DEGREE BURN LOCAL,16000,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
DRESS/DEBRIDE SML BURN W/O ANE,16020,CPT,450,RC,,OUTPATIENT,,,361,144.4,UNITED HEALTH,UNITED COMMERCIAL,,,,306.85,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
HLA A HIGH RES BY DNA,81380,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.2,OTHER,564.56,737.7,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA A HIGH RES BY DNA,81380,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,MONUMENT,COMMERCIAL,,,,602.2,,564.56,737.7,
"BURN TREATMENT W/O ANES, SM",16020,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,158.25,206.78,PERCENT OF TOTAL BILLED CHARGES
CALCULUS (STONE),82365,CPT,300,RC,,OUTPATIENT,,,82.25,32.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.8,OTHER,61.69,80.61,PERCENT OF CHARGES BASED ON HCPCS CODE
CALCULUS (STONE),82365,CPT,300,RC,,OUTPATIENT,,,82.25,32.9,MONUMENT,COMMERCIAL,,,,65.8,,61.69,80.61,
DRESS/DEBRISE MED BRN W/O ANE,16025,CPT,450,RC,,OUTPATIENT,,,495.25,198.1,UNITED HEALTH,UNITED COMMERCIAL,,,,420.9625,OTHER,371.44,485.35,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.064,OTHER,79.7,104.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,MONUMENT,COMMERCIAL,,,,85.1,,79.7,104.2,
DRESS/DEBRIDE LRG BURN W/O ANE,16030,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UNITED HEALTH,UNITED COMMERCIAL,,,,585.9135,OTHER,472.88,617.89,PERCENT OF TOTAL BILLED CHARGES
HEREDITARY SPHEROCYTOSIS EVAL,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,147,OTHER,137.81,180.08,PERCENT OF CHARGES BASED ON HCPCS CODE
HEREDITARY SPHEROCYTOSIS EVAL,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,MONUMENT,COMMERCIAL,,,,147,,137.81,180.08,
CHEMICAL CAUTERIZATION,17250,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,BLUE CROSS ANTHEM,COMMERCIAL,,,,76,OTHER,71.3,93.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,MONUMENT,COMMERCIAL,,,,76,,71.3,93.1,
INJECTION FOR BREAST XRAY,19030,CPT,401,RC,,OUTPATIENT,,,396.25,158.5,UNITED HEALTH,UNITED COMMERCIAL,,,,336.8125,OTHER,297.19,388.33,PERCENT OF TOTAL BILLED CHARGES
Z STACLOT LUPUS ANTICOAGULANT,85598,CPT,300,RC,,OUTPATIENT,,,241.25,96.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,193,OTHER,180.94,236.43,PERCENT OF CHARGES BASED ON HCPCS CODE
Z STACLOT LUPUS ANTICOAGULANT,85598,CPT,300,RC,,OUTPATIENT,,,241.25,96.5,MONUMENT,COMMERCIAL,,,,193,,180.94,236.43,
BX BREAST 1ST LESION STRTCTC,19081,CPT,401,RC,,OUTPATIENT,,,2904.5,1161.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2468.825,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,BLUE CROSS ANTHEM,COMMERCIAL,,,,76,OTHER,71.3,93.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,MONUMENT,COMMERCIAL,,,,76,,71.3,93.1,
BX BREAST ADD LESION STRTCTC,19082,CPT,401,RC,,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN ANTIGEN,85385,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.2,OTHER,162.38,212.17,PERCENT OF CHARGES BASED ON HCPCS CODE
FIBRINOGEN ANTIGEN,85385,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,MONUMENT,COMMERCIAL,,,,173.2,,162.38,212.17,
BX BREAST 1ST LESION STEREO RT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2400.1875,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
HYDROXYPROGESTERONE - 17,83498,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,145,OTHER,135.94,177.63,PERCENT OF CHARGES BASED ON HCPCS CODE
HYDROXYPROGESTERONE - 17,83498,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,MONUMENT,COMMERCIAL,,,,145,,135.94,177.63,
BX BREAST 1ST LESION STEREO LT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2400.1875,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
"CRYSTINURIA PROFILE,QUANT",82136,CPT,301,RC,,OUTPATIENT,,,235,94,BLUE CROSS ANTHEM,COMMERCIAL,,,,188,OTHER,176.25,230.3,PERCENT OF CHARGES BASED ON HCPCS CODE
"CRYSTINURIA PROFILE,QUANT",82136,CPT,301,RC,,OUTPATIENT,,,235,94,MONUMENT,COMMERCIAL,,,,188,,176.25,230.3,
US BIOPSY BREAST BILATERAL 1EA,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,2941.31,3843.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
P HYDROXYPROGESTERONE 17-ALPHA,83498,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,53,OTHER,49.69,64.93,PERCENT OF CHARGES BASED ON HCPCS CODE
P HYDROXYPROGESTERONE 17-ALPHA,83498,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,MONUMENT,COMMERCIAL,,,,53,,49.69,64.93,
US BRST BX VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,2117.81,2767.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
BX BREAST VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
GAMMA HYDROXYBUTYRIC ACID URIN,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
GAMMA HYDROXYBUTYRIC ACID URIN,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
US BRST BX VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,2117.81,2767.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
BX BREAST VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.144,OTHER,41.44,54.15,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,MONUMENT,COMMERCIAL,,,,44.2,,41.44,54.15,
BX BREAST VAC ASSIST BIL 1ST,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
US BX BREAST 1ST LESION,19083,CPT,401,RC,,OUTPATIENT,,,1960.75,784.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1470.56,1921.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B GENOTYPE,87912,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,BLUE CROSS ANTHEM,COMMERCIAL,,,,411.92,OTHER,372.19,486.33,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B GENOTYPE,87912,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,MONUMENT,COMMERCIAL,,,,397,,372.19,486.33,
BX BREAST 1ST LESION RT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1750.15,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
BX BREAST 1ST LESION LT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1750.15,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES FRAC FREE URINE,82384,CPT,300,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
CATECHOLAMINES FRAC FREE URINE,82384,CPT,300,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,UNITED HEALTH,UNITED COMMERCIAL,,,,3333.4875,OTHER,2941.31,3843.32,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID AMP PROBE,87150,CPT,300,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
ID BY NUCLEIC ACID AMP PROBE,87150,CPT,300,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,4117.5,1647,UNITED HEALTH,UNITED COMMERCIAL,,,,3499.875,OTHER,3088.13,4035.15,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
BX BREAST ADD LESION STEREO RT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1750.15,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
Z MICRODILUTION MLC EACH PLATE,87187,CPT,300,RC,,OUTPATIENT,,,91,36.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.8,OTHER,68.25,89.18,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MICRODILUTION MLC EACH PLATE,87187,CPT,300,RC,,OUTPATIENT,,,91,36.4,MONUMENT,COMMERCIAL,,,,72.8,,68.25,89.18,
BX BREAST ADD LESION STEREO LT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1750.15,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,87188,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MACROBROTH DILUTION EA AGENT,87188,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
BX BREAST VAC ASSIST L2 SITES,19084,CPT,402,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID DIRECT PRBE,87149,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
ID BY NUCLEIC ACID DIRECT PRBE,87149,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
US BX BREAST ADD LESION,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1544.25,2017.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOBACT IDENT BY SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.576,OTHER,164.25,214.62,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOBACT IDENT BY SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,MONUMENT,COMMERCIAL,,,,175.2,,164.25,214.62,
BX BREAST ADD LESION RT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1171.5125,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA PLATE,8718891,CPT,300,RC,91,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MACROBROTH DILUTION EA PLATE,8718891,CPT,300,RC,91,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
BX BREAST ADD LESION LT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1171.5125,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
D-DIMER,85378,CPT,305,RC,,OUTPATIENT,,,209.25,83.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.4,OTHER,156.94,205.07,PERCENT OF CHARGES BASED ON HCPCS CODE
D-DIMER,85378,CPT,305,RC,,OUTPATIENT,,,209.25,83.7,MONUMENT,COMMERCIAL,,,,167.4,,156.94,205.07,
BX BREAST ADD LESION BI,19084,CPT,402,RC,,OUTPATIENT,,,787.5,315,UNITED HEALTH,UNITED COMMERCIAL,,,,669.375,OTHER,590.63,771.75,PERCENT OF TOTAL BILLED CHARGES
OXALATE PLASMA,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.2,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
OXALATE PLASMA,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
BX BREAST 1ST LESION UNI,19085,CPT,610,RC,,OUTPATIENT,,,4345,1738,UNITED HEALTH,UNITED COMMERCIAL,,,,3693.25,OTHER,3258.75,4258.1,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,8718859,CPT,300,RC,59,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MACROBROTH DILUTION EA AGENT,8718859,CPT,300,RC,59,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
BX BREAST ADD LESION,19086,CPT,610,RC,,OUTPATIENT,,,2441.25,976.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2075.0625,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
MUCOR IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
MUCOR IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
US BIOPSY BREAST BI 1ST LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
US BIOPSY BREAST BI 2ND LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.664,OTHER,25,32.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,MONUMENT,COMMERCIAL,,,,26.7,,25,32.7,
US BIOPSY BREAST BI 3RD LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JAK2 V617F MUTATION DETECTION,81270,CPT,300,RC,,OUTPATIENT,,,613.25,245.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,490.6,OTHER,459.94,600.99,PERCENT OF CHARGES BASED ON HCPCS CODE
JAK2 V617F MUTATION DETECTION,81270,CPT,300,RC,,OUTPATIENT,,,613.25,245.3,MONUMENT,COMMERCIAL,,,,490.6,,459.94,600.99,
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
ISO PURIFIED NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.6,OTHER,337.13,440.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ISO PURIFIED NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,MONUMENT,COMMERCIAL,,,,359.6,,337.13,440.51,
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE 1ST,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE 1ST,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
BREAST MARKER PLACEMENT,19281,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,409.13,534.59,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,856.5,342.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,685.2,OTHER,642.38,839.37,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,856.5,342.6,MONUMENT,COMMERCIAL,,,,685.2,,642.38,839.37,
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,433.88,566.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,433.88,566.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
US BREAST MARKER PLCMT ADD'L,19286,CPT,402,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
CT MUSCLE NEEDLE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,936,1223.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETAION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETAION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
LEVEL II,20206,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1570.5875,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
US MUSCLE CORE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1060.8,OTHER,936,1223.04,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
BONE BIOPSY TROCAR/NEEDLE,20220,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1818.575,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN,80307,CPT,301,RC,,OUTPATIENT,,,124.28,49.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.424,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
ACETAMINOPHEN,80307,CPT,301,RC,,OUTPATIENT,,,124.28,49.712,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
BONE BIOPSY TROCAR/NEEDLE DEEP,20225,CPT,321,RC,,OUTPATIENT,,,2139.5,855.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1818.575,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
Z B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.368,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
REM FOREIGN BODY IN MUSCLE,20520,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UNITED HEALTH,UNITED COMMERCIAL,,,,896.325,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
Z N K CELLS TOTAL COUNT,86357,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.368,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z N K CELLS TOTAL COUNT,86357,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
INJ NEEDLE PLACEMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,UNITED HEALTH,UNITED COMMERCIAL,,,,536.35,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
Z T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.368,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
Z T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
INJ TENDON SHEATH LIGAMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,UNITED HEALTH,UNITED COMMERCIAL,,,,536.35,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
Z T CELL ABSOLUTE COUNT RATIO,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.2,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
Z T CELL ABSOLUTE COUNT RATIO,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
INJ TENDONS/LIGAMENTS;SINGLE,20550,CPT,320,RC,,OUTPATIENT,,,561.25,224.5,UNITED HEALTH,UNITED COMMERCIAL,,,,477.0625,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
PARALDEHYDE PLASMA,82000,CPT,300,RC,,OUTPATIENT,,,169.75,67.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.8,OTHER,127.31,166.36,PERCENT OF CHARGES BASED ON HCPCS CODE
PARALDEHYDE PLASMA,82000,CPT,300,RC,,OUTPATIENT,,,169.75,67.9,MONUMENT,COMMERCIAL,,,,135.8,,127.31,166.36,
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UNITED HEALTH,UNITED COMMERCIAL,,,,442.476,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE EA ADD'L,8389691,CPT,300,RC,91,OUTPATIENT,,,393.25,157.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,314.6,OTHER,294.94,385.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE EA ADD'L,8389691,CPT,300,RC,91,OUTPATIENT,,,393.25,157.3,MONUMENT,COMMERCIAL,,,,314.6,,294.94,385.39,
INJ SGL/MULT TRIGGER PTS 1OR2,20552,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,UNITED HEALTH,UNITED COMMERCIAL,,,,477.0625,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
T CELL ANTIGEN RECEPTOR GAMMA,81342,CPT,312,RC,,OUTPATIENT,,,870.75,348.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,696.6,OTHER,653.06,853.34,PERCENT OF CHARGES BASED ON HCPCS CODE
T CELL ANTIGEN RECEPTOR GAMMA,81342,CPT,312,RC,,OUTPATIENT,,,870.75,348.3,MONUMENT,COMMERCIAL,,,,696.6,,653.06,853.34,
INJECT TRIGGER POINTS 3/>,20553,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UNITED HEALTH,UNITED COMMERCIAL,,,,442.476,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
ACETONE SERUM QUAL,82009,CPT,301,RC,,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
ACETONE SERUM QUAL,82009,CPT,301,RC,,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
INJ SGL/MULT TRIGGER PTS 3>,20553,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,UNITED HEALTH,UNITED COMMERCIAL,,,,477.0625,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
RBC ENZYMES,83915,CPT,301,RC,,OUTPATIENT,,,797.25,318.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,637.8,OTHER,597.94,781.31,PERCENT OF CHARGES BASED ON HCPCS CODE
RBC ENZYMES,83915,CPT,301,RC,,OUTPATIENT,,,797.25,318.9,MONUMENT,COMMERCIAL,,,,637.8,,597.94,781.31,
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,UNITED HEALTH,UNITED COMMERCIAL,,,,48.977,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
FRUCTOSAMINE,82985,CPT,300,RC,,OUTPATIENT,,,82,32.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.6,OTHER,61.5,80.36,PERCENT OF CHARGES BASED ON HCPCS CODE
FRUCTOSAMINE,82985,CPT,300,RC,,OUTPATIENT,,,82,32.8,MONUMENT,COMMERCIAL,,,,65.6,,61.5,80.36,
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,UNITED HEALTH,UNITED COMMERCIAL,,,,41.803,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 4,81403,CPT,300,RC,,OUTPATIENT,,,1365,546,BLUE CROSS ANTHEM,COMMERCIAL,,,,1092,OTHER,1023.75,1337.7,PERCENT OF CHARGES BASED ON HCPCS CODE
MOPATH PROCEDURE LEVEL 4,81403,CPT,300,RC,,OUTPATIENT,,,1365,546,MONUMENT,COMMERCIAL,,,,1092,,1023.75,1337.7,
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,UNITED HEALTH,UNITED COMMERCIAL,,,,48.977,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,UNITED HEALTH,UNITED COMMERCIAL,,,,41.803,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,550,220,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,412.5,539,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,528.02,211.208,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,396,517.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
JOINT ARTHOCENTESIS ASSIST SM,20600,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
C-NEURONAL (V-G) K+ CHANNEL AB,83519,CPT,300,RC,,OUTPATIENT,,,219.5,87.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,175.6,OTHER,164.63,215.11,PERCENT OF CHARGES BASED ON HCPCS CODE
C-NEURONAL (V-G) K+ CHANNEL AB,83519,CPT,300,RC,,OUTPATIENT,,,219.5,87.8,MONUMENT,COMMERCIAL,,,,175.6,,164.63,215.11,
ARTHRO SM W/US GUIDANCE,20604,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,442.88,578.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ACETYLCHOLINE RECEPTOR AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
ACETYLCHOLINE RECEPTOR AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
JOINT ARTHROCENTISIS ASSIST ME,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
Z SLIDE REVIEW MOLECULAR GENE,88387,CPT,310,RC,,OUTPATIENT,,,195,78,BLUE CROSS ANTHEM,COMMERCIAL,,,,156,OTHER,146.25,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SLIDE REVIEW MOLECULAR GENE,88387,CPT,310,RC,,OUTPATIENT,,,195,78,MONUMENT,COMMERCIAL,,,,156,,146.25,191.1,
JOINT ARTHOCENTESIS ASSIST MED,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
TSH RECEPTOR ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
TSH RECEPTOR ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
STEROID/CONTRAST INJECTION,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UNITED HEALTH,UNITED COMMERCIAL,,,,563.3375,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
MELATONIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
MELATONIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
STEROID/CONTRAST INJ LG JOINT,20610,CPT,320,RC,,OUTPATIENT,,,631,252.4,UNITED HEALTH,UNITED COMMERCIAL,,,,536.35,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
MELANTONIN 24 HR URINE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
MELANTONIN 24 HR URINE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
DRAIN/INJ JOINT/BURSA W/O US,20610,CPT,320,RC,,OUTPATIENT,,,520.56,208.224,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,390.4,510.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ACH RECEPTOR BINDING AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ACH RECEPTOR BINDING AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
DRN/INJ JNT/BURSA W/O US BILA,20610,CPT,320,RC,,OUTPATIENT,,,1041.12,416.448,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,780.8,1020.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ACH RECEPTOR BINDING AB,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ACH RECEPTOR BINDING AB,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
JOINT ARTHOCENTESIS ASSIST LG,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UNITED HEALTH,UNITED COMMERCIAL,,,,563.3375,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
HYDROXYLASE 21 ANTIBODIES,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
HYDROXYLASE 21 ANTIBODIES,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
REMOVAL MJR JOINT OR BURSA,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UNITED HEALTH,UNITED COMMERCIAL,,,,563.3375,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTOR MUSCLE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
ACH RECEPTOR MUSCLE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
"ARTHRO,ASSIST LG W/US GUIDANCE",20611,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,442.88,578.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DESMOGLEIN 1&3 SERUM,83516,CPT,300,RC,,OUTPATIENT,,,174.6,69.84,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.68,OTHER,130.95,171.11,PERCENT OF CHARGES BASED ON HCPCS CODE
DESMOGLEIN 1&3 SERUM,83516,CPT,300,RC,,OUTPATIENT,,,174.6,69.84,MONUMENT,COMMERCIAL,,,,139.68,,130.95,171.11,
ASPIRATE/INJ GAGLION,20612,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE RIA,83519,CPT,300,RC,,OUTPATIENT,,,1491.5,596.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1193.2,OTHER,1118.63,1461.67,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY FOR ANALYTE RIA,83519,CPT,300,RC,,OUTPATIENT,,,1491.5,596.6,MONUMENT,COMMERCIAL,,,,1193.2,,1118.63,1461.67,
REMOVAL FIXATION DEVICE;SUPER,20670,CPT,450,RC,,OUTPATIENT,,,3136.96,1254.784,UNITED HEALTH,UNITED COMMERCIAL,,,,2666.416,OTHER,2352.7,3074.2,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE MULT,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY FOR ANALYTE MULT,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
FLUID PRESSURE MUSCLE,20950,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
ACID PHOS TOTAL,84060,CPT,300,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
ACID PHOS TOTAL,84060,CPT,300,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
TRT CLSD NASAL BONE FRACTURE,21310,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,397,158.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,317.6,OTHER,297.75,389.06,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,397,158.8,MONUMENT,COMMERCIAL,,,,317.6,,297.75,389.06,
CLOSED TRMT OF NASAL BONE FX,21315,CPT,450,RC,,OUTPATIENT,,,1297.25,518.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1102.6625,OTHER,972.94,1271.31,PERCENT OF TOTAL BILLED CHARGES
INFECT AGT NUCLEIC ACID QUANT,87799,CPT,300,RC,,OUTPATIENT,,,228,91.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,182.4,OTHER,171,223.44,PERCENT OF CHARGES BASED ON HCPCS CODE
INFECT AGT NUCLEIC ACID QUANT,87799,CPT,300,RC,,OUTPATIENT,,,228,91.2,MONUMENT,COMMERCIAL,,,,182.4,,171,223.44,
DISLOCATION CLOSED TREATMENT,21480,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
Z ANTI HBC TOTAL,86704,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANTI HBC TOTAL,86704,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
ABSCESS DRAIN NECK/CHEST,21501,CPT,761,RC,,OUTPATIENT,,,3972.25,1588.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3376.4125,OTHER,2979.19,3892.81,PERCENT OF TOTAL BILLED CHARGES
Z HBS AB QUAL QUANT,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.2,OTHER,89.25,116.62,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HBS AB QUAL QUANT,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,MONUMENT,COMMERCIAL,,,,95.2,,89.25,116.62,
CT NECK/CHEST BIOPSY,21550,CPT,350,RC,,OUTPATIENT,,,1862.25,744.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1396.69,1825.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HEP A TOTAL ANTIBODIES,86708,CPT,300,RC,,OUTPATIENT,,,32.25,12.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.8,OTHER,24.19,31.61,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HEP A TOTAL ANTIBODIES,86708,CPT,300,RC,,OUTPATIENT,,,32.25,12.9,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
TRT CLSD RIB FRACTURE UNCOMP,21800,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z HCV,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HCV,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
BIOPSY DEEP TISSUE OF BACK CT,21925,CPT,361,RC,,OUTPATIENT,,,2552.25,1020.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2169.4125,OTHER,1914.19,2501.21,PERCENT OF TOTAL BILLED CHARGES
Z HBS ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HBS ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
SHLDER INJ FOR MR/CT ARTHRO L,23350,CPT,,,,OUTPATIENT,,,598,239.2,UNITED HEALTH,UNITED COMMERCIAL,,,,508.3,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
ACTH LEVEL,82024,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,91.4,OTHER,85.69,111.97,PERCENT OF CHARGES BASED ON HCPCS CODE
ACTH LEVEL,82024,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
SHLDER INJ FOR MR/CT ARTHRO R,23350,CPT,,,,OUTPATIENT,,,598,239.2,UNITED HEALTH,UNITED COMMERCIAL,,,,508.3,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
Z ESTRADIOL ENHANCED,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.2,OTHER,154.88,202.37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ESTRADIOL ENHANCED,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,MONUMENT,COMMERCIAL,,,,165.2,,154.88,202.37,
XRAY SHOULDER INJECTION,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,UNITED HEALTH,UNITED COMMERCIAL,,,,452.8375,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
Z ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
XRAY SHOULDER INJECTION RT,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,UNITED HEALTH,UNITED COMMERCIAL,,,,452.8375,OTHER,399.6,522.1,PERCENT OF TOTAL BILLED CHARGES
GALECTIN-3,82777,CPT,300,RC,,OUTPATIENT,,,195,78,BLUE CROSS ANTHEM,COMMERCIAL,,,,156,OTHER,146.25,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
GALECTIN-3,82777,CPT,300,RC,,OUTPATIENT,,,195,78,MONUMENT,COMMERCIAL,,,,156,,146.25,191.1,
TRT CLSD CLAVICULAR FRACTURE,23500,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
EXTENDEND CORD BLOOD TYPING,86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
EXTENDEND CORD BLOOD TYPING,86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
TRT CLSD PRX HUMERAL FX W/O,23600,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
REPTILASE TIME,85635,CPT,300,RC,,OUTPATIENT,,,113,45.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.4,OTHER,84.75,110.74,PERCENT OF CHARGES BASED ON HCPCS CODE
REPTILASE TIME,85635,CPT,300,RC,,OUTPATIENT,,,113,45.2,MONUMENT,COMMERCIAL,,,,90.4,,84.75,110.74,
DISLOCATION CLOSED SHLD UNI,23650,CPT,450,RC,,OUTPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,376.125,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
EVAL FINE NEEDLE ASP ADDL SPEC,88177,CPT,300,RC,,OUTPATIENT,,,66.25,26.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,53,OTHER,49.69,64.93,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL FINE NEEDLE ASP ADDL SPEC,88177,CPT,300,RC,,OUTPATIENT,,,66.25,26.5,MONUMENT,COMMERCIAL,,,,53,,49.69,64.93,
CLOSED REDUCTION OF SHDLR ANES,23655,CPT,450,RC,,OUTPATIENT,,,1884.25,753.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1601.6125,OTHER,1413.19,1846.57,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGM, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.4,OTHER,146.63,191.59,PERCENT OF CHARGES BASED ON HCPCS CODE
"CHIKUNGUNYA IGM, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,MONUMENT,COMMERCIAL,,,,156.4,,146.63,191.59,
CLSD REDUCT SHLDER W/ANES BILA,23655,CPT,450,RC,,OUTPATIENT,,,2890.9,1156.36,UNITED HEALTH,UNITED COMMERCIAL,,,,2457.265,OTHER,2168.2,2833.1,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGG, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.4,OTHER,146.63,191.59,PERCENT OF CHARGES BASED ON HCPCS CODE
"CHIKUNGUNYA IGG, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,MONUMENT,COMMERCIAL,,,,156.4,,146.63,191.59,
CLTX SHLD DISLC W/FX HUMERAL,23665,CPT,450,RC,,OUTPATIENT,,,1500,600,UNITED HEALTH,UNITED COMMERCIAL,,,,1275,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN  SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
ALBUMIN  SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
CLSD TRMT SHLD DIS W/SURG,23675,CPT,450,RC,,OUTPATIENT,,,1500,600,UNITED HEALTH,UNITED COMMERCIAL,,,,1275,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN BODY FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.2,OTHER,50.81,66.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ALBUMIN BODY FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,MONUMENT,COMMERCIAL,,,,54.2,,50.81,66.4,
REMOVAL FB UPPER ARM/ELBOW SUB,24200,CPT,450,RC,,OUTPATIENT,,,675,270,UNITED HEALTH,UNITED COMMERCIAL,,,,573.75,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
NMO IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
NMO IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
CLSD TRMT HUMERAL FRACTURE,24535,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,383.25,153.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,306.6,OTHER,287.44,375.59,PERCENT OF CHARGES BASED ON HCPCS CODE
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,383.25,153.3,MONUMENT,COMMERCIAL,,,,306.6,,287.44,375.59,
CLSD TRMT HUMERAL FX,24565,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
GRANULOCYTE ANTIBODIES,86021,CPT,300,RC,,OUTPATIENT,,,232.5,93,BLUE CROSS ANTHEM,COMMERCIAL,,,,186,OTHER,174.38,227.85,PERCENT OF CHARGES BASED ON HCPCS CODE
GRANULOCYTE ANTIBODIES,86021,CPT,300,RC,,OUTPATIENT,,,232.5,93,MONUMENT,COMMERCIAL,,,,186,,174.38,227.85,
TRT CLSD ELBOW DISLOCATION,24600,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS TPMT GENETICS,81401,CPT,300,RC,,OUTPATIENT,,,372.25,148.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,297.8,OTHER,279.19,364.81,PERCENT OF CHARGES BASED ON HCPCS CODE
PROMETHEUS TPMT GENETICS,81401,CPT,300,RC,,OUTPATIENT,,,372.25,148.9,MONUMENT,COMMERCIAL,,,,297.8,,279.19,364.81,
TRMT CLOSED ELBOW DISLOCATION,24605,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TPMT GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,716.75,286.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,573.4,OTHER,537.56,702.42,PERCENT OF CHARGES BASED ON HCPCS CODE
TPMT GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,716.75,286.7,MONUMENT,COMMERCIAL,,,,573.4,,537.56,702.42,
TRT CLSD RAD HD W/MANIPUL,24640,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CHROMOTOGRAPHY QUANT SINGLE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOTOGRAPHY QUANT SINGLE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
TRT CLSD HD W/O MANIPULATION,24650,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,102.2,OTHER,95.81,125.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,MONUMENT,COMMERCIAL,,,,102.2,,95.81,125.2,
CLSD TRMT RAD HD OR NK FX W/MA,24655,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
"17 KETOSTEROID, 24 HR",83582,CPT,301,RC,,OUTPATIENT,,,291,116.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,232.8,OTHER,218.25,285.18,PERCENT OF CHARGES BASED ON HCPCS CODE
"17 KETOSTEROID, 24 HR",83582,CPT,301,RC,,OUTPATIENT,,,291,116.4,MONUMENT,COMMERCIAL,,,,232.8,,218.25,285.18,
EXCISE TENDON FOREARM/WRIST,25109,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UNITED HEALTH,UNITED COMMERCIAL,,,,896.325,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GALOP AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
WRIST INJ FOR MR/CT ARTHRO LT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,UNITED HEALTH,UNITED COMMERCIAL,,,,495.55,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GALOP AUTOANTIBODIES,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
WRIST INJ FOR MR/CR ARTHRO RT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,UNITED HEALTH,UNITED COMMERCIAL,,,,495.55,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATHOLOGY PROC,81401,CPT,300,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR PATHOLOGY PROC,81401,CPT,300,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
XRAY WRIST INJECTION,25246,CPT,320,RC,,OUTPATIENT,,,532.75,213.1,UNITED HEALTH,UNITED COMMERCIAL,,,,452.8375,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATH PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,957.75,383.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,766.2,OTHER,718.31,938.6,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR PATH PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,957.75,383.1,MONUMENT,COMMERCIAL,,,,766.2,,718.31,938.6,
REPAIR TENDON FLEXOR FA/WRIST,25260,CPT,450,RC,,OUTPATIENT,,,1910.25,764.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1623.7125,OTHER,1432.69,1872.05,PERCENT OF TOTAL BILLED CHARGES
DEHYDROCHOLESTEROL 7-/8,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.4,OTHER,155.06,202.62,PERCENT OF CHARGES BASED ON HCPCS CODE
DEHYDROCHOLESTEROL 7-/8,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
TRT CLSD RAD SHAFT FRCT W/O MA,25500,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
SYNTHETIC CANNABINOIDS,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.4,OTHER,155.06,202.62,PERCENT OF CHARGES BASED ON HCPCS CODE
SYNTHETIC CANNABINOIDS,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
TRT CLSD RAD SHAFT FRCT W/MAN,25505,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY VIRUS PCR,87631,CPT,300,RC,,OUTPATIENT,,,557.5,223,BLUE CROSS ANTHEM,COMMERCIAL,,,,446,OTHER,418.13,546.35,PERCENT OF CHARGES BASED ON HCPCS CODE
RESPIRATORY VIRUS PCR,87631,CPT,300,RC,,OUTPATIENT,,,557.5,223,MONUMENT,COMMERCIAL,,,,446,,418.13,546.35,
TREAT FRACTURE OF RADIUS,25520,CPT,450,RC,,OUTPATIENT,,,2814.98,1125.992,UNITED HEALTH,UNITED COMMERCIAL,,,,2392.733,OTHER,2111.2,2758.7,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY PANEL PCR,87633,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,BLUE CROSS ANTHEM,COMMERCIAL,,,,666.848,OTHER,496.13,648.27,PERCENT OF CHARGES BASED ON HCPCS CODE
RESPIRATORY PANEL PCR,87633,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,MONUMENT,COMMERCIAL,,,,529.2,,496.13,648.27,
TRT CLSD ULNAR SH W/O MANIP,25530,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MPL EXON 10 MUTATION DETECT,81403,CPT,300,RC,,OUTPATIENT,,,797.75,319.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,638.2,OTHER,598.31,781.8,PERCENT OF CHARGES BASED ON HCPCS CODE
MPL EXON 10 MUTATION DETECT,81403,CPT,300,RC,,OUTPATIENT,,,797.75,319.1,MONUMENT,COMMERCIAL,,,,638.2,,598.31,781.8,
CLSD TRMT RAD/ULN SHAFT,25565,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CALR MUTATION ANALYSIS MPN,81219,CPT,300,RC,,OUTPATIENT,,,864,345.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,691.2,OTHER,648,846.72,PERCENT OF CHARGES BASED ON HCPCS CODE
CALR MUTATION ANALYSIS MPN,81219,CPT,300,RC,,OUTPATIENT,,,864,345.6,MONUMENT,COMMERCIAL,,,,691.2,,648,846.72,
TRT CLSD COLLES FX W/O MANIP,25600,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MITOTANE,G0480,HCPCS,300,RC,,BOTH,,,165.5,66.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,150.61,OTHER,124.13,162.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MITOTANE,G0480,HCPCS,300,RC,,BOTH,,,165.5,66.2,MONUMENT,COMMERCIAL,,,,132.4,,124.13,162.19,
MITOTANE,G0480,HCPCS,300,RC,,BOTH,,,165.5,66.2,UNITED HEALTH,UNITED COMMERCIAL,,,,124.13,,124.13,162.19,
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
CLSD TRMT DISTAL RADIAL FRACTU,25605,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
DRAINAGE OF FINGER ABS/SIMPLE,26010,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
DRAINAGE OF FINGER ABSCESS,26011,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
DISTAL PHALANX OF FINGER,26236,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
REPAIR FINGER/HAND TENDON,26350,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1574.4125,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
"REPAIR EXT TENDON, FINGER",26418,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1574.4125,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
TRT CLSD MCAPRAL FX W/O MAN,26600,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
FBNA GENE KM,81403,CPT,300,RC,,OUTPATIENT,,,938.75,375.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,751,OTHER,704.06,919.98,PERCENT OF CHARGES BASED ON HCPCS CODE
FBNA GENE KM,81403,CPT,300,RC,,OUTPATIENT,,,938.75,375.5,MONUMENT,COMMERCIAL,,,,751,,704.06,919.98,
FRACTURE W/MANIPULATION,26605,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR DIAG ISO EA NUCLEIC,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
TRT CLSD DISL THUMB W/MANIP,26641,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,8390991,CPT,300,RC,91,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR DIAG ISO EA NUCLEIC,8390991,CPT,300,RC,91,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
TRT CLSD CMC FX THUMB W/MANIP,26645,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD CMC DISL EX THUMB W/M,26670,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD MCP DISL W/MANIP,26700,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD PHALANGEAL FX W/O MAN,26720,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD PHALANGEAL FX W/MANIP,26725,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREAT FINGER FRACTURE,26742,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD DIST PHAL FX W/O MANI,26750,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD DIST PHAL FX W/MANIP,26755,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREAT FINGER FRACTURE EACH,26765,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,UNITED HEALTH,UNITED COMMERCIAL,,,,4864.958,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREATMENT JOINT DISLOCATION,26770,CPT,450,RC,,OUTPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,376.125,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREAT FINGER DISLOCATION,26775,CPT,450,RC,,OUTPATIENT,,,580,232,UNITED HEALTH,UNITED COMMERCIAL,,,,493,OTHER,435,568.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
AMPUTATION OF FINGER/THUMB,26951,CPT,450,RC,,OUTPATIENT,,,3417.75,1367.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2905.0875,OTHER,2563.31,3349.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
HIP INJECT FOR HIP XRAY,27093,CPT,320,RC,,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,,212.5,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJECTION FOR HIP LT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,UNITED HEALTH,UNITED COMMERCIAL,,,,582.25,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJECTION FOR HIP CT RIGHT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,UNITED HEALTH,UNITED COMMERCIAL,,,,582.25,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
FLURO GUIDED SI JOINT INJECTIO,27096,CPT,350,RC,,OUTPATIENT,,,2455.25,982.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2086.9625,OTHER,1841.4,2406.1,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN EPITHELIA PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD HIP DSLOC W/O ANESTH,27250,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREAT HIP,27252,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1574.4125,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
HIP DISLOCATION W/MANIPULATION,27257,CPT,450,RC,,OUTPATIENT,,,3282.25,1312.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2789.9125,OTHER,2461.69,3216.61,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
POST HIP ARTHROPLASTY DISLOCAT,27265,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRMT POST HIP ARTHRO,27266,CPT,450,RC,,OUTPATIENT,,,887.75,355.1,UNITED HEALTH,UNITED COMMERCIAL,,,,754.5875,OTHER,665.81,870,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLTX THIGH FX W/MNPJ,27268,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
DRAIN THIGH/KNEE LESION,27301,CPT,450,RC,,OUTPATIENT,,,4791.96,1916.784,UNITED HEALTH,UNITED COMMERCIAL,,,,4073.166,OTHER,3594,4696.1,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJECTION FOR KNEE XRAY,27370,CPT,320,RC,,OUTPATIENT,,,275.75,110.3,UNITED HEALTH,UNITED COMMERCIAL,,,,234.3875,OTHER,206.81,270.24,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003 91,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL I,86003 91,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REM FOREIGN BODY KNEE/THIGH,27372,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2350.4625,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
SUTURE INFRAPATELLAR TENDON PR,27380,CPT,450,RC,,OUTPATIENT,,,892.5,357,UNITED HEALTH,UNITED COMMERCIAL,,,,758.625,OTHER,669.38,874.65,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD OF THIGH FRACTURE,27502,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.3,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRT FEMO FX W/MANIP,27503,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD KNEE DISL W/O ANESTHE,27550,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREAT KNEECAP,27560,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLOSED TRMT OF PATELLAR DISC,27562,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD TIBIAL FX W/O MANIP,27750,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREATMENT OF TIBIA FRACTURE,27752,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD MEDIAL MAL FX W/O MAN,27760,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRMT MED MALLCOLOURS FX,27762,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,UNITED HEALTH,UNITED COMMERCIAL,,,,2358.903,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN HOUSE DUST PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,UNITED HEALTH,UNITED COMMERCIAL,,,,2358.903,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRMT DISTAL FIBULAR FX WO,27786,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD FX DISTAL FIBULA W/MA,27788,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRMT BIMALLEOLAR ANKLE FX,27810,CPT,450,RC,,OUTPATIENT,,,634,253.6,UNITED HEALTH,UNITED COMMERCIAL,,,,538.9,OTHER,475.5,621.32,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLSD TRMT TRIMALLCOLAR ANK FX,27818,CPT,450,RC,,OUTPATIENT,,,708.75,283.5,UNITED HEALTH,UNITED COMMERCIAL,,,,602.4375,OTHER,531.56,694.58,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE,82542,CPT,301,RC,,OUTPATIENT,,,260.75,104.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.6,OTHER,195.56,255.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CLONIDINE,82542,CPT,301,RC,,OUTPATIENT,,,260.75,104.3,MONUMENT,COMMERCIAL,,,,208.6,,195.56,255.54,
TREAT LOWER LEG FRACTURE,27825,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,UNITED HEALTH,UNITED COMMERCIAL,,,,494.275,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLOSED TX ANKLE DISLOCATION,27840,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,UNITED HEALTH,UNITED COMMERCIAL,,,,494.275,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REM FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,503.25,657.58,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REM FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2350.4625,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REM FOREIGN BODY FOOT COMPLICA,28193,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1460.5125,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
REPAIR OF FOOT TENDON EXTENSOR,28208,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,UNITED HEALTH,UNITED COMMERCIAL,,,,4864.958,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD FX GREAT TOE W/O MANI,28490,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
ALDOLASE,82085,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
ALDOLASE,82085,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
TRT CLSD FX GREAT TOE W/MANIP,28495,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TRT CLSD FX OTH PHALANX W/O MA,28510,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLOBAZAM,80339,CPT,301,RC,,OUTPATIENT,,,158,63.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,126.4,OTHER,118.5,154.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOBAZAM,80339,CPT,301,RC,,OUTPATIENT,,,158,63.2,MONUMENT,COMMERCIAL,,,,126.4,,118.5,154.84,
TRT CLSD FX OTH PHALANX W/MANI,28515,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 9,81408,CPT,300,RC,,OUTPATIENT,,,4000,1600,BLUE CROSS ANTHEM,COMMERCIAL,,,,3200,OTHER,2155.69,2816.77,PERCENT OF CHARGES BASED ON HCPCS CODE
MOPATH PROCEDURE LEVEL 9,81408,CPT,300,RC,,OUTPATIENT,,,4000,1600,MONUMENT,COMMERCIAL,,,,2299.4,,2155.69,2816.77,
CLSD TRMT TARSAL BONE DISLOC,28545,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR DIAGNOS ENZ DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
TRT CLSD TARSOMETAT DISL W/O A,28600,CPT,450,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,488.75,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR DIAGNOS ENZ DIGEST,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
TRT CLSD META JOINT DISL W/O A,28630,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR EA NUCLEIC SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
TRT CLSD INTPHAL JT DISL W/O A,28660,CPT,450,RC,,OUTPATIENT,,,430,172,UNITED HEALTH,UNITED COMMERCIAL,,,,365.5,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR EA NUCLEIC SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CLTX INTERPHALANGEAL JT,28665,CPT,450,RC,,OUTPATIENT,,,675,270,UNITED HEALTH,UNITED COMMERCIAL,,,,573.75,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR DIAG SEP AND IDENT,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
LONG ARM CAST,29065,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,UNITED HEALTH,UNITED COMMERCIAL,,,,408.5865,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,8390991,CPT,300,RC,91,OUTPATIENT,,,2146.5,858.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1717.2,OTHER,1609.88,2103.57,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR DIAG SEP AND IDENT,8390991,CPT,300,RC,91,OUTPATIENT,,,2146.5,858.6,MONUMENT,COMMERCIAL,,,,1717.2,,1609.88,2103.57,
APPLICATION SHORT ARM CAST,29075,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,UNITED HEALTH,UNITED COMMERCIAL,,,,408.5865,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
LYSOZYME SERUM,85549,CPT,300,RC,,OUTPATIENT,,,160,64,BLUE CROSS ANTHEM,COMMERCIAL,,,,128,OTHER,120,156.8,PERCENT OF CHARGES BASED ON HCPCS CODE
LYSOZYME SERUM,85549,CPT,300,RC,,OUTPATIENT,,,160,64,MONUMENT,COMMERCIAL,,,,128,,120,156.8,
APPLICATION HAND/FOREARM CAST,29085,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
ALDOSTERONE SERUM,82088,CPT,300,RC,,OUTPATIENT,,,255,102,BLUE CROSS ANTHEM,COMMERCIAL,,,,204,OTHER,191.25,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ALDOSTERONE SERUM,82088,CPT,300,RC,,OUTPATIENT,,,255,102,MONUMENT,COMMERCIAL,,,,204,,191.25,249.9,
APPLICATION CAST FINGER,29086,CPT,,,,OUTPATIENT,,,281.4,112.56,UNITED HEALTH,UNITED COMMERCIAL,,,,239.19,OTHER,211.1,275.8,PERCENT OF TOTAL BILLED CHARGES
Z EH MUMPS (IMMUNITY),86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.2,OTHER,91.13,119.07,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH MUMPS (IMMUNITY),86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,MONUMENT,COMMERCIAL,,,,97.2,,91.13,119.07,
APPLICATION LONG ARM SPLINT,29105,CPT,450,RC,,OUTPATIENT,,,361,144.4,UNITED HEALTH,UNITED COMMERCIAL,,,,306.85,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
Z EH MEASLES,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH MEASLES,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
SHORT ARM,29125,CPT,450,RC,,OUTPATIENT,,,330.75,132.3,UNITED HEALTH,UNITED COMMERCIAL,,,,281.1375,OTHER,248.06,324.14,PERCENT OF TOTAL BILLED CHARGES
Z EH VARICELLA ZOSTER IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.2,OTHER,100.5,131.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH VARICELLA ZOSTER IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,MONUMENT,COMMERCIAL,,,,107.2,,100.5,131.32,
APPLY FOREARM SPLINT,29125,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,124.5,162.68,PERCENT OF TOTAL BILLED CHARGES
Z EH RUBELLA,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH RUBELLA,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
APPLY FOREARM SPLINT,29126,CPT,450,RC,,OUTPATIENT,,,331,132.4,UNITED HEALTH,UNITED COMMERCIAL,,,,281.35,OTHER,248.3,324.4,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.2,OTHER,89.25,116.62,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH HEP B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,MONUMENT,COMMERCIAL,,,,95.2,,89.25,116.62,
FINGER SPLINT: STATIC,29130,CPT,450,RC,,OUTPATIENT,,,287.75,115.1,UNITED HEALTH,UNITED COMMERCIAL,,,,244.5875,OTHER,215.81,282,PERCENT OF TOTAL BILLED CHARGES
Z EH HIV,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH HIV,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
APPLICATION OF FINGER SPLINT,29130,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
Z EH HEPATITIS C VIRUS,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH HEPATITIS C VIRUS,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
APPLICATION OF FINGER SPLINT,29131,CPT,450,RC,,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,122.4,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EH HEP B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
STRAPPING THORAX,29200,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
EH HIV NEEDLESTICK F/U,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
EH HIV NEEDLESTICK F/U,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
STRAPPING OF SHOULDER,29240,CPT,450,RC,,OUTPATIENT,,,912,364.8,UNITED HEALTH,UNITED COMMERCIAL,,,,775.2,OTHER,684,893.8,PERCENT OF TOTAL BILLED CHARGES
HCV NEEDLESTICK F/U,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HCV NEEDLESTICK F/U,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
EH STREP A ANTIGEN,3000455,CDM,,,,INPATIENT,,,32.25,12.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.35,OTHER,24.19,31.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EH STREP A ANTIGEN,3000455,CDM,,,,INPATIENT,,,32.25,12.9,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
EH STREP A ANTIGEN,3000455,CDM,,,,INPATIENT,,,32.25,12.9,UNITED HEALTH,UNITED COMMERCIAL,,,,24.19,,24.19,31.61,
EH STREP CULTURE,3000456,CDM,300,RC,,INPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.97,OTHER,14.81,19.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EH STREP CULTURE,3000456,CDM,300,RC,,INPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
EH STREP CULTURE,3000456,CDM,300,RC,,INPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,,14.81,,14.81,19.36,
HEMOLYSINS/AGGLUTININS,86941,CPT,300,RC,,OUTPATIENT,,,187,74.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.6,OTHER,140.25,183.26,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOLYSINS/AGGLUTININS,86941,CPT,300,RC,,OUTPATIENT,,,187,74.8,MONUMENT,COMMERCIAL,,,,149.6,,140.25,183.26,
STRAPPING FINGER OR HAND,29280,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
ITRACONAZOLE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ITRACONAZOLE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
APPLICATION LONG LEG CAST,29345,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
FTA ABS IGG BY IFA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.2,OTHER,79.88,104.37,PERCENT OF CHARGES BASED ON HCPCS CODE
FTA ABS IGG BY IFA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,MONUMENT,COMMERCIAL,,,,85.2,,79.88,104.37,
APPLICATION SHORT LEG CAST,29405,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UNITED HEALTH,UNITED COMMERCIAL,,,,387.3875,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
TBNK QN,86355,CPT,300,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
TBNK QN,86355,CPT,300,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
LONG LEG,29505,CPT,450,RC,,OUTPATIENT,,,450.5,180.2,UNITED HEALTH,UNITED COMMERCIAL,,,,382.925,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO,86357,CPT,300,RC,,OUTPATIENT,,,214.75,85.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,171.8,OTHER,161.06,210.46,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTO,86357,CPT,300,RC,,OUTPATIENT,,,214.75,85.9,MONUMENT,COMMERCIAL,,,,171.8,,161.06,210.46,
SHORT LEG,29515,CPT,450,RC,,OUTPATIENT,,,361,144.4,UNITED HEALTH,UNITED COMMERCIAL,,,,306.85,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
BAL,86359,CPT,300,RC,,OUTPATIENT,,,240,96,BLUE CROSS ANTHEM,COMMERCIAL,,,,192,OTHER,180,235.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BAL,86359,CPT,300,RC,,OUTPATIENT,,,240,96,MONUMENT,COMMERCIAL,,,,192,,180,235.2,
APPLICATION LOWER LEG SPLINT,29515,CPT,450,RC,,OUTPATIENT,,,281.39,112.556,UNITED HEALTH,UNITED COMMERCIAL,,,,239.1815,OTHER,139.5,182.28,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR FUNCT,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
C1 ESTERASE INHIBITOR FUNCT,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
STRAPPING OF HIP,29520,CPT,450,RC,,OUTPATIENT,,,297,118.8,UNITED HEALTH,UNITED COMMERCIAL,,,,252.45,OTHER,222.8,291.1,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.8,OTHER,36.38,47.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,MONUMENT,COMMERCIAL,,,,38.8,,36.38,47.53,
STRAPPING KNEE,29530,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,300,RC,,OUTPATIENT,,,169,67.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.2,OTHER,126.75,165.62,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,300,RC,,OUTPATIENT,,,169,67.6,MONUMENT,COMMERCIAL,,,,135.2,,126.75,165.62,
STRAPPING ANKLE,29540,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE ISO,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,133.2,OTHER,124.88,163.17,PERCENT OF CHARGES BASED ON HCPCS CODE
ALKALINE PHOSPHATASE ISO,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,MONUMENT,COMMERCIAL,,,,133.2,,124.88,163.17,
STRAPPING TOES,29550,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.8,OTHER,36.38,47.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,MONUMENT,COMMERCIAL,,,,38.8,,36.38,47.53,
STRAPPING UNNA BOOT,29580,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
FECAL FATS QUANT 24 48 72 HR,82710,CPT,301,RC,,OUTPATIENT,,,159,63.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.2,OTHER,119.25,155.82,PERCENT OF CHARGES BASED ON HCPCS CODE
FECAL FATS QUANT 24 48 72 HR,82710,CPT,301,RC,,OUTPATIENT,,,159,63.6,MONUMENT,COMMERCIAL,,,,127.2,,119.25,155.82,
REM OR BIVALV ARM/LEG CAST,29705,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
HEROIN METOBOLITC,80356,CPT,300,RC,,OUTPATIENT,,,285,114,BLUE CROSS ANTHEM,COMMERCIAL,,,,228,OTHER,213.75,279.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HEROIN METOBOLITC,80356,CPT,300,RC,,OUTPATIENT,,,285,114,MONUMENT,COMMERCIAL,,,,228,,213.75,279.3,
WINDOWING OF CAST,29730,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,252.6625,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
BONE ALKALINE PHOSPHATASE,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,133.2,OTHER,124.88,163.17,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE ALKALINE PHOSPHATASE,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,MONUMENT,COMMERCIAL,,,,133.2,,124.88,163.17,
REMOVAL NASAL FOREIGN,30300,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ALLERGENS-SINGLE ASSAY,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGENS-SINGLE ASSAY,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CONTROL NASAL HEMORRHAGE SIMPL,30901,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN HAZELNUT TEST,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN HAZELNUT TEST,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CONTROL NASAL HEMORRHAGE COMPL,30903,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1 ANTITRYPSIN GENOTYPING,81332,CPT,300,RC,,OUTPATIENT,,,435.25,174.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,348.2,OTHER,326.44,426.55,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA-1 ANTITRYPSIN GENOTYPING,81332,CPT,300,RC,,OUTPATIENT,,,435.25,174.1,MONUMENT,COMMERCIAL,,,,348.2,,326.44,426.55,
CONTROL OF NOSEBLEED POSTERIOR,30905,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1-ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.75,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA-1-ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
NASAL SURGERY,30999,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
"FENTANYL WITH METABOLITE,URINE",G0480,HCPCS,300,RC,,BOTH,,,369,147.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,335.79,OTHER,276.75,361.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"FENTANYL WITH METABOLITE,URINE",G0480,HCPCS,300,RC,,BOTH,,,369,147.6,MONUMENT,COMMERCIAL,,,,295.2,,276.75,361.62,
"FENTANYL WITH METABOLITE,URINE",G0480,HCPCS,300,RC,,BOTH,,,369,147.6,UNITED HEALTH,UNITED COMMERCIAL,,,,276.75,,276.75,361.62,
Z ALPHA 1 ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.75,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALPHA 1 ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
ENDOTRACHEAL INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UNITED HEALTH,UNITED COMMERCIAL,,,,671.2875,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
A1A PHENOTYPE,82104,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.4,OTHER,33.19,43.37,PERCENT OF CHARGES BASED ON HCPCS CODE
A1A PHENOTYPE,82104,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,MONUMENT,COMMERCIAL,,,,35.4,,33.19,43.37,
INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.5,315.8,UNITED HEALTH,UNITED COMMERCIAL,,,,671.075,OTHER,592.13,773.71,PERCENT OF TOTAL BILLED CHARGES
A1A,82103,CPT,301,RC,,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.75,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
A1A,82103,CPT,301,RC,,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
INFANT INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UNITED HEALTH,UNITED COMMERCIAL,,,,671.2875,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
ALPHA SUBUNIT PITUITARY TM,83520,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA SUBUNIT PITUITARY TM,83520,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
LARYNGOSCOPY FLEXIBLE DIAG,31575,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UNITED HEALTH,UNITED COMMERCIAL,,,,671.2875,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
PROSTAGLANDIN,84150,CPT,300,RC,,OUTPATIENT,,,142,56.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.6,OTHER,106.5,139.16,PERCENT OF CHARGES BASED ON HCPCS CODE
PROSTAGLANDIN,84150,CPT,300,RC,,OUTPATIENT,,,142,56.8,MONUMENT,COMMERCIAL,,,,113.6,,106.5,139.16,
TRACHEOSTOMY TRANSTRACHAEL,31603,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2791.1875,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
"TRACHEOSTOMY, EME PROCEDURE",31605,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2791.1875,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
SUCTION ENDOTRACHEAL NON-VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
SUCTION ENDOTRACHEAL NON VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,OUTPATIENT,,,385.92,154.368,UNITED HEALTH,UNITED COMMERCIAL,,,,328.032,OTHER,289.4,378.2,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CT CORE LUNG/MEDIA NEEDLE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1148.25,1500.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,580,232,BLUE CROSS ANTHEM,COMMERCIAL,,,,464,OTHER,435,568.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,580,232,MONUMENT,COMMERCIAL,,,,464,,435,568.4,
US LUNG/MEDIASTINUM CORE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1148.25,1500.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HYDROXYPROLINE  TOTAL URINE,83505,CPT,301,RC,,OUTPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.6,OTHER,90.56,118.34,PERCENT OF CHARGES BASED ON HCPCS CODE
HYDROXYPROLINE  TOTAL URINE,83505,CPT,301,RC,,OUTPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
US THORACENTESIS,32421,CPT,361,RC,,OUTPATIENT,,,1049,419.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,786.75,1028.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALPHA FETO PROTEIN BODY FLUIDS,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.8,OTHER,140.44,183.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA FETO PROTEIN BODY FLUIDS,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,MONUMENT,COMMERCIAL,,,,149.8,,140.44,183.51,
CT CHEST TUBE PLCMT FOR ABCESS,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,858.38,1121.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALPHA FETO PROTEIN,82105,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,133.2,OTHER,124.88,163.17,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA FETO PROTEIN,82105,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,MONUMENT,COMMERCIAL,,,,133.2,,124.88,163.17,
CT CHEST TUBE PLCMT FOR PNEUMO,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,858.38,1121.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CA 72 4,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.8,OTHER,140.44,183.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CA 72 4,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,MONUMENT,COMMERCIAL,,,,149.8,,140.44,183.51,
CHEST TUBE ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,,972.825,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
AFP,82106,CPT,300,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
AFP,82106,CPT,300,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
THORACOTOMY ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,,972.825,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
ACETYLOCHOLINESTERASE ASSAY,82013,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
ACETYLOCHOLINESTERASE ASSAY,82013,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
TUBE THORACOSTOMY,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,,972.825,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
AMNIOTIC FLUID SCAN,82143,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
AMNIOTIC FLUID SCAN,82143,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
CT FIDUCIAL MARKER PLACEMENT,32553,CPT,760,RC,,OUTPATIENT,,,2515.73,1006.292,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1541.25,2013.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELECTROPHORECTIC TEST,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
ELECTROPHORECTIC TEST,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
THORACENTESIS,32554,CPT,450,RC,,OUTPATIENT,,,1079.54,431.816,UNITED HEALTH,UNITED COMMERCIAL,,,,917.609,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
Z ELECTROPHORECTIC TEST,8266491,CPT,301,RC,91,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ELECTROPHORECTIC TEST,8266491,CPT,301,RC,91,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
CT THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1473.75,1925.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ETHYLENE GLYCOL LEVEL,82693,CPT,300,RC,,OUTPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
ETHYLENE GLYCOL LEVEL,82693,CPT,300,RC,,OUTPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
CT THORACENTESIS (BNSP),32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1473.75,1925.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN ANTIBODY  SERUM,86337,CPT,302,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN ANTIBODY  SERUM,86337,CPT,302,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
US THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1473.75,1925.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APTT MIX 1:1,85732,CPT,300,RC,,OUTPATIENT,,,163.5,65.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,130.8,OTHER,122.63,160.23,PERCENT OF CHARGES BASED ON HCPCS CODE
APTT MIX 1:1,85732,CPT,300,RC,,OUTPATIENT,,,163.5,65.4,MONUMENT,COMMERCIAL,,,,130.8,,122.63,160.23,
THORACENTESIS;W/IMAGING,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UNITED HEALTH,UNITED COMMERCIAL,,,,1670.25,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
EUGLOBULIN LYSIS TIME,85360,CPT,300,RC,,OUTPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,94,OTHER,88.13,115.15,PERCENT OF CHARGES BASED ON HCPCS CODE
EUGLOBULIN LYSIS TIME,85360,CPT,300,RC,,OUTPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
CHEST TUBE PLACEMENT,32557,CPT,320,RC,,OUTPATIENT,,,1708,683.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1451.8,OTHER,1281,1673.84,PERCENT OF TOTAL BILLED CHARGES
LATEX IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
LATEX IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
PERICARDIOCENTESIS INITIAL,33010,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,UNITED HEALTH,UNITED COMMERCIAL,,,,815.3625,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
INSERT ELECTRD/PM CATH SNGL,33210,CPT,450,RC,,OUTPATIENT,,,16488.76,6595.504,UNITED HEALTH,UNITED COMMERCIAL,,,,14015.446,OTHER,12366.6,16159,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,119,OTHER,111.56,145.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,MONUMENT,COMMERCIAL,,,,119,,111.56,145.78,
REPAIR BLOOD VESSEL UPPER EXT,35206,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2698.9625,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.4,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
"RPR BLOOD VESSEL, HAND, FINGER",35207,CPT,450,RC,,OUTPATIENT,,,2625,1050,UNITED HEALTH,UNITED COMMERCIAL,,,,2231.25,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
P HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
P HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
REPAIR BLD VESSEL LOWER EXTREM,35226,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2698.9625,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION PANEL B,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.4,OTHER,115.69,151.17,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL IDENTIFICATION PANEL B,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,MONUMENT,COMMERCIAL,,,,123.4,,115.69,151.17,
MIDLINE INSERTION,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,UNITED HEALTH,UNITED COMMERCIAL,,,,414.8,OTHER,366,478.2,PERCENT OF TOTAL BILLED CHARGES
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
MID LINE PLACEMENT W/US GUIDAN,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,366,478.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FUNGAL IDENTIFICATION PANEL A,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.4,OTHER,115.69,151.17,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL IDENTIFICATION PANEL A,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,MONUMENT,COMMERCIAL,,,,123.4,,115.69,151.17,
VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,,22.1,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
FUNGAL D2 SEQUENCING ID,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.576,OTHER,164.25,214.62,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL D2 SEQUENCING ID,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,MONUMENT,COMMERCIAL,,,,175.2,,164.25,214.62,
DRAWING FEE-SPEC KIT,36415,CPT,300,RC,,OUTPATIENT,,,50.75,20.3,UNITED HEALTH,UNITED COMMERCIAL,,,,43.1375,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
AMEBIASIS ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.8,OTHER,92.63,121.03,PERCENT OF CHARGES BASED ON HCPCS CODE
AMEBIASIS ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
ROUTINE VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,8,3.2,UNITED HEALTH,UNITED COMMERCIAL,,,,6.8,OTHER,6,7.84,PERCENT OF TOTAL BILLED CHARGES
THYROTROPIN RELEASING HORMONE,83519,CPT,300,RC,,OUTPATIENT,,,373.75,149.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,299,OTHER,280.31,366.28,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROTROPIN RELEASING HORMONE,83519,CPT,300,RC,,OUTPATIENT,,,373.75,149.5,MONUMENT,COMMERCIAL,,,,299,,280.31,366.28,
COLL OF BLOOD BY VENI PUNCTUR,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,,22.1,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
SPECIMEN COLLECTION CAPILLARY,36416,CPT,300,RC,,OUTPATIENT,,,6.25,2.5,UNITED HEALTH,UNITED COMMERCIAL,,,,5.3125,OTHER,4.69,6.13,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN - TROUGH,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
AMIKACIN - TROUGH,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
BLOOD TRANS SER 4-8 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1232.2875,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS,80197,CPT,300,RC,,OUTPATIENT,,,433.75,173.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,347,OTHER,325.31,425.08,PERCENT OF CHARGES BASED ON HCPCS CODE
TACROLIMUS,80197,CPT,300,RC,,OUTPATIENT,,,433.75,173.5,MONUMENT,COMMERCIAL,,,,347,,325.31,425.08,
BLOOD TRANS SER 2-4 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1062.2875,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN PEAK,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
AMIKACIN PEAK,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
BLOOD TRANS SER 1-2 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UNITED HEALTH,UNITED COMMERCIAL,,,,977.2875,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
KRAS ADDITIONAL VARIANT,81276,CPT,300,RC,,OUTPATIENT,,,386.5,154.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,309.2,OTHER,230.25,300.86,PERCENT OF CHARGES BASED ON HCPCS CODE
KRAS ADDITIONAL VARIANT,81276,CPT,300,RC,,OUTPATIENT,,,386.5,154.6,MONUMENT,COMMERCIAL,,,,245.6,,230.25,300.86,
BLOOD TRANS SER 0-1 HOUR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UNITED HEALTH,UNITED COMMERCIAL,,,,892.2875,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRACTION NUCLIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,65.25,26.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.2,OTHER,48.94,63.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRACTION NUCLIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,65.25,26.1,MONUMENT,COMMERCIAL,,,,52.2,,48.94,63.95,
BLOOD TRANS BLD OR COMP,36430,CPT,391,RC,,OUTPATIENT,,,1003.75,401.5,UNITED HEALTH,UNITED COMMERCIAL,,,,853.1875,OTHER,752.81,983.68,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
BLOOD ADM ONC (0-1HRS),36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,787.3,1028.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
BLOOD ADM ONC (1-2HRS),36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,862.3,1126.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
BLOOD ADM ONC (2-4HRS),36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,937.3,1224.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
BLOOD ADM ONC (4-8HRS),36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1087.3,1420.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
BLOOD TRANSFUSION SERV 4-8 HR,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1232.2875,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
BLOOD TRANSFUSION SERV 1-2 HR,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UNITED HEALTH,UNITED COMMERCIAL,,,,977.2875,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
BLOOD TRANSFUSION SERV 2-4 HR,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1062.2875,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
BLOOD TRANSFUSION SERV 0-1 HR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UNITED HEALTH,UNITED COMMERCIAL,,,,892.2875,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
PICC LINE INSERTION,36489,CPT,361,RC,,OUTPATIENT,,,839.5,335.8,UNITED HEALTH,UNITED COMMERCIAL,,,,713.575,OTHER,629.63,822.71,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
UMBILICAL CATH PROCEDURE,36510,CPT,360,RC,,OUTPATIENT,,,548.25,219.3,UNITED HEALTH,UNITED COMMERCIAL,,,,466.0125,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
CENTRAL LINE PLCMT ASSIST<5YRS,36555,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1729.5375,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
CENTRAL LINE PLCMT ASSIST>5YRS,36556,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1729.5375,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
INSERT NON-TUNNEL CV CATH,36556,CPT,450,RC,,OUTPATIENT,,,5703.74,2281.496,UNITED HEALTH,UNITED COMMERCIAL,,,,4848.179,OTHER,4277.8,5589.7,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
INSERT TUNNELED CV CATH,36558,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1729.5375,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
US PICC LINE PLACEMENT,36569,CPT,361,RC,,OUTPATIENT,,,2033,813.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1524.75,1992.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
INSERT PICC CATH,36569,CPT,361,RC,,OUTPATIENT,,,1672,668.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1421.2,OTHER,1254,1638.56,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
PICC PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,3124,1249.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2655.4,OTHER,2343,3061.52,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
FLURO,36573,CPT,320,RC,,OUTPATIENT,,,660.75,264.3,UNITED HEALTH,UNITED COMMERCIAL,,,,561.6375,OTHER,495.56,647.54,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
US GUIDANCE NEEDLE PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,545.5,218.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,409.13,534.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
US PICC LINE ONLY,36573,CPT,320,RC,,OUTPATIENT,,,2578.5,1031.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1933.88,2526.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYMATIC DIGESTION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYMATIC DIGESTION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
VENOUS CATHETER REMOVAL,36589,CPT,760,RC,,OUTPATIENT,,,1885.5,754.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1602.675,OTHER,1414.13,1847.79,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
BLOOD DRAW FROM IMPLNT PORT,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,UNITED HEALTH,UNITED COMMERCIAL,,,,244.375,OTHER,215.63,281.75,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,UNITED HEALTH,UNITED COMMERCIAL,,,,244.375,OTHER,215.6,281.8,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
BLOOD DRAW OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,223.14,89.256,UNITED HEALTH,UNITED COMMERCIAL,,,,189.669,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
COLLECT BLOOD PICC LINE LVL I,36592,CPT,761,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,132.94,173.71,PERCENT OF TOTAL BILLED CHARGES
Z IODINE,83789,CPT,300,RC,,OUTPATIENT,,,300,120,BLUE CROSS ANTHEM,COMMERCIAL,,,,240,OTHER,225,294,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IODINE,83789,CPT,300,RC,,OUTPATIENT,,,300,120,MONUMENT,COMMERCIAL,,,,240,,225,294,
COLLECT BLOOD PICC LINE LVL II,36592,CPT,761,RC,,OUTPATIENT,,,232,92.8,UNITED HEALTH,UNITED COMMERCIAL,,,,197.2,OTHER,174,227.36,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,224,89.6,UNITED HEALTH,UNITED COMMERCIAL,,,,190.4,OTHER,168,219.5,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,223.14,89.256,UNITED HEALTH,UNITED COMMERCIAL,,,,189.669,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
DECLOTTING AGENT OF IMPLT,36593,CPT,761,RC,,OUTPATIENT,,,804,321.6,UNITED HEALTH,UNITED COMMERCIAL,,,,683.4,OTHER,603,787.92,PERCENT OF TOTAL BILLED CHARGES
AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,306,122.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.8,OTHER,229.5,299.88,PERCENT OF CHARGES BASED ON HCPCS CODE
AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,306,122.4,MONUMENT,COMMERCIAL,,,,244.8,,229.5,299.88,
CENTRAL VENOUS ACCESS EVAL,36598,CPT,320,RC,,OUTPATIENT,,,568,227.2,UNITED HEALTH,UNITED COMMERCIAL,,,,482.8,OTHER,426,556.64,PERCENT OF TOTAL BILLED CHARGES
Z AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
ABG PUNCTURE,36600,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
ARTERIAL CATH; PERCUTANEOUS,36620,CPT,450,RC,,OUTPATIENT,,,550,220,UNITED HEALTH,UNITED COMMERCIAL,,,,467.5,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,2677.25,1070.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2141.8,OTHER,2007.94,2623.71,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,2677.25,1070.9,MONUMENT,COMMERCIAL,,,,2141.8,,2007.94,2623.71,
I O INSERTION,36680,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,UNITED HEALTH,UNITED COMMERCIAL,,,,457.8015,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
Z CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,68.85,27.54,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.08,OTHER,51.6,67.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,68.85,27.54,MONUMENT,COMMERCIAL,,,,55.1,,51.6,67.5,
XRAY FILTER GUIDANCE,37191,CPT,361,RC,,OUTPATIENT,,,3145.75,1258.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2673.8875,OTHER,2359.31,3082.84,PERCENT OF TOTAL BILLED CHARGES
GENOMIC SEQ HEMATOLYMPHOID DNA,81450,CPT,310,RC,,OUTPATIENT,,,1519.06,607.624,BLUE CROSS ANTHEM,COMMERCIAL,,,,1215.248,OTHER,975,1274,PERCENT OF CHARGES BASED ON HCPCS CODE
GENOMIC SEQ HEMATOLYMPHOID DNA,81450,CPT,310,RC,,OUTPATIENT,,,1519.06,607.624,MONUMENT,COMMERCIAL,,,,1040,,975,1274,
IVC FILTER PLACEMENT,37191,CPT,361,RC,,OUTPATIENT,,,6206.5,2482.6,UNITED HEALTH,UNITED COMMERCIAL,,,,5275.525,OTHER,4654.88,6082.37,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
THROMBOLYTIC CEREBRAL IV INFUS,37195,CPT,450,RC,,OUTPATIENT,,,619.37,247.748,UNITED HEALTH,UNITED COMMERCIAL,,,,526.4645,OTHER,330.75,432.18,PERCENT OF TOTAL BILLED CHARGES
HLA I&II TYPING LR,81370,CPT,300,RC,,OUTPATIENT,,,1000,400,BLUE CROSS ANTHEM,COMMERCIAL,,,,800,OTHER,750,980,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA I&II TYPING LR,81370,CPT,300,RC,,OUTPATIENT,,,1000,400,MONUMENT,COMMERCIAL,,,,800,,750,980,
UNLIST PROCEDURE SUTURE VEIN,37799,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1460.5125,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
BONE MARROW BIOPSY,38221,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1818.575,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.4,OTHER,76.31,99.72,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,MONUMENT,COMMERCIAL,,,,81.4,,76.31,99.72,
BONE MARROW BX & ASP SAME SITE,38222,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1818.575,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.4,OTHER,76.31,99.72,PERCENT OF CHARGES BASED ON HCPCS CODE
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,MONUMENT,COMMERCIAL,,,,81.4,,76.31,99.72,
US BIOPSY LYMPH SUPERFICIAL,38505,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1385.81,1810.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,300,RC,,OUTPATIENT,,,110.25,44.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.2,OTHER,82.69,108.05,PERCENT OF CHARGES BASED ON HCPCS CODE
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,300,RC,,OUTPATIENT,,,110.25,44.1,MONUMENT,COMMERCIAL,,,,88.2,,82.69,108.05,
RPR LIP FULL THICKNESS VERMILI,40650,CPT,450,RC,,OUTPATIENT,,,901.62,360.648,UNITED HEALTH,UNITED COMMERCIAL,,,,766.377,OTHER,676.2,883.6,PERCENT OF TOTAL BILLED CHARGES
DRVVT DILUTED,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.2,OTHER,97.69,127.65,PERCENT OF CHARGES BASED ON HCPCS CODE
DRVVT DILUTED,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
RPR LIP FULL THKNS>ONE-HALF HE,40654,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.4,653.9,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE  RBC,82482,CPT,301,RC,,OUTPATIENT,,,177.5,71,BLUE CROSS ANTHEM,COMMERCIAL,,,,142,OTHER,133.13,173.95,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLINESTERASE  RBC,82482,CPT,301,RC,,OUTPATIENT,,,177.5,71,MONUMENT,COMMERCIAL,,,,142,,133.13,173.95,
DRAINAGE OF MOUTH,40800,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGG,86651,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CALIF VIRUS LAC AB IGG,86651,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,OUTPATIENT,,,1663.6,665.44,UNITED HEALTH,UNITED COMMERCIAL,,,,1414.06,OTHER,1247.7,1630.3,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGG CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
EAST EQUINE ENCEP IGG CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
RPR FLOOR MTH AND/OR TONGUE,41250,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGM CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
EAST EQUINE ENCEP IGM CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
"TONGUE, FLOOR OF MOUTH UNLISTE",41599,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE ENCEP IGG CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
WEST EQUINE ENCEP IGG CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
DRAINAGE OF GUM,41800,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE EHCEP IGM CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
WEST EQUINE EHCEP IGM CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
DENTAL SURGERY PROCEDURE,41899,CPT,450,RC,,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGM,86651,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CALIF VIRUS LAC AB IGM,86651,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
DRAINAGE OF TONSIL ABSCESS,42700,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
AMYLASE (SO),82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AMYLASE (SO),82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
REM FOREIGN BODY PHARYNX,42809,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,UNITED HEALTH,UNITED COMMERCIAL,,,,457.8015,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
17 HYROXYPREGNEN,84143,CPT,300,RC,,OUTPATIENT,,,211,84.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.8,OTHER,158.25,206.78,PERCENT OF CHARGES BASED ON HCPCS CODE
17 HYROXYPREGNEN,84143,CPT,300,RC,,OUTPATIENT,,,211,84.4,MONUMENT,COMMERCIAL,,,,168.8,,158.25,206.78,
FEEDING TUBE PLACEMENT,43752,CPT,320,RC,,OUTPATIENT,,,538.59,215.436,UNITED HEALTH,UNITED COMMERCIAL,,,,457.8015,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
SPINOCEREBELLAR ATAXIA TYPE 1,81178,CPT,300,RC,,OUTPATIENT,,,716,286.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,572.8,OTHER,537,701.68,PERCENT OF CHARGES BASED ON HCPCS CODE
SPINOCEREBELLAR ATAXIA TYPE 1,81178,CPT,300,RC,,OUTPATIENT,,,716,286.4,MONUMENT,COMMERCIAL,,,,572.8,,537,701.68,
NG-OG TUBE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,UNITED HEALTH,UNITED COMMERCIAL,,,,448.0265,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
DPYD GENE ANALYSIS,81232,CPT,300,RC,,OUTPATIENT,,,1123,449.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,898.4,OTHER,842.25,1100.54,PERCENT OF CHARGES BASED ON HCPCS CODE
DPYD GENE ANALYSIS,81232,CPT,300,RC,,OUTPATIENT,,,1123,449.2,MONUMENT,COMMERCIAL,,,,898.4,,842.25,1100.54,
GASTRIC LAVAGE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,UNITED HEALTH,UNITED COMMERCIAL,,,,448.0265,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
GI PATHOGEN 6-11 TARGETS,87506,CPT,300,RC,,OUTPATIENT,,,525.98,210.392,BLUE CROSS ANTHEM,COMMERCIAL,,,,420.784,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
GI PATHOGEN 6-11 TARGETS,87506,CPT,300,RC,,OUTPATIENT,,,525.98,210.392,MONUMENT,COMMERCIAL,,,,400,,375,490,
G-TUBE CHANGE,43762,CPT,450,RC,,OUTPATIENT,,,720.25,288.1,UNITED HEALTH,UNITED COMMERCIAL,,,,612.2125,OTHER,540.19,705.85,PERCENT OF TOTAL BILLED CHARGES
PARIETAL CELL ANTIBODIES  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
PARIETAL CELL ANTIBODIES  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
FEEDING TUBE REPLACEMENT,43999,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,675,882,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR BASEMENT MEM AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLOMERULAR BASEMENT MEM AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
INTRO GASTROINTESTINAL TUBE,44500,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,525,686,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTORS,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
ACH RECEPTORS,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
PX SMALL INTESTINE,44799,CPT,360,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,977.06,1276.7,PERCENT OF TOTAL BILLED CHARGES
STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,UNITED HEALTH,UNITED COMMERCIAL,,,,1756.8055,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY ANALYTE-QUANT,8625691,CPT,300,RC,91,OUTPATIENT,,,138.5,55.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,110.8,OTHER,103.88,135.73,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY ANALYTE-QUANT,8625691,CPT,300,RC,91,OUTPATIENT,,,138.5,55.4,MONUMENT,COMMERCIAL,,,,110.8,,103.88,135.73,
INCISION OF RECTAL,46040,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,UNITED HEALTH,UNITED COMMERCIAL,,,,1756.8055,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
ANTI KU,83516,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.4,OTHER,42.56,55.62,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI KU,83516,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
I&D PERIANAL ABSCESS SUPERFCL,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UNITED HEALTH,UNITED COMMERCIAL,,,,1344.5895,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
MULTIPLEX PROBE STAIN EA,88374,CPT,300,RC,,OUTPATIENT,,,426,170.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,340.8,OTHER,319.5,417.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MULTIPLEX PROBE STAIN EA,88374,CPT,300,RC,,OUTPATIENT,,,426,170.4,MONUMENT,COMMERCIAL,,,,340.8,,319.5,417.48,
DRAINAGE OF ANAL ABSCESS,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UNITED HEALTH,UNITED COMMERCIAL,,,,1344.5895,OTHER,393,513.52,PERCENT OF TOTAL BILLED CHARGES
URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.2,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
INC OF THROMBOSED HEMORRD EXT,46083,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,657.475,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
Z URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
INCISE EXTERNAL HEMORRHOID,46083,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,UNITED HEALTH,UNITED COMMERCIAL,,,,450.891,OTHER,342,446.88,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
REMOVE EXT HEM GROUPS 2+,46250,CPT,450,RC,,OUTPATIENT,,,5432.66,2173.064,UNITED HEALTH,UNITED COMMERCIAL,,,,4617.761,OTHER,4074.5,5324,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
EXC OF THROMBOSED HEMORRD EXTR,46320,CPT,450,RC,,OUTPATIENT,,,2397.5,959,UNITED HEALTH,UNITED COMMERCIAL,,,,2037.875,OTHER,1798.13,2349.55,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
ANOSCOPY REMOVE FOR BODY,46608,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UNITED HEALTH,UNITED COMMERCIAL,,,,1344.5895,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
US LIVER CORE BX,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1145.06,1496.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
BIOPSY OF LIVER  NEEDLE,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1297.7375,OTHER,1145.06,1496.22,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
T-TUBE INJECTION,47505,CPT,320,RC,,OUTPATIENT,,,308,123.2,UNITED HEALTH,UNITED COMMERCIAL,,,,261.8,OTHER,231,301.84,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
BILIARY CATH CHANGE,47525,CPT,320,RC,,OUTPATIENT,,,6430.08,2572.032,UNITED HEALTH,UNITED COMMERCIAL,,,,5465.568,OTHER,1387.13,1812.51,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
CHOLANGIOGRAM PTOP,47531,CPT,320,RC,,OUTPATIENT,,,6345.05,2538.02,UNITED HEALTH,UNITED COMMERCIAL,,,,5393.2925,OTHER,478.31,625,PERCENT OF TOTAL BILLED CHARGES
"HUMAN EPIDIDYMIS PROTEIN 4,SER",86305,CPT,302,RC,,OUTPATIENT,,,277,110.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.6,OTHER,207.75,271.46,PERCENT OF CHARGES BASED ON HCPCS CODE
"HUMAN EPIDIDYMIS PROTEIN 4,SER",86305,CPT,302,RC,,OUTPATIENT,,,277,110.8,MONUMENT,COMMERCIAL,,,,221.6,,207.75,271.46,
CT CHOLECYSTOSTOMY W DRAIN,47533,CPT,350,RC,,OUTPATIENT,,,6430.08,2572.032,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,3633.94,4748.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UR FENTANYL CON,80299,CPT,300,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
UR FENTANYL CON,80299,CPT,300,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
CT PANCREAS CORE BX,48102,CPT,361,RC,,OUTPATIENT,,,2769,1107.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2076.75,2713.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLYCOMARK,84378,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.4,OTHER,151.31,197.72,PERCENT OF CHARGES BASED ON HCPCS CODE
GLYCOMARK,84378,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
PARACENTESIS,49080,CPT,361,RC,,OUTPATIENT,,,582.5,233,UNITED HEALTH,UNITED COMMERCIAL,,,,495.125,OTHER,436.88,570.85,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,U0003,HCPCS,300,RC,,BOTH,,,180,72,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.8,OTHER,135,176.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COVID19 SARS2 RNA QUAL RT PCR,U0003,HCPCS,300,RC,,BOTH,,,180,72,MONUMENT,COMMERCIAL,,,,144,,135,176.4,
COVID19 SARS2 RNA QUAL RT PCR,U0003,HCPCS,300,RC,,BOTH,,,180,72,UNITED HEALTH,UNITED COMMERCIAL,,,,135,,135,176.4,
COVID-19 IGG,U0002,HCPCS,302,RC,,BOTH,,,86,34.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.26,OTHER,64.5,84.28,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COVID-19 IGG,U0002,HCPCS,302,RC,,BOTH,,,86,34.4,MONUMENT,COMMERCIAL,,,,68.8,,64.5,84.28,
COVID-19 IGG,U0002,HCPCS,302,RC,,BOTH,,,86,34.4,UNITED HEALTH,UNITED COMMERCIAL,,,,64.5,,64.5,84.28,
COVID-19 PCR TEST,U0003,HCPCS,300,RC,,INPATIENT,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,,,,68.25,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COVID-19 PCR TEST,U0003,HCPCS,300,RC,,INPATIENT,,,75,30,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
COVID-19 PCR TEST,U0003,HCPCS,300,RC,,INPATIENT,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,,,,74.25,,74.25,97.02,
INFEC AGEN DETEC AMPLI PROBE,U0005,HCPCS,300,RC,,INPATIENT,,,24,9.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,21.84,OTHER,18,23.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INFEC AGEN DETEC AMPLI PROBE,U0005,HCPCS,300,RC,,INPATIENT,,,24,9.6,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
INFEC AGEN DETEC AMPLI PROBE,U0005,HCPCS,300,RC,,INPATIENT,,,24,9.6,UNITED HEALTH,UNITED COMMERCIAL,,,,18,,18,23.5,
HEPATITIS C GENOTYPE,87902,CPT,300,RC,,OUTPATIENT,,,678.75,271.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,543,OTHER,509.06,665.18,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C GENOTYPE,87902,CPT,300,RC,,OUTPATIENT,,,678.75,271.5,MONUMENT,COMMERCIAL,,,,543,,509.06,665.18,
ABD PARACENTESIS W/O IMAGING,49082,CPT,450,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C AMPLIFIED PROBE,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,261,OTHER,244.69,319.73,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C AMPLIFIED PROBE,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,MONUMENT,COMMERCIAL,,,,261,,244.69,319.73,
CT GUIDED PARACENTESIS,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1210.2,1581.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPARIN ANTI-XA,85520,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.8,OTHER,182.63,238.63,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPARIN ANTI-XA,85520,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,MONUMENT,COMMERCIAL,,,,194.8,,182.63,238.63,
PARACENTESIS W/IMAGE GUIDANCE,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C MEDICARE SCREEN,G0472,HCPCS,300,RC,,INPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.01,OTHER,122.81,160.48,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEPATITIS C MEDICARE SCREEN,G0472,HCPCS,300,RC,,INPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
HEPATITIS C MEDICARE SCREEN,G0472,HCPCS,300,RC,,INPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,,122.81,,122.81,160.48,
TISSUE TRANSGLUTAMINASE AB IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE TRANSGLUTAMINASE AB IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
ABD PARACENTESIS W/IMAG GUIDAN,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
GLOMERULAR (GBM) IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
BX ABD/RETROPERITONEAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1286.05,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
GLOMERULAR (GBM) IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
NEEDLE BIOPSY ABDOMINAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1286.05,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) ELISHA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
GLOMERULAR (GBM) ELISHA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
IMAGE CATH FLUID COLXN VISC CT,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,UNITED HEALTH,UNITED COMMERCIAL,,,,2417.094,OTHER,2132.7,2786.8,PERCENT OF TOTAL BILLED CHARGES
ANDROSTENEDIONE,82157,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.4,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ANDROSTENEDIONE,82157,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
IMAGE CATH FLUID COLXN VISC US,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,2132.7,2786.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS C RNA AMP PROBE,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,371.2,OTHER,348,454.72,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C RNA AMP PROBE,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,MONUMENT,COMMERCIAL,,,,371.2,,348,454.72,
CT ABSCESS DRAINAGE W/CATH,49406,CPT,361,RC,,OUTPATIENT,,,4165.75,1666.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,3124.31,4082.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELOPEROXIDASE,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELOPEROXIDASE,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
ABCESS DRAINAGE - ABDOMEN,49406,CPT,361,RC,,OUTPATIENT,,,3982,1592.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3384.7,OTHER,2986.5,3902.36,PERCENT OF TOTAL BILLED CHARGES
PROTEINASE 3 ANTIBODY,8351659,CPT,,,59,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEINASE 3 ANTIBODY,8351659,CPT,,,59,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
ABSCESS DRAINAGE,49419,CPT,320,RC,,OUTPATIENT,,,3599.5,1439.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3059.575,OTHER,2699.63,3527.51,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE,82542,CPT,301,RC,,OUTPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.6,OTHER,159,207.76,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXAMETHASONE,82542,CPT,301,RC,,OUTPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
ASSESS CYST CONTRACT INJ,49424,CPT,350,RC,,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,,425,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TISS TRANSGLUTAMINASE IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1961.5,784.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1667.275,OTHER,1471.13,1922.27,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGG,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TISS TRANSGLUTAMINASE IGG,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1868,747.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1587.8,OTHER,1401,1830.64,PERCENT OF TOTAL BILLED CHARGES
F ACTIN,83516,CPT,300,RC,,OUTPATIENT,,,220,88,BLUE CROSS ANTHEM,COMMERCIAL,,,,176,OTHER,165,215.6,PERCENT OF CHARGES BASED ON HCPCS CODE
F ACTIN,83516,CPT,300,RC,,OUTPATIENT,,,220,88,MONUMENT,COMMERCIAL,,,,176,,165,215.6,
GUIDED GASTROSTOMY TUBE PLC,49450,CPT,350,RC,,OUTPATIENT,,,2507.5,1003,UNITED HEALTH,UNITED COMMERCIAL,,,,2131.375,OTHER,1880.63,2457.35,PERCENT OF TOTAL BILLED CHARGES
PRADER-WILLI/ANGELMAN SYN,81331,CPT,300,RC,,OUTPATIENT,,,500.5,200.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,400.4,OTHER,375.38,490.49,PERCENT OF CHARGES BASED ON HCPCS CODE
PRADER-WILLI/ANGELMAN SYN,81331,CPT,300,RC,,OUTPATIENT,,,500.5,200.2,MONUMENT,COMMERCIAL,,,,400.4,,375.38,490.49,
GASTRO TUBE REPLACEMENT,49450,CPT,350,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,570,744.8,PERCENT OF TOTAL BILLED CHARGES
METHDIOXYAMPH,G0480,HCPCS,300,RC,,BOTH,,,56.25,22.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.19,OTHER,42.19,55.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
METHDIOXYAMPH,G0480,HCPCS,300,RC,,BOTH,,,56.25,22.5,MONUMENT,COMMERCIAL,,,,45,,42.19,55.13,
METHDIOXYAMPH,G0480,HCPCS,300,RC,,BOTH,,,56.25,22.5,UNITED HEALTH,UNITED COMMERCIAL,,,,42.19,,42.19,55.13,
ANGIOTENSIN CONVERTING ENZYME,82164,CPT,300,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
ANGIOTENSIN CONVERTING ENZYME,82164,CPT,300,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
GASTROSTOMY TUBE CHANGE,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,490.5,640.92,PERCENT OF TOTAL BILLED CHARGES
NICOTINE/COTININE META URINE,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.81,OTHER,139.13,181.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NICOTINE/COTININE META URINE,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,MONUMENT,COMMERCIAL,,,,148.4,,139.13,181.79,
NICOTINE/COTININE META URINE,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,UNITED HEALTH,UNITED COMMERCIAL,,,,139.13,,139.13,181.79,
CYCLIC CITRULLINATED  PEP AB,86200,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.4,OTHER,83.81,109.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CYCLIC CITRULLINATED  PEP AB,86200,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,MONUMENT,COMMERCIAL,,,,89.4,,83.81,109.52,
GI TUBE PLACEMENT,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,987.56,1290.42,PERCENT OF TOTAL BILLED CHARGES
CYCLIC AMP URINARY EXCRETAION,82030,CPT,300,RC,,OUTPATIENT,,,213.5,85.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,170.8,OTHER,160.13,209.23,PERCENT OF CHARGES BASED ON HCPCS CODE
CYCLIC AMP URINARY EXCRETAION,82030,CPT,300,RC,,OUTPATIENT,,,213.5,85.4,MONUMENT,COMMERCIAL,,,,170.8,,160.13,209.23,
OBSTRUCTION REMOVAL FROM TUBE,49460,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UNITED HEALTH,UNITED COMMERCIAL,,,,1371.611,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
CSF P1433 PROTEIN SPINAL FLUID,82528,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,123,OTHER,115.31,150.68,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF P1433 PROTEIN SPINAL FLUID,82528,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,MONUMENT,COMMERCIAL,,,,123,,115.31,150.68,
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,OUTPATIENT,,,543,217.2,UNITED HEALTH,UNITED COMMERCIAL,,,,461.55,OTHER,407.25,532.14,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES PLASMA,82384,CPT,300,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
CATECHOLAMINES PLASMA,82384,CPT,300,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
CT RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1275.38,1666.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIBODY TITER (COOMBS TEST),86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIBODY TITER (COOMBS TEST),86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
US RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1275.38,1666.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIMITOCHONDRIAL M2 AB  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIMITOCHONDRIAL M2 AB  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
CT RENAL CYST/PELVIS ASPIRATE,50390,CPT,361,RC,,OUTPATIENT,,,3053,1221.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2289.75,2991.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIOLIPIN AB IGG  IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOLIPIN AB IGG  IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
NEPHROSTOGRAM,50431,CPT,320,RC,,OUTPATIENT,,,1542.5,617,UNITED HEALTH,UNITED COMMERCIAL,,,,1311.125,OTHER,1156.88,1511.65,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN ANTIBODY IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOLIPIN ANTIBODY IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
CT NEPHROSTOMY TUBE PLACEMENT,50432,CPT,361,RC,,OUTPATIENT,,,2752.75,1101.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2064.56,2697.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIOLIPIN ANTIBODIES IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOLIPIN ANTIBODIES IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
NEPHROSTOMY TUBE REPLACEMENT,50435,CPT,361,RC,,OUTPATIENT,,,3000,1200,UNITED HEALTH,UNITED COMMERCIAL,,,,2550,OTHER,2064.56,2697.7,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGG (MAYO),86147,CPT,300,RC,,OUTPATIENT,,,50.9,20.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.72,OTHER,30.38,39.69,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CARDIOLIPIN AB IGG (MAYO),86147,CPT,300,RC,,OUTPATIENT,,,50.9,20.36,MONUMENT,COMMERCIAL,,,,32.4,,30.38,39.69,
NEPHROSTOMY TUBE CHANGE FLUORO,50435,CPT,361,RC,,OUTPATIENT,,,3738.02,1495.208,UNITED HEALTH,UNITED COMMERCIAL,,,,3177.317,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGM (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,50.9,20.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.72,OTHER,30.38,39.69,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CARDIOLIPIN AB IGM (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,50.9,20.36,MONUMENT,COMMERCIAL,,,,32.4,,30.38,39.69,
CT NEPHROSTOMY TUBE CHANGE,50435,CPT,361,RC,,OUTPATIENT,,,1839.5,735.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1563.575,OTHER,1379.63,1802.71,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGG (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOLIPIN AB IGG (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
ASPIRATION OF BLADDER,51102,CPT,350,RC,,OUTPATIENT,,,2759,1103.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2345.15,OTHER,2069.25,2703.82,PERCENT OF TOTAL BILLED CHARGES
ANTI MULLERIAN HORMONE,83520,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI MULLERIAN HORMONE,83520,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
DRAIN BL W/CATH INSERTION,51102,CPT,350,RC,,OUTPATIENT,,,3738.02,1495.208,UNITED HEALTH,UNITED COMMERCIAL,,,,3177.317,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
QUANTIFERON-TB GOLD BLOOD,86481,CPT,300,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,147.56,192.82,PERCENT OF CHARGES BASED ON HCPCS CODE
QUANTIFERON-TB GOLD BLOOD,86481,CPT,300,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,157.4,,147.56,192.82,
INJ PROC CYSTOGRAPHY,51600,CPT,320,RC,,OUTPATIENT,,,436.5,174.6,UNITED HEALTH,UNITED COMMERCIAL,,,,371.025,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83516,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,83516,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
INJECTION FOR BLADDER XRAY,51610,CPT,320,RC,,OUTPATIENT,,,856.5,342.6,UNITED HEALTH,UNITED COMMERCIAL,,,,728.025,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
HUMAN ANTI - MOUSE AB ELISA,83520,CPT,300,RC,,OUTPATIENT,,,304.25,121.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,243.4,OTHER,228.19,298.17,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMAN ANTI - MOUSE AB ELISA,83520,CPT,300,RC,,OUTPATIENT,,,304.25,121.7,MONUMENT,COMMERCIAL,,,,243.4,,228.19,298.17,
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UNITED HEALTH,UNITED COMMERCIAL,,,,528.275,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
ANTI DNA AB SINGLE STRAND,86226,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI DNA AB SINGLE STRAND,86226,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UNITED HEALTH,UNITED COMMERCIAL,,,,528.275,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
CULTURE STREP (THROAT),87081,CPT,306,RC,,OUTPATIENT,,,29.25,11.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.4,OTHER,21.94,28.67,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE STREP (THROAT),87081,CPT,306,RC,,OUTPATIENT,,,29.25,11.7,MONUMENT,COMMERCIAL,,,,23.4,,21.94,28.67,
STRAIGHT CATHETER,51701,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
ASSAY CELLULAR FUNCTION,86352,CPT,300,RC,,OUTPATIENT,,,323.75,129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,259,OTHER,242.81,317.28,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY CELLULAR FUNCTION,86352,CPT,300,RC,,OUTPATIENT,,,323.75,129.5,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
FOLEY CATH INSERTION SIMPLE,51702,CPT,320,RC,,OUTPATIENT,,,244.25,97.7,UNITED HEALTH,UNITED COMMERCIAL,,,,207.6125,OTHER,183.19,239.37,PERCENT OF TOTAL BILLED CHARGES
E. COLI 0157,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.2,OTHER,38.63,50.47,PERCENT OF CHARGES BASED ON HCPCS CODE
E. COLI 0157,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
FOLEY CATHETER,51702,CPT,320,RC,,OUTPATIENT,,,343.75,137.5,UNITED HEALTH,UNITED COMMERCIAL,,,,292.1875,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
COVID-19 POC RAPID,87635,CPT,300,RC,,OUTPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,64,OTHER,60,78.4,PERCENT OF CHARGES BASED ON HCPCS CODE
COVID-19 POC RAPID,87635,CPT,300,RC,,OUTPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
FOLEY CATH INSERTION COMPLCTD,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,UNITED HEALTH,UNITED COMMERCIAL,,,,382.925,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH AG DFA,87270,CPT,300,RC,,OUTPATIENT,,,107.25,42.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.8,OTHER,80.44,105.11,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAMYDIA TRACH AG DFA,87270,CPT,300,RC,,OUTPATIENT,,,107.25,42.9,MONUMENT,COMMERCIAL,,,,85.8,,80.44,105.11,
FOLEY CATHETER COMP,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,UNITED HEALTH,UNITED COMMERCIAL,,,,382.925,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE SERUM ASSAY,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLINESTERASE SERUM ASSAY,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
CYSTOSTOMY TUBE CHANGE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,600.25,240.1,UNITED HEALTH,UNITED COMMERCIAL,,,,510.2125,OTHER,450.19,588.25,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH BY DNA PROBE,87490,CPT,300,RC,,OUTPATIENT,,,96.25,38.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,77,OTHER,72.19,94.33,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAMYDIA TRACH BY DNA PROBE,87490,CPT,300,RC,,OUTPATIENT,,,96.25,38.5,MONUMENT,COMMERCIAL,,,,77,,72.19,94.33,
CHANGE OF BLADDER TUBE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,UNITED HEALTH,UNITED COMMERCIAL,,,,450.891,OTHER,397.8,519.9,PERCENT OF TOTAL BILLED CHARGES
NEISSERIA GONORRHEA DNA PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.2,OTHER,68.63,89.67,PERCENT OF CHARGES BASED ON HCPCS CODE
NEISSERIA GONORRHEA DNA PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,MONUMENT,COMMERCIAL,,,,73.2,,68.63,89.67,
CYSTOSTOMY TUBE COMPLD CHANGE,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2181.7375,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH DNA AMP PROBE,87491,CPT,306,RC,,OUTPATIENT,,,96.25,38.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,77,OTHER,72.19,94.33,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAMYDIA TRACH DNA AMP PROBE,87491,CPT,306,RC,,OUTPATIENT,,,96.25,38.5,MONUMENT,COMMERCIAL,,,,77,,72.19,94.33,
CYSTOSTOMY TUBE CHANGE COMPL,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2181.7375,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
GONORRHEA DNA AMP PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.2,OTHER,68.63,89.67,PERCENT OF CHARGES BASED ON HCPCS CODE
GONORRHEA DNA AMP PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,MONUMENT,COMMERCIAL,,,,73.2,,68.63,89.67,
CHANGE OF BLADDER TUBE COMPLEX,51710,CPT,320,RC,,OUTPATIENT,,,572.8,229.12,UNITED HEALTH,UNITED COMMERCIAL,,,,486.88,OTHER,429.6,561.3,PERCENT OF TOTAL BILLED CHARGES
N GONORHEA ANTIBODY SERUM,86609,CPT,300,RC,,OUTPATIENT,,,192,76.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,153.6,OTHER,144,188.16,PERCENT OF CHARGES BASED ON HCPCS CODE
N GONORHEA ANTIBODY SERUM,86609,CPT,300,RC,,OUTPATIENT,,,192,76.8,MONUMENT,COMMERCIAL,,,,153.6,,144,188.16,
INTRAVESICAL CHEMO ADMIN,51720,CPT,331,RC,,OUTPATIENT,,,1252.97,501.188,UNITED HEALTH,UNITED COMMERCIAL,,,,1065.0245,OTHER,939.73,1227.91,PERCENT OF TOTAL BILLED CHARGES
GLUTERIC ACIDS,82544,CPT,300,RC,,OUTPATIENT,,,379.25,151.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,303.4,OTHER,284.44,371.67,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUTERIC ACIDS,82544,CPT,300,RC,,OUTPATIENT,,,379.25,151.7,MONUMENT,COMMERCIAL,,,,303.4,,284.44,371.67,
US URINE CAPACITY MEASURE,51798,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,466.13,609.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEALTH FAIR PANEL,3001000,CDM,,,,INPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43,OTHER,35.44,46.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR PANEL,3001000,CDM,,,,INPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
HEALTH FAIR PANEL,3001000,CDM,,,,INPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,,35.44,,35.44,46.31,
HEALTH FAIR HSCRP,3001002,CDM,,,,INPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.95,OTHER,33.75,44.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR HSCRP,3001002,CDM,,,,INPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.75,44.1,
HEALTH FAIR HSCRP,3001002,CDM,,,,INPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,,33.75,,33.75,44.1,
HEALTH FAIR VITAMIN D,3001004,CDM,,,,INPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.95,OTHER,33.75,44.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEALTH FAIR VITAMIN D,3001004,CDM,,,,INPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.75,44.1,
HEALTH FAIR VITAMIN D,3001004,CDM,,,,INPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,,33.75,,33.75,44.1,
PBG DEAMINASE WB,82657,CPT,300,RC,,OUTPATIENT,,,190.25,76.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.2,OTHER,142.69,186.45,PERCENT OF CHARGES BASED ON HCPCS CODE
PBG DEAMINASE WB,82657,CPT,300,RC,,OUTPATIENT,,,190.25,76.1,MONUMENT,COMMERCIAL,,,,152.2,,142.69,186.45,
CIRCUMCISION,54150,CPT,360,RC,,OUTPATIENT,,,1304.5,521.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1108.825,OTHER,978.38,1278.41,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME PERIPHERAL BLOOD,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,771.2,OTHER,723,944.72,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME PERIPHERAL BLOOD,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,MONUMENT,COMMERCIAL,,,,771.2,,723,944.72,
INCISION & DRAINAGE EPIDIDYMIS,54700,CPT,450,RC,,OUTPATIENT,,,975,390,UNITED HEALTH,UNITED COMMERCIAL,,,,828.75,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOMONAL IN SITU HYBRID,88272,CPT,310,RC,,OUTPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.6,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOMONAL IN SITU HYBRID,88272,CPT,310,RC,,OUTPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
INCISION AND DRAINAGE SCROTUM,54700,CPT,450,RC,,OUTPATIENT,,,975,390,UNITED HEALTH,UNITED COMMERCIAL,,,,828.75,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
HIV-1 P24 ANTIGEN,87390,CPT,306,RC,,OUTPATIENT,,,153.25,61.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,122.6,OTHER,114.94,150.19,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV-1 P24 ANTIGEN,87390,CPT,306,RC,,OUTPATIENT,,,153.25,61.3,MONUMENT,COMMERCIAL,,,,122.6,,114.94,150.19,
DRAINAGE OF SCROTUM ABCESS,55100,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
CITRATES ASSAY,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.8,OTHER,128.25,167.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CITRATES ASSAY,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,MONUMENT,COMMERCIAL,,,,136.8,,128.25,167.58,
I&D OF VULVA/PERINEUM,56405,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,UNITED HEALTH,UNITED COMMERCIAL,,,,476.8755,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
ZONISAMIDE,80203,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ZONISAMIDE,80203,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
DRAINAGE OF GLAND,56420,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
Z URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
INTRO ANY HEMOSTATIC AGENT,57180,CPT,450,RC,,OUTPATIENT,,,577.5,231,UNITED HEALTH,UNITED COMMERCIAL,,,,490.875,OTHER,433.13,565.95,PERCENT OF TOTAL BILLED CHARGES
CLOSTRIDIUM DIFFICLE TOXIN PCR,87493,CPT,300,RC,,OUTPATIENT,,,266,106.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.8,OTHER,199.5,260.68,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSTRIDIUM DIFFICLE TOXIN PCR,87493,CPT,300,RC,,OUTPATIENT,,,266,106.4,MONUMENT,COMMERCIAL,,,,212.8,,199.5,260.68,
REPAIR VAGINA/PERINEUM,57210,CPT,450,RC,,OUTPATIENT,,,6049.04,2419.616,UNITED HEALTH,UNITED COMMERCIAL,,,,5141.684,OTHER,4536.8,5928.1,PERCENT OF TOTAL BILLED CHARGES
URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.8,OTHER,128.25,167.58,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,MONUMENT,COMMERCIAL,,,,136.8,,128.25,167.58,
REMOVE INTRAUTERINE DEVICE,58301,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,UNITED HEALTH,UNITED COMMERCIAL,,,,476.8755,OTHER,282.38,368.97,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLETHANOL,G0480,HCPCS,300,RC,,BOTH,,,153.25,61.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.46,OTHER,114.94,150.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PHOSPHATIDYLETHANOL,G0480,HCPCS,300,RC,,BOTH,,,153.25,61.3,MONUMENT,COMMERCIAL,,,,122.6,,114.94,150.19,
PHOSPHATIDYLETHANOL,G0480,HCPCS,300,RC,,BOTH,,,153.25,61.3,UNITED HEALTH,UNITED COMMERCIAL,,,,114.94,,114.94,150.19,
CHROMOSOME ANALYSIS,88269,CPT,311,RC,,OUTPATIENT,,,894.75,357.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,715.8,OTHER,671.06,876.86,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME ANALYSIS,88269,CPT,311,RC,,OUTPATIENT,,,894.75,357.9,MONUMENT,COMMERCIAL,,,,715.8,,671.06,876.86,
HYSTEO INJECTION,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,UNITED HEALTH,UNITED COMMERCIAL,,,,441.7875,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.8,OTHER,403.88,527.73,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE CULTURE,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,MONUMENT,COMMERCIAL,,,,430.8,,403.88,527.73,
HYSTEROSALPINGOGRAM,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,UNITED HEALTH,UNITED COMMERCIAL,,,,441.7875,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
ANALYZE 20-25 CELLS,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,746.8,OTHER,700.13,914.83,PERCENT OF CHARGES BASED ON HCPCS CODE
ANALYZE 20-25 CELLS,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,MONUMENT,COMMERCIAL,,,,746.8,,700.13,914.83,
CATHETER FOR HYSTEROGRAPHY,58340,CPT,320,RC,,OUTPATIENT,,,447.5,179,UNITED HEALTH,UNITED COMMERCIAL,,,,380.375,OTHER,335.63,438.55,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULTURE NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,616.75,246.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,493.4,OTHER,462.56,604.42,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TISSUE CULTURE NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,616.75,246.7,MONUMENT,COMMERCIAL,,,,493.4,,462.56,604.42,
US AMNIOCENTESIS,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,446.25,583.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE PROCESSING FOR CULTURE,87176,CPT,300,RC,,OUTPATIENT,,,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.2,OTHER,55.5,72.52,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE PROCESSING FOR CULTURE,87176,CPT,300,RC,,OUTPATIENT,,,74,29.6,MONUMENT,COMMERCIAL,,,,59.2,,55.5,72.52,
AMNIOCENTESIS PROCEDURE,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,UNITED HEALTH,UNITED COMMERCIAL,,,,1073.1165,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME 15-20  CELLS,88262,CPT,310,RC,,OUTPATIENT,,,1042,416.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,833.6,OTHER,781.5,1021.16,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CHROMOSOME 15-20  CELLS,88262,CPT,310,RC,,OUTPATIENT,,,1042,416.8,MONUMENT,COMMERCIAL,,,,833.6,,781.5,1021.16,
OCT (INCLUDES EFM),59020,CPT,720,RC,,OUTPATIENT,,,670,268,UNITED HEALTH,UNITED COMMERCIAL,,,,569.5,OTHER,502.5,656.6,PERCENT OF TOTAL BILLED CHARGES
"CHROMOSOMAL MICROARRAY,CONGEN",81229,CPT,300,RC,,OUTPATIENT,,,3083,1233.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2466.4,OTHER,2312.25,3021.34,PERCENT OF CHARGES BASED ON HCPCS CODE
"CHROMOSOMAL MICROARRAY,CONGEN",81229,CPT,300,RC,,OUTPATIENT,,,3083,1233.2,MONUMENT,COMMERCIAL,,,,2466.4,,2312.25,3021.34,
NST/EFM,59025,CPT,720,RC,,OUTPATIENT,,,445.25,178.1,UNITED HEALTH,UNITED COMMERCIAL,,,,378.4625,OTHER,333.94,436.35,PERCENT OF TOTAL BILLED CHARGES
CULTURE GROUP B STREP,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE GROUP B STREP,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,OUTPATIENT,,,5697.98,2279.192,UNITED HEALTH,UNITED COMMERCIAL,,,,4843.283,OTHER,4273.5,5584,PERCENT OF TOTAL BILLED CHARGES
PYRUVATE KINASE ERYTHROCYTES,84220,CPT,300,RC,,OUTPATIENT,,,145.75,58.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.6,OTHER,109.31,142.84,PERCENT OF CHARGES BASED ON HCPCS CODE
PYRUVATE KINASE ERYTHROCYTES,84220,CPT,300,RC,,OUTPATIENT,,,145.75,58.3,MONUMENT,COMMERCIAL,,,,116.6,,109.31,142.84,
VERSION (INCLUDES EFM),59412,CPT,720,RC,,OUTPATIENT,,,2396,958.4,UNITED HEALTH,UNITED COMMERCIAL,,,,2036.6,OTHER,1797,2348.08,PERCENT OF TOTAL BILLED CHARGES
ANA,86038,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ANA,86038,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
DELIVER PLACENTA,59414,CPT,722,RC,,OUTPATIENT,,,5228.48,2091.392,UNITED HEALTH,UNITED COMMERCIAL,,,,4444.208,OTHER,3921.4,5123.9,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
CT THYROID CORE BX,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,631.88,825.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US CORE BIOPSY OF THYROID,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,631.88,825.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SACCHAROMYCES CEREVISIAE IGA,83520,CPT,300,RC,,OUTPATIENT,,,90,36,BLUE CROSS ANTHEM,COMMERCIAL,,,,72,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
SACCHAROMYCES CEREVISIAE IGA,83520,CPT,300,RC,,OUTPATIENT,,,90,36,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
CT ADRENAL CORE BX,60699,CPT,,,,OUTPATIENT,,,1513,605.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1134.75,1482.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
DRAIN SPINAL CORD CYST,62268,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,UNITED HEALTH,UNITED COMMERCIAL,,,,1414.145,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CEREVISIAE IGG,83520,CPT,300,RC,,OUTPATIENT,,,90,36,BLUE CROSS ANTHEM,COMMERCIAL,,,,72,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
SACCHAROMYCES CEREVISIAE IGG,83520,CPT,300,RC,,OUTPATIENT,,,90,36,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
FLUORESCENT ANTIBODY SCREENING,86255,CPT,300,RC,,OUTPATIENT,,,90,36,BLUE CROSS ANTHEM,COMMERCIAL,,,,72,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREENING,86255,CPT,300,RC,,OUTPATIENT,,,90,36,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CUTANEOUS IMMUNOFLUOR AB IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
LUMBAR PUNCTURE SPINAL,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,8625591,CPT,300,RC,91,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CUTANEOUS IMMUNOFLUOR AB IGG,8625591,CPT,300,RC,91,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
TRANSFORMING GRWTH FACTOR BETA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
TRANSFORMING GRWTH FACTOR BETA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
"INJECTION, EPIDURAL PATCH",62273,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
SCLERODERMA ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
SCLERODERMA ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MYELOGRAM/FLUOROSCOPY,62284,CPT,350,RC,,OUTPATIENT,,,1052.5,421,UNITED HEALTH,UNITED COMMERCIAL,,,,894.625,OTHER,789.38,1031.45,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLOUR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,44.63,58.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIRECT IMMUNOFLOUR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
LUMBAR INJECTION CT MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,825,330,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,618.75,808.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,44.63,58.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
LUMBAR INJECTION FOR MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,2329,931.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1979.65,OTHER,1746.75,2282.42,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,44.63,58.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,44.63,58.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,44.63,58.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,47.6,,44.63,58.31,
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1369.75,547.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1164.2875,OTHER,1027.31,1342.36,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PROMETHEUS INFLIXAMAB HACA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
EPIDURAL INJECTION,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,894,1168.16,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,8352059,CPT,301,RC,59,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PROMETHEUS INFLIXAMAB HACA,8352059,CPT,301,RC,59,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
NJX INTERLAMINAR LMBR/SAC,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
RNA POLYMERASE III AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
RNA POLYMERASE III AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
LUMBAR PUNCTURE SPINAL FLUID,62328,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS,83520,CPT,300,RC,,OUTPATIENT,,,289.75,115.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,231.8,OTHER,217.31,283.96,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS,83520,CPT,300,RC,,OUTPATIENT,,,289.75,115.9,MONUMENT,COMMERCIAL,,,,231.8,,217.31,283.96,
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,320,RC,,OUTPATIENT,,,1283.34,513.336,UNITED HEALTH,UNITED COMMERCIAL,,,,1090.839,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
CANNABINOIDS CONFIRM,G0480,HCPCS,300,RC,,BOTH,,,100,40,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,75,98,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CANNABINOIDS CONFIRM,G0480,HCPCS,300,RC,,BOTH,,,100,40,MONUMENT,COMMERCIAL,,,,80,,75,98,
CANNABINOIDS CONFIRM,G0480,HCPCS,300,RC,,BOTH,,,100,40,UNITED HEALTH,UNITED COMMERCIAL,,,,75,,75,98,
URINE PROTEIN,84156,CPT,301,RC,,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.75,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE PROTEIN,84156,CPT,301,RC,,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
N BLOCK INJ TRIGEMINAL,64400,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
KIT GENE ANALYS D816 VARIANT,81273,CPT,300,RC,,OUTPATIENT,,,1125.75,450.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,900.6,OTHER,844.31,1103.24,PERCENT OF CHARGES BASED ON HCPCS CODE
KIT GENE ANALYS D816 VARIANT,81273,CPT,300,RC,,OUTPATIENT,,,1125.75,450.3,MONUMENT,COMMERCIAL,,,,900.6,,844.31,1103.24,
N BLOCK INJ FACIAL,64402,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
TGFBR1 GENE KNOWN MUTATION,81403,CPT,300,RC,,OUTPATIENT,,,1361.75,544.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1089.4,OTHER,1021.31,1334.52,PERCENT OF CHARGES BASED ON HCPCS CODE
TGFBR1 GENE KNOWN MUTATION,81403,CPT,300,RC,,OUTPATIENT,,,1361.75,544.7,MONUMENT,COMMERCIAL,,,,1089.4,,1021.31,1334.52,
NJX AA&/STRD GR OCPL NRV,64405,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UNITED HEALTH,UNITED COMMERCIAL,,,,442.476,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.6,OTHER,337.13,440.51,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,MONUMENT,COMMERCIAL,,,,359.6,,337.13,440.51,
N BLOCK INJ OCCIPITAL,64405,CPT,361,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAGNOSTICS,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR DIAGNOSTICS,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
NJX AA&/STRD BRACH PLEXUS,64415,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,UNITED HEALTH,UNITED COMMERCIAL,,,,1393.405,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
NJX AA&/STRD AXILLARY NRV,64417,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,UNITED HEALTH,UNITED COMMERCIAL,,,,1393.405,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC AMPLI EACH,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE NUCLEIC AMPLI EACH,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
GENETIC EXAMINATION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
GENETIC EXAMINATION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEIC ACID HIGH RESOLUTE,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
INJ ANES/SCIATIC NERVE SINGLE,64445,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE ADD,8390959,CPT,300,RC,59,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEIC ACID HIGH RESOLUTE ADD,8390959,CPT,300,RC,59,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC ADD'L,8381959,CPT,300,RC,59,OUTPATIENT,,,449.5,179.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.6,OTHER,337.13,440.51,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE ISOLATE NUCLEIC ADD'L,8381959,CPT,300,RC,59,OUTPATIENT,,,449.5,179.8,MONUMENT,COMMERCIAL,,,,359.6,,337.13,440.51,
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,UNITED HEALTH,UNITED COMMERCIAL,,,,515.525,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC TRANSFER,83897,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,119,OTHER,111.56,145.78,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE NUCLEIC TRANSFER,83897,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,MONUMENT,COMMERCIAL,,,,119,,111.56,145.78,
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
N BLOCK INJ PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,UNITED HEALTH,UNITED COMMERCIAL,,,,515.525,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
N BLOCK INJ PERIPHERAL BILAT,64450,CPT,361,RC,,OUTPATIENT,,,1298.5,519.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1103.725,OTHER,973.9,1272.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ NERVE BLOCK PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,155.25,202.86,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD NRV NRVTG SI JT B,64451,CPT,361,RC,,OUTPATIENT,,,2529.68,1011.872,UNITED HEALTH,UNITED COMMERCIAL,,,,2150.228,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,OUTPATIENT,,,1283.34,513.336,UNITED HEALTH,UNITED COMMERCIAL,,,,1090.839,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
PVB THORACIC SINGLE INJ SITE,64461,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T 1 LT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T 1 RT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T 1 BI,64479,CPT,,,,OUTPATIENT,,,2529.68,1011.872,UNITED HEALTH,UNITED COMMERCIAL,,,,2150.228,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T LT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2251.65,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T RT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2251.65,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI C/T BIL,64480,CPT,,,,OUTPATIENT,,,5298,2119.2,UNITED HEALTH,UNITED COMMERCIAL,,,,4503.3,OTHER,3973.5,5192,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI L/S 1,64483,CPT,361,RC,,OUTPATIENT,,,1693.3,677.32,UNITED HEALTH,UNITED COMMERCIAL,,,,1439.305,OTHER,1270,1659.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI L/S 1 BI,64483,CPT,361,RC,,OUTPATIENT,,,3278.6,1311.44,UNITED HEALTH,UNITED COMMERCIAL,,,,2786.81,OTHER,2459,3213,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
NJX AA&/STRD TFRM EPI L/S EA,64484,CPT,361,RC,,OUTPATIENT,,,1270.87,508.348,UNITED HEALTH,UNITED COMMERCIAL,,,,1080.2395,OTHER,953.2,1245.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TAP BLOCK BI INJECTION,64488,CPT,361,RC,,OUTPATIENT,,,7130,2852,UNITED HEALTH,UNITED COMMERCIAL,,,,6060.5,OTHER,5347.5,6987.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 1 LEV L,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,UNITED HEALTH,UNITED COMMERCIAL,,,,1393.405,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 1 LEV R,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,UNITED HEALTH,UNITED COMMERCIAL,,,,1393.405,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 1 LEV B,64490,CPT,350,RC,,OUTPATIENT,,,2458.95,983.58,UNITED HEALTH,UNITED COMMERCIAL,,,,2090.1075,OTHER,1844.2,2409.8,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.34,942.136,UNITED HEALTH,UNITED COMMERCIAL,,,,2002.039,OTHER,1766.5,2308.2,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.54,942.216,UNITED HEALTH,UNITED COMMERCIAL,,,,2002.209,OTHER,1766.7,2308.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 2 LEV B,64491,CPT,350,RC,,OUTPATIENT,,,4710.68,1884.272,UNITED HEALTH,UNITED COMMERCIAL,,,,4004.078,OTHER,3533,4616.5,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,350,RC,,OUTPATIENT,,,2287.66,915.064,UNITED HEALTH,UNITED COMMERCIAL,,,,1944.511,OTHER,1715.7,2241.9,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
FLUORO GUIDED FACET JOINT INJ,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,UNITED HEALTH,UNITED COMMERCIAL,,,,1443.555,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CT FACET INJ LEVEL 1,64493,CPT,350,RC,,OUTPATIENT,,,1777.25,710.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1332.94,1741.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CMV IGG ANTIBODY,86644,CPT,302,RC,,OUTPATIENT,,,119.75,47.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.8,OTHER,89.81,117.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CMV IGG ANTIBODY,86644,CPT,302,RC,,OUTPATIENT,,,119.75,47.9,MONUMENT,COMMERCIAL,,,,95.8,,89.81,117.36,
CT FACET INJ 1 LEVEL,64493,CPT,350,RC,,OUTPATIENT,,,1777,710.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1332.75,1741.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VENLAFAXINE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,129.75,51.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.8,OTHER,97.31,127.16,PERCENT OF CHARGES BASED ON HCPCS CODE
VENLAFAXINE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,129.75,51.9,MONUMENT,COMMERCIAL,,,,103.8,,97.31,127.16,
INJ PARAVERT F JNT L/S LEV 1,64493,CPT,350,RC,,OUTPATIENT,,,1763.58,705.432,UNITED HEALTH,UNITED COMMERCIAL,,,,1499.043,OTHER,1322.7,1728.3,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,1524.5,609.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1219.6,OTHER,1143.38,1494.01,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,1524.5,609.8,MONUMENT,COMMERCIAL,,,,1219.6,,1143.38,1494.01,
INJ PARAVERT F JNT L/S 1 LEV,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,UNITED HEALTH,UNITED COMMERCIAL,,,,1443.555,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,132.5,53,BLUE CROSS ANTHEM,COMMERCIAL,,,,106,OTHER,99.38,129.85,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,132.5,53,MONUMENT,COMMERCIAL,,,,106,,99.38,129.85,
INJ PARAVERT F JNT L/S 1 LEV B,64493,CPT,350,RC,,OUTPATIENT,,,3396.6,1358.64,UNITED HEALTH,UNITED COMMERCIAL,,,,2887.11,OTHER,2547.5,3328.7,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,8638291,CPT,300,RC,91,OUTPATIENT,,,132.5,53,BLUE CROSS ANTHEM,COMMERCIAL,,,,106,OTHER,99.38,129.85,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUTRALIZATION TEST VIRAL,8638291,CPT,300,RC,91,OUTPATIENT,,,132.5,53,MONUMENT,COMMERCIAL,,,,106,,99.38,129.85,
CT JOINT INJECTION 2 SITE,64494,CPT,350,RC,,OUTPATIENT,,,772.5,309,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,579.38,757.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADH (VASOPRESSIN),84588,CPT,300,RC,,OUTPATIENT,,,372,148.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,297.6,OTHER,279,364.56,PERCENT OF CHARGES BASED ON HCPCS CODE
ADH (VASOPRESSIN),84588,CPT,300,RC,,OUTPATIENT,,,372,148.8,MONUMENT,COMMERCIAL,,,,297.6,,279,364.56,
CT FACET INJ 2 LEVELS,64494,CPT,350,RC,,OUTPATIENT,,,426,170.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,319.5,417.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,110.4,OTHER,103.5,135.24,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,MONUMENT,COMMERCIAL,,,,110.4,,103.5,135.24,
INJ PARAVERT F JNT L/S LEV 2,64494,CPT,350,RC,,OUTPATIENT,,,2730.94,1092.376,UNITED HEALTH,UNITED COMMERCIAL,,,,2321.299,OTHER,2048.2,2676.3,PERCENT OF TOTAL BILLED CHARGES
Z APOLIPOROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
Z APOLIPOROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
INJ PARAVERT F JNT L/S 2 LEV,64494,CPT,350,RC,,OUTPATIENT,,,826,330.4,UNITED HEALTH,UNITED COMMERCIAL,,,,702.1,OTHER,619.5,809.5,PERCENT OF TOTAL BILLED CHARGES
Z LP(A) CHOLESTEROL ELECTROPHO,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LP(A) CHOLESTEROL ELECTROPHO,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
INJ PARAVERT F JNT L/S 2 LEV B,64494,CPT,350,RC,,OUTPATIENT,,,1652,660.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1404.2,OTHER,1239,1619,PERCENT OF TOTAL BILLED CHARGES
CMV CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.6,OTHER,173.06,226.14,PERCENT OF CHARGES BASED ON HCPCS CODE
CMV CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,MONUMENT,COMMERCIAL,,,,184.6,,173.06,226.14,
CT FACET INJ 3 LEVELS,64495,CPT,350,RC,,OUTPATIENT,,,399.75,159.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,299.81,391.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CMV DNA QUANTITATIVE BY PCR,87497,CPT,300,RC,,OUTPATIENT,,,408.5,163.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,326.8,OTHER,306.38,400.33,PERCENT OF CHARGES BASED ON HCPCS CODE
CMV DNA QUANTITATIVE BY PCR,87497,CPT,300,RC,,OUTPATIENT,,,408.5,163.4,MONUMENT,COMMERCIAL,,,,326.8,,306.38,400.33,
INJ PARAVERT F JNT L/S LEV 3,64495,CPT,350,RC,,OUTPATIENT,,,2490,996,UNITED HEALTH,UNITED COMMERCIAL,,,,2116.5,OTHER,1867.5,2440.2,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE W/ID IMM STAIN,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE CULTURE W/ID IMM STAIN,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
INJ PARAVERT F JNT L/S 3 LEV,64495,CPT,350,RC,,OUTPATIENT,,,1186,474.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1008.1,OTHER,889.5,1162.3,PERCENT OF TOTAL BILLED CHARGES
VIRAL SMEAR SHELL VIAL,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
VIRAL SMEAR SHELL VIAL,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
CHEMODENERV MUSC MIGRAINE,64615,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UNITED HEALTH,UNITED COMMERCIAL,,,,448.817,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
Z ANTISTREPTOLYSIN O,86060,CPT,300,RC,,OUTPATIENT,,,19.75,7.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,15.8,OTHER,14.81,19.36,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANTISTREPTOLYSIN O,86060,CPT,300,RC,,OUTPATIENT,,,19.75,7.9,MONUMENT,COMMERCIAL,,,,15.8,,14.81,19.36,
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,OUTPATIENT,,,3548.74,1419.496,UNITED HEALTH,UNITED COMMERCIAL,,,,3016.429,OTHER,2661.6,3477.8,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULUTRE  LYMPHOCYTE,88230,CPT,310,RC,,OUTPATIENT,,,553,221.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,442.4,OTHER,199.31,260.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TISSUE CULUTRE  LYMPHOCYTE,88230,CPT,310,RC,,OUTPATIENT,,,553,221.2,MONUMENT,COMMERCIAL,,,,212.6,,199.31,260.44,
DESTROY C/T FACET JNT,64633,CPT,361,RC,,OUTPATIENT,,,3469.78,1387.912,UNITED HEALTH,UNITED COMMERCIAL,,,,2949.313,OTHER,2602.3,3400.4,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME ANALYSIS 15-20,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,771.2,OTHER,723,944.72,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CHROMOSOME ANALYSIS 15-20,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,MONUMENT,COMMERCIAL,,,,771.2,,723,944.72,
DESTROY C/T FACET JNT ADDL,64634,CPT,361,RC,,OUTPATIENT,,,3512,1404.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2985.2,OTHER,2634,3441.8,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,158,63.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,126.4,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETICS MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,158,63.2,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,OUTPATIENT,,,3496.78,1398.712,UNITED HEALTH,UNITED COMMERCIAL,,,,2972.263,OTHER,2622.6,3426.8,PERCENT OF TOTAL BILLED CHARGES
AFP L3% TOTAL AFP,82107,CPT,300,RC,,OUTPATIENT,,,422.75,169.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,338.2,OTHER,317.06,414.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AFP L3% TOTAL AFP,82107,CPT,300,RC,,OUTPATIENT,,,422.75,169.1,MONUMENT,COMMERCIAL,,,,338.2,,317.06,414.3,
DESTROY L/S FACET JNT ADDL,64636,CPT,361,RC,,OUTPATIENT,,,4010,1604,UNITED HEALTH,UNITED COMMERCIAL,,,,3408.5,OTHER,3007.5,3929.8,PERCENT OF TOTAL BILLED CHARGES
STREP GRP A AMP PROBE TECH,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.144,OTHER,42.56,55.62,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP GRP A AMP PROBE TECH,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,UNITED HEALTH,UNITED COMMERCIAL,,,,1414.145,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A/B PCR,87502,CPT,306,RC,,OUTPATIENT,,,191.6,76.64,BLUE CROSS ANTHEM,COMMERCIAL,,,,153.28,OTHER,91.5,119.56,PERCENT OF CHARGES BASED ON HCPCS CODE
INFLUENZA A/B PCR,87502,CPT,306,RC,,OUTPATIENT,,,191.6,76.64,MONUMENT,COMMERCIAL,,,,97.6,,91.5,119.56,
INJECTION TRTMNT OF NERVE BILA,64640,CPT,361,RC,,OUTPATIENT,,,3327.4,1330.96,UNITED HEALTH,UNITED COMMERCIAL,,,,2828.29,OTHER,2495.6,3260.9,PERCENT OF TOTAL BILLED CHARGES
RSV AMPLIFIED PROBE TECHNIQUE,87634,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.32,OTHER,76.5,99.96,PERCENT OF CHARGES BASED ON HCPCS CODE
RSV AMPLIFIED PROBE TECHNIQUE,87634,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
NERVOUS SYSTEM SURGERY UNLISTE,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UNITED HEALTH,UNITED COMMERCIAL,,,,448.817,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN ANTIGEN,85301,CPT,305,RC,,OUTPATIENT,,,186.5,74.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.2,OTHER,139.88,182.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTITHROMBIN ANTIGEN,85301,CPT,305,RC,,OUTPATIENT,,,186.5,74.6,MONUMENT,COMMERCIAL,,,,149.2,,139.88,182.77,
NERVE BLOCK UNLISTED,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UNITED HEALTH,UNITED COMMERCIAL,,,,448.817,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS FUMIGATUS,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
ASPERGILLUS FUMIGATUS,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
REM FOREIGN BODY EYE EXTERNAL,65205,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UNITED HEALTH,UNITED COMMERCIAL,,,,590.5375,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
FUNGUS ANTIBODY,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGUS ANTIBODY,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
REMOVAL FOREIGN BODY CORNEAL,65220,CPT,450,RC,,OUTPATIENT,,,707.75,283.1,UNITED HEALTH,UNITED COMMERCIAL,,,,601.5875,OTHER,530.81,693.6,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS ANTIGEN,87305,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,111,OTHER,104.06,135.98,PERCENT OF CHARGES BASED ON HCPCS CODE
ASPERGILLUS ANTIGEN,87305,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,MONUMENT,COMMERCIAL,,,,111,,104.06,135.98,
REM FOREIGN BODY CORNEAL W/SLI,65222,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UNITED HEALTH,UNITED COMMERCIAL,,,,590.5375,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS IGM ANTIBODIES,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
ASPERGILLUS IGM ANTIBODIES,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
REMOVE FOREIGN BODY FROM EYE,65235,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UNITED HEALTH,UNITED COMMERCIAL,,,,590.5375,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION(MAYO),87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL IDENTIFICATION(MAYO),87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
DRAINAGE OF EYELID ABCESS,67700,CPT,450,RC,,OUTPATIENT,,,563.64,225.456,UNITED HEALTH,UNITED COMMERCIAL,,,,479.094,OTHER,422.7,552.4,PERCENT OF TOTAL BILLED CHARGES
YEAST ID PANEL,87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
YEAST ID PANEL,87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
CANTHOTOMY,67715,CPT,450,RC,,OUTPATIENT,,,2205,882,UNITED HEALTH,UNITED COMMERCIAL,,,,1874.25,OTHER,1653.75,2160.9,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,91.5,36.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.2,OTHER,68.63,89.67,PERCENT OF CHARGES BASED ON HCPCS CODE
HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,91.5,36.6,MONUMENT,COMMERCIAL,,,,73.2,,68.63,89.67,
REPAIR EYELID WOUND,67935,CPT,450,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN URINE,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.2,OTHER,186.75,244.02,PERCENT OF CHARGES BASED ON HCPCS CODE
HISTOPLASMA ANTIGEN URINE,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,MONUMENT,COMMERCIAL,,,,199.2,,186.75,244.02,
REMOVE FOREIGN BODY EYELID,67938,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UNITED HEALTH,UNITED COMMERCIAL,,,,590.5375,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS BLOOD,86890,CPT,300,RC,,OUTPATIENT,,,563.5,225.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.8,OTHER,422.63,552.23,PERCENT OF CHARGES BASED ON HCPCS CODE
AUTOLOGOUS BLOOD,86890,CPT,300,RC,,OUTPATIENT,,,563.5,225.4,MONUMENT,COMMERCIAL,,,,450.8,,422.63,552.23,
DRAIN EXTERNAL EAR LESION,69000,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN SERUM,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.2,OTHER,186.75,244.02,PERCENT OF CHARGES BASED ON HCPCS CODE
HISTOPLASMA ANTIGEN SERUM,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,MONUMENT,COMMERCIAL,,,,199.2,,186.75,244.02,
REM FOREIGN BODY EAR,69200,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UNITED HEALTH,UNITED COMMERCIAL,,,,240.7625,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTEIN 1 AB IGA,86146,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BETA-2 GLYCOPROTEIN 1 AB IGA,86146,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
CLEAR OUTER EAR CANAL,69200,CPT,450,RC,,OUTPATIENT,,,318,127.2,UNITED HEALTH,UNITED COMMERCIAL,,,,270.3,OTHER,238.5,311.64,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGG,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BETA-2 GLYCOPROTIEN 1 AB IGG,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
FOREIGN BODY REMOVAL EAR W/GA,69205,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UNITED HEALTH,UNITED COMMERCIAL,,,,240.7625,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGM,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BETA-2 GLYCOPROTIEN 1 AB IGM,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
REMOVAL IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UNITED HEALTH,UNITED COMMERCIAL,,,,240.7625,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
BETA-2-MICROGLOBULIN,82232,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
BETA-2-MICROGLOBULIN,82232,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
REMOVE IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,115.84,46.336,UNITED HEALTH,UNITED COMMERCIAL,,,,98.464,OTHER,86.9,113.5,PERCENT OF TOTAL BILLED CHARGES
BETA-2 TRANSFERRIN BODY FLUID,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,179.4,OTHER,168.19,219.77,PERCENT OF CHARGES BASED ON HCPCS CODE
BETA-2 TRANSFERRIN BODY FLUID,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,MONUMENT,COMMERCIAL,,,,179.4,,168.19,219.77,
REM IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UNITED HEALTH,UNITED COMMERCIAL,,,,240.7625,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
RISPERIDONE,G0480,HCPCS,300,RC,,BOTH,,,185.25,74.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.58,OTHER,138.94,181.55,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RISPERIDONE,G0480,HCPCS,300,RC,,BOTH,,,185.25,74.1,MONUMENT,COMMERCIAL,,,,148.2,,138.94,181.55,
RISPERIDONE,G0480,HCPCS,300,RC,,BOTH,,,185.25,74.1,UNITED HEALTH,UNITED COMMERCIAL,,,,138.94,,138.94,181.55,
EA ADD'L SINGLE PROBE STAIN,88364,CPT,300,RC,,OUTPATIENT,,,547.5,219,BLUE CROSS ANTHEM,COMMERCIAL,,,,438,OTHER,410.63,536.55,PERCENT OF CHARGES BASED ON HCPCS CODE
EA ADD'L SINGLE PROBE STAIN,88364,CPT,300,RC,,OUTPATIENT,,,547.5,219,MONUMENT,COMMERCIAL,,,,438,,410.63,536.55,
REMOVE IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,127,50.8,UNITED HEALTH,UNITED COMMERCIAL,,,,107.95,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
MULTIPLER PROBE STAIN PROC,88377,CPT,300,RC,,OUTPATIENT,,,622.75,249.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,498.2,OTHER,467.06,610.3,PERCENT OF CHARGES BASED ON HCPCS CODE
MULTIPLER PROBE STAIN PROC,88377,CPT,300,RC,,OUTPATIENT,,,622.75,249.1,MONUMENT,COMMERCIAL,,,,498.2,,467.06,610.3,
ORBITS FOR MRI,70030,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,200.44,261.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HCG QUANTATATIVE,84702,CPT,301,RC,,OUTPATIENT,,,194.25,77.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,155.4,OTHER,145.69,190.37,PERCENT OF CHARGES BASED ON HCPCS CODE
HCG QUANTATATIVE,84702,CPT,301,RC,,OUTPATIENT,,,194.25,77.7,MONUMENT,COMMERCIAL,,,,155.4,,145.69,190.37,
MANDIBLE 4 VIEWS,70110,CPT,320,RC,,OUTPATIENT,,,420.75,168.3,UNITED HEALTH,UNITED COMMERCIAL,,,,357.6375,OTHER,315.56,412.34,PERCENT OF TOTAL BILLED CHARGES
B TYPE NATRIURECTIC PEPTIDE,83880,CPT,301,RC,,OUTPATIENT,,,475.5,190.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,380.4,OTHER,356.63,465.99,PERCENT OF CHARGES BASED ON HCPCS CODE
B TYPE NATRIURECTIC PEPTIDE,83880,CPT,301,RC,,OUTPATIENT,,,475.5,190.2,MONUMENT,COMMERCIAL,,,,380.4,,356.63,465.99,
FACE BONE 3 VIEWS,70150,CPT,320,RC,,OUTPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,454.325,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
BETA-HYDROXYBUTYRIC ACID,82010,CPT,300,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
BETA-HYDROXYBUTYRIC ACID,82010,CPT,300,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
NASAL BONES,70160,CPT,320,RC,,OUTPATIENT,,,292,116.8,UNITED HEALTH,UNITED COMMERCIAL,,,,248.2,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
BETA-GLOBIN GENE SEQUENCING B,81364,CPT,300,RC,,OUTPATIENT,,,797,318.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,637.6,OTHER,597.75,781.06,PERCENT OF CHARGES BASED ON HCPCS CODE
BETA-GLOBIN GENE SEQUENCING B,81364,CPT,300,RC,,OUTPATIENT,,,797,318.8,MONUMENT,COMMERCIAL,,,,637.6,,597.75,781.06,
ORBITS,70190,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UNITED HEALTH,UNITED COMMERCIAL,,,,227.1625,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
COCAINE & METABOLITES DETECT,G0480,HCPCS,300,RC,,BOTH,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,65.98,OTHER,54.38,71.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COCAINE & METABOLITES DETECT,G0480,HCPCS,300,RC,,BOTH,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
COCAINE & METABOLITES DETECT,G0480,HCPCS,300,RC,,BOTH,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,54.38,,54.38,71.05,
DIRECT COOMBS,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
DIRECT COOMBS,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
SINUS 1 VIEW,70210,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,137.0625,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
Z PRE DAT,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PRE DAT,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
SINUS 4 VIEWS,70220,CPT,320,RC,,OUTPATIENT,,,425,170,UNITED HEALTH,UNITED COMMERCIAL,,,,361.25,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
Z POST DAT,8688091,CPT,300,RC,91,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z POST DAT,8688091,CPT,300,RC,91,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
SELLA TURCICA EXAM,70240,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,137.0625,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DNA ANTIBODY IGG,86225,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
DNA ANTIBODY IGG,86225,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
SKULL 3 VIEWS,70250,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UNITED HEALTH,UNITED COMMERCIAL,,,,366.9875,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN DIRECT,82248,CPT,301,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
BILIRUBIN DIRECT,82248,CPT,301,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
SKULL COMPLETE,70260,CPT,320,RC,,OUTPATIENT,,,542.25,216.9,UNITED HEALTH,UNITED COMMERCIAL,,,,460.9125,OTHER,406.69,531.41,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,786.75,314.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,629.4,OTHER,590.06,771.02,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,786.75,314.7,MONUMENT,COMMERCIAL,,,,629.4,,590.06,771.02,
TEMPEROMANDIBULAR JT,70328,CPT,320,RC,,OUTPATIENT,,,581.75,232.7,UNITED HEALTH,UNITED COMMERCIAL,,,,494.4875,OTHER,436.31,570.12,PERCENT OF TOTAL BILLED CHARGES
CRMP S IGG WESTERN BLOT,84182,CPT,300,RC,,OUTPATIENT,,,192,76.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,153.6,OTHER,144,188.16,PERCENT OF CHARGES BASED ON HCPCS CODE
CRMP S IGG WESTERN BLOT,84182,CPT,300,RC,,OUTPATIENT,,,192,76.8,MONUMENT,COMMERCIAL,,,,153.6,,144,188.16,
NECK SOFT TISSUE,70360,CPT,320,RC,,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
Z URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
SIALAGRAM,70390,CPT,320,RC,,OUTPATIENT,,,563.5,225.4,UNITED HEALTH,UNITED COMMERCIAL,,,,478.975,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
CT HEAD W/O CONTRAST (HDWO),70450,CPT,350,RC,,OUTPATIENT,,,1525,610,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1143.75,1494.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MERCURY  URINE,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.2,OTHER,83.63,109.27,PERCENT OF CHARGES BASED ON HCPCS CODE
MERCURY  URINE,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,MONUMENT,COMMERCIAL,,,,89.2,,83.63,109.27,
CT HEAD W/CONTRAST (HDWC),70460,CPT,350,RC,,OUTPATIENT,,,1877.5,751,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1408.13,1839.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
CT HEAD W/WO CONTRAST (HDWW),70470,CPT,350,RC,,OUTPATIENT,,,2113.75,845.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1585.31,2071.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BILIRUBIN  NEONATAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
BILIRUBIN  NEONATAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
CT IAC/ORB/SELLA W/O CONT,70480,CPT,350,RC,,OUTPATIENT,,,1659.5,663.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1244.63,1626.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BIOTINIDASE SERUM,82261,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
BIOTINIDASE SERUM,82261,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
CT IAC/ORB/SELLA W/CONT (IACW),70481,CPT,350,RC,,OUTPATIENT,,,2050.75,820.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1538.06,2009.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
P BIOTINIDASE,82261,CPT,300,RC,,OUTPATIENT,,,33.74,13.496,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.992,OTHER,6.94,9.07,PERCENT OF CHARGES BASED ON HCPCS CODE
P BIOTINIDASE,82261,CPT,300,RC,,OUTPATIENT,,,33.74,13.496,MONUMENT,COMMERCIAL,,,,7.4,,6.94,9.07,
CT IAC/ORB/SELLA W/WO CNT(IAWW,70482,CPT,350,RC,,OUTPATIENT,,,2516,1006.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1887,2465.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLEEDING TIME,85002,CPT,305,RC,,OUTPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.6,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
BLEEDING TIME,85002,CPT,305,RC,,OUTPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
CT MAXILLO FACIAL W/O CONT,70486,CPT,350,RC,,OUTPATIENT,,,1200,480,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,900,1176,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FUNGUS ANTIBODY ADD'L,8667191,CPT,300,RC,91,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGUS ANTIBODY ADD'L,8667191,CPT,300,RC,91,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
CT SINUS (SINU),70486,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MEASLES RUBEOLA AB IGM,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
MEASLES RUBEOLA AB IGM,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
CT MAXILLO FACIAL W/CONT(MFWC),70487,CPT,350,RC,,OUTPATIENT,,,1250,500,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,937.5,1225,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MEASLES RUBEOLA AB IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
MEASLES RUBEOLA AB IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
MAXILLOFACIAL W/WO,70488,CPT,350,RC,,OUTPATIENT,,,1300,520,UNITED HEALTH,UNITED COMMERCIAL,,,,1105,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB  CF,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.4,OTHER,60.38,78.89,PERCENT OF CHARGES BASED ON HCPCS CODE
BLASTOMYCES AB  CF,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,MONUMENT,COMMERCIAL,,,,64.4,,60.38,78.89,
CT SOFT TISSUE NECK W/O (NEWO),70490,CPT,350,RC,,OUTPATIENT,,,1100.5,440.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,825.38,1078.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOMIPRAMINE & METABOLITE,82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOMIPRAMINE & METABOLITE,82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
CT SOFT TISSUE NECK W/CONT,70491,CPT,350,RC,,OUTPATIENT,,,1684.25,673.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1263.19,1650.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLASTOMYCES AB,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.4,OTHER,60.38,78.89,PERCENT OF CHARGES BASED ON HCPCS CODE
BLASTOMYCES AB,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,MONUMENT,COMMERCIAL,,,,64.4,,60.38,78.89,
CT SOFT TISSUE NCK W/WO (NEWW),70492,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1431,1869.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PREALBUMIN,84134,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,53,OTHER,49.69,64.93,PERCENT OF CHARGES BASED ON HCPCS CODE
PREALBUMIN,84134,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,MONUMENT,COMMERCIAL,,,,53,,49.69,64.93,
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,2275,910,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1706.25,2229.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLASTOMYCES AB,8661291,CPT,300,RC,91,OUTPATIENT,,,80.5,32.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.4,OTHER,60.38,78.89,PERCENT OF CHARGES BASED ON HCPCS CODE
BLASTOMYCES AB,8661291,CPT,300,RC,91,OUTPATIENT,,,80.5,32.2,MONUMENT,COMMERCIAL,,,,64.4,,60.38,78.89,
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,1470,588,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1102.5,1440.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ACYLCARNITINE QUANTITATIVE,82017,CPT,301,RC,,OUTPATIENT,,,176.5,70.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.2,OTHER,132.38,172.97,PERCENT OF CHARGES BASED ON HCPCS CODE
ACYLCARNITINE QUANTITATIVE,82017,CPT,301,RC,,OUTPATIENT,,,176.5,70.6,MONUMENT,COMMERCIAL,,,,141.2,,132.38,172.97,
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1431,1869.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BORDETELLA PERTUSSIS AB IGG,86615,CPT,300,RC,,OUTPATIENT,,,178.5,71.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,142.8,OTHER,133.88,174.93,PERCENT OF CHARGES BASED ON HCPCS CODE
BORDETELLA PERTUSSIS AB IGG,86615,CPT,300,RC,,OUTPATIENT,,,178.5,71.4,MONUMENT,COMMERCIAL,,,,142.8,,133.88,174.93,
CT ANGIO PARATHYROID W/WO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1431,1869.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BORDETELLA PERTUSSIS AB IGA,86615,CPT,300,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BORDETELLA PERTUSSIS AB IGA,86615,CPT,300,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,945,378,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,708.75,926.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CADMIUM BLOOD,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.4,OTHER,46.31,60.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CADMIUM BLOOD,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,MONUMENT,COMMERCIAL,,,,49.4,,46.31,60.52,
MRI FACE/NECK/OR WO CONTRAST,70540,CPT,610,RC,,OUTPATIENT,,,3169.5,1267.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2377.13,3106.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INFECTIOUS AGENT DETECTION APT,87801,CPT,300,RC,,OUTPATIENT,,,231,92.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.8,OTHER,173.25,226.38,PERCENT OF CHARGES BASED ON HCPCS CODE
INFECTIOUS AGENT DETECTION APT,87801,CPT,300,RC,,OUTPATIENT,,,231,92.4,MONUMENT,COMMERCIAL,,,,184.8,,173.25,226.38,
MRI FACE NECK ORBIT W CONTRAST,70542,CPT,610,RC,,OUTPATIENT,,,3577.75,1431.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2683.31,3506.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
MRI FACE/NECK/ORBIT W/WO,70543,CPT,610,RC,,OUTPATIENT,,,4389.75,1755.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3292.31,4301.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z COCCIDIOIDES AB IGG BY CF,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z COCCIDIOIDES AB IGG BY CF,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
MRA ANGIO HEAD W/O CONTRAST,70544,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2169.19,2834.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z COCCIDIOIDES AB IGG BY IMMUN,8663591,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z COCCIDIOIDES AB IGG BY IMMUN,8663591,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
MRA ANGIO HEAD W/CONTRAST,70545,CPT,610,RC,,OUTPATIENT,,,3099,1239.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2324.25,3037.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z COCCIDIOIDES AB IGM BY IMMUN,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z COCCIDIOIDES AB IGM BY IMMUN,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
MRA ANGIO HEAD W/WO CONTRAST,70546,CPT,610,RC,,OUTPATIENT,,,3173,1269.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2379.75,3109.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UREA NITROGEN (BUN),84520,CPT,301,RC,,OUTPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,64,OTHER,60,78.4,PERCENT OF CHARGES BASED ON HCPCS CODE
UREA NITROGEN (BUN),84520,CPT,301,RC,,OUTPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
MRA ANGIO NECK W/O CONTRAST,70547,CPT,610,RC,,OUTPATIENT,,,2223,889.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1667.25,2178.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BILE ACIDS FRACTIONATE TOTAL,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
BILE ACIDS FRACTIONATE TOTAL,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
MRA ANGIO NECK W/CONTRAST,70548,CPT,610,RC,,OUTPATIENT,,,2434.25,973.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1825.69,2385.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IODINE URINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IODINE URINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
MRA ANGIO NECK W/WO CONTRAST,70549,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2169.19,2834.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MANGANESE SERUM,83785,CPT,300,RC,,OUTPATIENT,,,184.75,73.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.8,OTHER,138.56,181.06,PERCENT OF CHARGES BASED ON HCPCS CODE
MANGANESE SERUM,83785,CPT,300,RC,,OUTPATIENT,,,184.75,73.9,MONUMENT,COMMERCIAL,,,,147.8,,138.56,181.06,
MRI HEAD W/O CONTRAST,70551,CPT,610,RC,,OUTPATIENT,,,2888.5,1155.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2166.38,2830.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IODINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IODINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
MRI HEAD W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,3071.75,1228.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2303.81,3010.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIOPURINE METHYLTRANSFERESE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOPURINE METHYLTRANSFERESE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
MRI PITUITARY/IAC W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,4124.5,1649.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3093.38,4042.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CALPROTECTIN FECAL,83993,CPT,300,RC,,OUTPATIENT,,,435,174,BLUE CROSS ANTHEM,COMMERCIAL,,,,348,OTHER,326.25,426.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CALPROTECTIN FECAL,83993,CPT,300,RC,,OUTPATIENT,,,435,174,MONUMENT,COMMERCIAL,,,,348,,326.25,426.3,
MRI HEAD W/WO CONTRAST,70553,CPT,610,RC,,OUTPATIENT,,,3674.75,1469.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2756.06,3601.26,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MALARIA ANTIBODY SCREEN,86750,CPT,300,RC,,OUTPATIENT,,,344.25,137.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,275.4,OTHER,258.19,337.37,PERCENT OF CHARGES BASED ON HCPCS CODE
MALARIA ANTIBODY SCREEN,86750,CPT,300,RC,,OUTPATIENT,,,344.25,137.7,MONUMENT,COMMERCIAL,,,,275.4,,258.19,337.37,
MRI PITUITARY/IAC W/WO CONTRST,70553,CPT,610,RC,,OUTPATIENT,,,5173,2069.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3879.75,5069.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREP B DNA AMP PROBE,87653,CPT,300,RC,,OUTPATIENT,,,252.75,101.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.2,OTHER,189.56,247.7,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP B DNA AMP PROBE,87653,CPT,300,RC,,OUTPATIENT,,,252.75,101.1,MONUMENT,COMMERCIAL,,,,202.2,,189.56,247.7,
BABYGRAM,71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,275.1875,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
CULTURE SCREEN,87081,CPT,306,RC,,OUTPATIENT,,,14.25,5.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,11.4,OTHER,10.69,13.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE SCREEN,87081,CPT,306,RC,,OUTPATIENT,,,14.25,5.7,MONUMENT,COMMERCIAL,,,,11.4,,10.69,13.97,
CHEST 1 VIEW,71045,CPT,320,RC,,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,,127.5,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST (MINE),71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,275.1875,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST 2 VIEWS,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,UNITED HEALTH,UNITED COMMERCIAL,,,,283.475,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST (MINE) 2 VIEWS PRE-EMP,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,UNITED HEALTH,UNITED COMMERCIAL,,,,283.475,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST DECUBITUS,71046,CPT,320,RC,,OUTPATIENT,,,243.5,97.4,UNITED HEALTH,UNITED COMMERCIAL,,,,206.975,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST 3 VIEWS,71047,CPT,320,RC,,OUTPATIENT,,,371.75,148.7,UNITED HEALTH,UNITED COMMERCIAL,,,,315.9875,OTHER,278.81,364.32,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
CHEST 4 VIEWS,71048,CPT,320,RC,,OUTPATIENT,,,384.5,153.8,UNITED HEALTH,UNITED COMMERCIAL,,,,326.825,OTHER,288.38,376.81,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
RIBS UNILATERAL 2 VIEWS,71100,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UNITED HEALTH,UNITED COMMERCIAL,,,,366.9875,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
RIBS UNILATERAL W/ 1 VIEW CHES,71101,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
RIBS BILATERAL,71110,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,UNITED HEALTH,UNITED COMMERCIAL,,,,453.475,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
HEPARIN CO FACTOR II,85130,CPT,300,RC,,OUTPATIENT,,,338.5,135.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.8,OTHER,253.88,331.73,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPARIN CO FACTOR II,85130,CPT,300,RC,,OUTPATIENT,,,338.5,135.4,MONUMENT,COMMERCIAL,,,,270.8,,253.88,331.73,
RIBS BILATERAL W/ 1 VIEW CHEST,71111,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
RIBS-BILAT/PA CHEST 4 VIEWS,71111,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,UNITED HEALTH,UNITED COMMERCIAL,,,,453.475,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS A ANTIBODY IGM,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.4,OTHER,95.06,124.22,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS A ANTIBODY IGM,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,MONUMENT,COMMERCIAL,,,,101.4,,95.06,124.22,
STERNUM 2 VIEWS,71120,CPT,320,RC,,OUTPATIENT,,,350.25,140.1,UNITED HEALTH,UNITED COMMERCIAL,,,,297.7125,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
C-PEPTIDE,84681,CPT,301,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
C-PEPTIDE,84681,CPT,301,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
STERNOCLAVICULAR JT 3 VIEWS,71130,CPT,320,RC,,OUTPATIENT,,,357,142.8,UNITED HEALTH,UNITED COMMERCIAL,,,,303.45,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGG,86628,CPT,300,RC,,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CANDIDA ANTIBODY IGG,86628,CPT,300,RC,,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
CT CHEST W/O CONTRAST (THWO),71250,CPT,350,RC,,OUTPATIENT,,,1563.5,625.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1172.63,1532.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CANDIDA ANTIBODY IGM,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CANDIDA ANTIBODY IGM,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1438.88,1880.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CANDIDA ANTIBODY IGA,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CANDIDA ANTIBODY IGA,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1438.88,1880.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CANDIDA ALBICANS ANTIGEN DETEC,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
CANDIDA ALBICANS ANTIGEN DETEC,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2697,1078.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2022.75,2643.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C-REACTIVE PROTEIN,86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
C-REACTIVE PROTEIN,86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2458.75,983.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1844.06,2409.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C-REACTIVE PROTEIN (BABY),86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
C-REACTIVE PROTEIN (BABY),86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
"CT CHEST ANGIO(PE,AORTA)(CTAC)",71275,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1512.38,1976.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OPIATES DRUG AND METABOLITES,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.66,OTHER,59.06,77.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OPIATES DRUG AND METABOLITES,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
OPIATES DRUG AND METABOLITES,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,,59.06,,59.06,77.18,
SHIGA TOXIN 1,87427,CPT,300,RC,,OUTPATIENT,,,41.5,16.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.2,OTHER,31.13,40.67,PERCENT OF CHARGES BASED ON HCPCS CODE
SHIGA TOXIN 1,87427,CPT,300,RC,,OUTPATIENT,,,41.5,16.6,MONUMENT,COMMERCIAL,,,,33.2,,31.13,40.67,
MRI CHEST W/O CONTRAST,71550,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2518.5,3290.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OPIATE CONFIRM MECONIUM,80361,CPT,300,RC,,OUTPATIENT,,,219.75,87.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,175.8,OTHER,164.81,215.36,PERCENT OF CHARGES BASED ON HCPCS CODE
OPIATE CONFIRM MECONIUM,80361,CPT,300,RC,,OUTPATIENT,,,219.75,87.9,MONUMENT,COMMERCIAL,,,,175.8,,164.81,215.36,
MRI CHEST W/CONTRAST,71551,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2827.69,3694.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHIGA TOXIN 2,8742759,CPT,300,RC,59,OUTPATIENT,,,41.5,16.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.2,OTHER,31.13,40.67,PERCENT OF CHARGES BASED ON HCPCS CODE
SHIGA TOXIN 2,8742759,CPT,300,RC,59,OUTPATIENT,,,41.5,16.6,MONUMENT,COMMERCIAL,,,,33.2,,31.13,40.67,
MRI CHEST W/WO CONTRAST,71552,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2978.06,3891.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"CRYPTOCOCCUS AG SCREEN,SERUM",87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.8,OTHER,105.75,138.18,PERCENT OF CHARGES BASED ON HCPCS CODE
"CRYPTOCOCCUS AG SCREEN,SERUM",87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,MONUMENT,COMMERCIAL,,,,112.8,,105.75,138.18,
SPINE SINGLE VIEW,72020,CPT,320,RC,,OUTPATIENT,,,196,78.4,UNITED HEALTH,UNITED COMMERCIAL,,,,166.6,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
C5 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
CERVICAL SPINE 3 VIEWS,72040,CPT,320,RC,,OUTPATIENT,,,364,145.6,UNITED HEALTH,UNITED COMMERCIAL,,,,309.4,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
C5 COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
CERVICAL SPINE 4 OR 5 VIEWS,72050,CPT,320,RC,,OUTPATIENT,,,560.25,224.1,UNITED HEALTH,UNITED COMMERCIAL,,,,476.2125,OTHER,420.19,549.05,PERCENT OF TOTAL BILLED CHARGES
CA 125,86304,CPT,300,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
CA 125,86304,CPT,300,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
CERVICAL SPINE 6 OR MORE VIEWS,72052,CPT,320,RC,,OUTPATIENT,,,618,247.2,UNITED HEALTH,UNITED COMMERCIAL,,,,525.3,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
C2 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
C2 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
THORACIC SPINE 2VIEWS,72070,CPT,320,RC,,OUTPATIENT,,,305.75,122.3,UNITED HEALTH,UNITED COMMERCIAL,,,,259.8875,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
CA 15-3,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
CA 15-3,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
THORACIC SPINE,72072,CPT,320,RC,,OUTPATIENT,,,375,150,UNITED HEALTH,UNITED COMMERCIAL,,,,318.75,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
CA 27.29,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
CA 27.29,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
THORACOLUMBAR 2 VIEWS,72080,CPT,320,RC,,OUTPATIENT,,,375,150,UNITED HEALTH,UNITED COMMERCIAL,,,,318.75,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
CA19-9 (GI),86301,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.6,OTHER,60.56,79.14,PERCENT OF CHARGES BASED ON HCPCS CODE
CA19-9 (GI),86301,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
SPINE ENTIRE 1 VIEW,72081,CPT,,,,OUTPATIENT,,,196,78.4,UNITED HEALTH,UNITED COMMERCIAL,,,,166.6,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
C4ADES,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
C4ADES,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
SCOLIOSIS AP,72082,CPT,320,RC,,OUTPATIENT,,,320.25,128.1,UNITED HEALTH,UNITED COMMERCIAL,,,,272.2125,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
C3A LEVEL,86160,CPT,300,RC,,OUTPATIENT,,,208.5,83.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,166.8,OTHER,156.38,204.33,PERCENT OF CHARGES BASED ON HCPCS CODE
C3A LEVEL,86160,CPT,300,RC,,OUTPATIENT,,,208.5,83.4,MONUMENT,COMMERCIAL,,,,166.8,,156.38,204.33,
LUMBAR AP & LAT 2 OR 3 VIEWS,72100,CPT,320,RC,,OUTPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,,376.125,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
LIVER CYTOSOL AUTOANTIBODIES,86376,CPT,300,RC,,OUTPATIENT,,,269,107.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,215.2,OTHER,201.75,263.62,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER CYTOSOL AUTOANTIBODIES,86376,CPT,300,RC,,OUTPATIENT,,,269,107.6,MONUMENT,COMMERCIAL,,,,215.2,,201.75,263.62,
LUMBAR 4 VIEWS,72110,CPT,320,RC,,OUTPATIENT,,,595,238,UNITED HEALTH,UNITED COMMERCIAL,,,,505.75,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
CORTISOL-FREE,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
CORTISOL-FREE,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
LUMBAR FLEX/EXT 5 VIEWS,72114,CPT,320,RC,,OUTPATIENT,,,667.25,266.9,UNITED HEALTH,UNITED COMMERCIAL,,,,567.1625,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CORTISOL SALIVA,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
CORTISOL SALIVA,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
"LUMBAR AP,FLEX/EXT",72120,CPT,320,RC,,OUTPATIENT,,,215.38,86.152,UNITED HEALTH,UNITED COMMERCIAL,,,,183.073,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
PANTOTHENIC ACID (VIT B5),84591,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.2,OTHER,137.06,179.1,PERCENT OF CHARGES BASED ON HCPCS CODE
PANTOTHENIC ACID (VIT B5),84591,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,MONUMENT,COMMERCIAL,,,,146.2,,137.06,179.1,
CT CERVICAL SPINE W/O CNT(CSWO,72125,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CALCITONIN,82308,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,91.4,OTHER,85.69,111.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CALCITONIN,82308,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
CT CERVICAL SPINE W/CONTRAST,72126,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CORD BLOOD ARTERIAL,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
CORD BLOOD ARTERIAL,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
CT CERVICAL SPINE W/O & W/DYE,72127,CPT,352,RC,,OUTPATIENT,,,3099,1239.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2324.3,3037,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CORD BLOOD VENOUS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
CORD BLOOD VENOUS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
CT THORACIC SPINE W/O (TSWO),72128,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
CT THORACIC SPINE W/CONT (TSWC,72129,CPT,350,RC,,OUTPATIENT,,,2478.5,991.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1858.88,2428.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CORD DRUG SCREEN,80301,CPT,301,RC,,OUTPATIENT,,,379.75,151.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,303.8,OTHER,284.81,372.16,PERCENT OF CHARGES BASED ON HCPCS CODE
CORD DRUG SCREEN,80301,CPT,301,RC,,OUTPATIENT,,,379.75,151.9,MONUMENT,COMMERCIAL,,,,303.8,,284.81,372.16,
CT CHEST SPINE W/O & W/DYE,72130,CPT,352,RC,,OUTPATIENT,,,2951.14,1180.456,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2213.4,2892.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCREEN SINGLE DRUG CLASS,80302,CPT,301,RC,,OUTPATIENT,,,109.5,43.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.6,OTHER,82.13,107.31,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCREEN SINGLE DRUG CLASS,80302,CPT,301,RC,,OUTPATIENT,,,109.5,43.8,MONUMENT,COMMERCIAL,,,,87.6,,82.13,107.31,
CT LUMBAR SPINE W/O CONT (LSWO,72131,CPT,350,RC,,OUTPATIENT,,,1769.25,707.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1326.94,1733.87,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.8,OTHER,73.88,96.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,MONUMENT,COMMERCIAL,,,,78.8,,73.88,96.53,
CT MYELOGRAM,72131,CPT,350,RC,,OUTPATIENT,,,2626.5,1050.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1969.88,2573.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHEMOGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
METHEMOGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
LUMBAR SPINE W/CONTRAST,72132,CPT,350,RC,,OUTPATIENT,,,2145.25,858.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1823.4625,OTHER,1608.94,2102.35,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.6,OTHER,18.38,24.01,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
LUMBAR SPINE W/WO CONTRAST,72133,CPT,350,RC,,OUTPATIENT,,,2495,998,UNITED HEALTH,UNITED COMMERCIAL,,,,2120.75,OTHER,1871.25,2445.1,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN A2 AND F,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.4,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN A2 AND F,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
MRI CERVICAL SPINE W/O CONTRST,72141,CPT,610,RC,,OUTPATIENT,,,2808.25,1123.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2106.19,2752.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CALCIUM TOTAL,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,BLUE CROSS ANTHEM,COMMERCIAL,,,,34,OTHER,31.88,41.65,PERCENT OF CHARGES BASED ON HCPCS CODE
CALCIUM TOTAL,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,MONUMENT,COMMERCIAL,,,,34,,31.88,41.65,
MRI CERVICAL SPINE W/CONTRAST,72142,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CALCIUM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,BLUE CROSS ANTHEM,COMMERCIAL,,,,34,OTHER,31.88,41.65,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CALCIUM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,MONUMENT,COMMERCIAL,,,,34,,31.88,41.65,
MRI THORACIC SPINE W/O CONTRST,72146,CPT,610,RC,,OUTPATIENT,,,2931,1172.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2198.25,2872.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NON DRUG ANALYTE MASS SPEC,82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
NON DRUG ANALYTE MASS SPEC,82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
MRI THORACIC SPINE W/CONTRAST,72147,CPT,610,RC,,OUTPATIENT,,,3108,1243.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2331,3045.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PREGABALIN (LYRICA),80366,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
PREGABALIN (LYRICA),80366,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
MRI LUMBAR SPINE W/O CONTRAST,72148,CPT,610,RC,,OUTPATIENT,,,2931.5,1172.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2198.63,2872.87,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
MRI LUMBAR SPINE W/CONTRAST,72149,CPT,610,RC,,OUTPATIENT,,,3350.75,1340.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2513.06,3283.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.2,OTHER,57.38,74.97,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,MONUMENT,COMMERCIAL,,,,61.2,,57.38,74.97,
MRI CERVICAL SPINE W/WO CONTRT,72156,CPT,610,RC,,OUTPATIENT,,,3765.75,1506.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2824.31,3690.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE QUANTITATIVE TIMED SPEC,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.2,OTHER,57.38,74.97,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE QUANTITATIVE TIMED SPEC,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,MONUMENT,COMMERCIAL,,,,61.2,,57.38,74.97,
MRI THORACIC SPINE W/WO CONTRT,72157,CPT,610,RC,,OUTPATIENT,,,3352.25,1340.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2514.19,3285.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VOLUME MEASUREMENT TIMED COLL,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,27,OTHER,25.31,33.08,PERCENT OF CHARGES BASED ON HCPCS CODE
VOLUME MEASUREMENT TIMED COLL,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
MRI LUMBAR SPINE W/WO CONTRAST,72158,CPT,610,RC,,OUTPATIENT,,,3560.75,1424.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2670.56,3489.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BENZODIAZEPINE CONFIRM URINE,G0483,HCPCS,301,RC,,BOTH,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.66,OTHER,59.06,77.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BENZODIAZEPINE CONFIRM URINE,G0483,HCPCS,301,RC,,BOTH,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
BENZODIAZEPINE CONFIRM URINE,G0483,HCPCS,301,RC,,BOTH,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,,59.06,,59.06,77.18,
CYP2C9 GENE COM VARIANTS,81227,CPT,300,RC,,OUTPATIENT,,,1059.5,423.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,847.6,OTHER,794.63,1038.31,PERCENT OF CHARGES BASED ON HCPCS CODE
CYP2C9 GENE COM VARIANTS,81227,CPT,300,RC,,OUTPATIENT,,,1059.5,423.8,MONUMENT,COMMERCIAL,,,,847.6,,794.63,1038.31,
PELVIS AP,72170,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,UNITED HEALTH,UNITED COMMERCIAL,,,,211.8625,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
VKORC1 GENE,81355,CPT,300,RC,,OUTPATIENT,,,176.4,70.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.12,OTHER,1.31,1.72,PERCENT OF CHARGES BASED ON HCPCS CODE
VKORC1 GENE,81355,CPT,300,RC,,OUTPATIENT,,,176.4,70.56,MONUMENT,COMMERCIAL,,,,1.4,,1.31,1.72,
PELVIS 3 VIEWS,72190,CPT,320,RC,,OUTPATIENT,,,409.5,163.8,UNITED HEALTH,UNITED COMMERCIAL,,,,348.075,OTHER,307.13,401.31,PERCENT OF TOTAL BILLED CHARGES
TRICHOMONAS VAGINALIS AMP RNA,87661,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.8,OTHER,182.63,238.63,PERCENT OF CHARGES BASED ON HCPCS CODE
TRICHOMONAS VAGINALIS AMP RNA,87661,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,MONUMENT,COMMERCIAL,,,,194.8,,182.63,238.63,
CT ANGIOGRAPH PELV W/O&W/DYE,72191,CPT,352,RC,,OUTPATIENT,,,879.74,351.896,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,659.8,862.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARBON DIOXIDE (CO2),82374,CPT,301,RC,,OUTPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,64,OTHER,60,78.4,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBON DIOXIDE (CO2),82374,CPT,301,RC,,OUTPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
CT PELVIS W/O CONTRAST,72192,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1147.69,1499.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE CALCIUM  RANDOM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,BLUE CROSS ANTHEM,COMMERCIAL,,,,34,OTHER,31.88,41.65,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CALCIUM  RANDOM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,MONUMENT,COMMERCIAL,,,,34,,31.88,41.65,
CT PELVIS W/CONTRAST (PELW),72193,CPT,350,RC,,OUTPATIENT,,,1871,748.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1403.25,1833.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.8,OTHER,73.88,96.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,MONUMENT,COMMERCIAL,,,,78.8,,73.88,96.53,
CT PELVIS W/WO CONTRAST (PELB),72194,CPT,350,RC,,OUTPATIENT,,,2135.75,854.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1601.81,2093.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CAROTENE,82380,CPT,301,RC,,OUTPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.6,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
CAROTENE,82380,CPT,301,RC,,OUTPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
MRI PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2610,3410.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DNA,86225,CPT,300,RC,,OUTPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.8,OTHER,37.31,48.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DNA,86225,CPT,300,RC,,OUTPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
MRA ANGIO PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2610,3410.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MRI PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2892.94,3780.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SSA,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SSA,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MRA ANGIO PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2892.94,3780.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SSB,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SSB,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MRI PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3682.69,4812.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SM,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SM,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MRA ANGIO PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3682.69,4812.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RNP,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RNP,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
MR ANGIO PELVIS W/O & W/DYE,72198,CPT,610,RC,,OUTPATIENT,,,2625,1050,UNITED HEALTH,UNITED COMMERCIAL,,,,2231.25,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
Z SC/70,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SC/70,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
SACROILIAC REGION 3 VIEWS,72202,CPT,320,RC,,OUTPATIENT,,,458.5,183.4,UNITED HEALTH,UNITED COMMERCIAL,,,,389.725,OTHER,343.88,449.33,PERCENT OF TOTAL BILLED CHARGES
Z JO1,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z JO1,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
SACRUM & COCCYX 2 VIEWS,72220,CPT,320,RC,,OUTPATIENT,,,362,144.8,UNITED HEALTH,UNITED COMMERCIAL,,,,307.7,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
Z ANA 2,86038,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANA 2,86038,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
LUMBAR PUNCTURE CT MYELOGRAM,72265,CPT,320,RC,,OUTPATIENT,,,2314,925.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1735.5,2267.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE ID NON URINE/OR,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE ID NON URINE/OR,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
MYELOGRAM/FLUOROSCOPY,72270,CPT,320,RC,,OUTPATIENT,,,2314,925.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1966.9,OTHER,1735.5,2267.72,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID NON URI/PERITONEAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE ID NON URI/PERITONEAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
ACROMIOCLAVICULAR JOINTS,73050,CPT,320,RC,,OUTPATIENT,,,348.5,139.4,UNITED HEALTH,UNITED COMMERCIAL,,,,296.225,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
CEA,82378,CPT,301,RC,,OUTPATIENT,,,423.71,169.484,BLUE CROSS ANTHEM,COMMERCIAL,,,,338.968,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CEA,82378,CPT,301,RC,,OUTPATIENT,,,423.71,169.484,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
UPPER EXTREMITY INFANT,73092,CPT,320,RC,,OUTPATIENT,,,229,91.6,UNITED HEALTH,UNITED COMMERCIAL,,,,194.65,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
CSF CELL CT W/DIFF,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF CELL CT W/DIFF,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
WRISTS BILAT 4 VIEWS ONLY,73100,CPT,,,,OUTPATIENT,,,491,196.4,UNITED HEALTH,UNITED COMMERCIAL,,,,417.35,OTHER,368.3,481.2,PERCENT OF TOTAL BILLED CHARGES
VDRL CSF,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.6,OTHER,50.25,65.66,PERCENT OF CHARGES BASED ON HCPCS CODE
VDRL CSF,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,MONUMENT,COMMERCIAL,,,,53.6,,50.25,65.66,
HAND 2 VIEWS BILATERAL,73120,CPT,,,,OUTPATIENT,,,434.38,173.752,UNITED HEALTH,UNITED COMMERCIAL,,,,369.223,OTHER,325.8,425.7,PERCENT OF TOTAL BILLED CHARGES
CELL CT/DIFF BODY FLUID,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CELL CT/DIFF BODY FLUID,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
CT UPPER EXTREMITY W/CONT RT,73201,CPT,350,RC,,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYANIDE ASSAY,82600,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.4,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
CYANIDE ASSAY,82600,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
CT SHOULDER ARTHROGRAM RIGHT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1701.9,2223.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROCALCITONIN SERUM,84145,CPT,300,RC,,OUTPATIENT,,,212.5,85,BLUE CROSS ANTHEM,COMMERCIAL,,,,170,OTHER,159.38,208.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PROCALCITONIN SERUM,84145,CPT,300,RC,,OUTPATIENT,,,212.5,85,MONUMENT,COMMERCIAL,,,,170,,159.38,208.25,
CT SHOULDER ARTHROGRAM LEFT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1701.9,2223.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOMATIC HYPERMUTATION IN BCLL,81263,CPT,300,RC,,OUTPATIENT,,,948,379.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,758.4,OTHER,711,929.04,PERCENT OF CHARGES BASED ON HCPCS CODE
SOMATIC HYPERMUTATION IN BCLL,81263,CPT,300,RC,,OUTPATIENT,,,948,379.2,MONUMENT,COMMERCIAL,,,,758.4,,711,929.04,
BRACHIAL PLEXUS W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,,2339.625,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
CYLERT (PEMOLINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
CYLERT (PEMOLINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
BRACHIAL PLEXUS W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,,2339.625,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
PYRUVIC ACID B,84210,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,147,OTHER,137.81,180.08,PERCENT OF CHARGES BASED ON HCPCS CODE
PYRUVIC ACID B,84210,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,MONUMENT,COMMERCIAL,,,,147,,137.81,180.08,
MRI FOREARM WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OLIGOCLONAL BAND SERUM,83916,CPT,301,RC,,OUTPATIENT,,,83.5,33.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,66.8,OTHER,62.63,81.83,PERCENT OF CHARGES BASED ON HCPCS CODE
OLIGOCLONAL BAND SERUM,83916,CPT,301,RC,,OUTPATIENT,,,83.5,33.4,MONUMENT,COMMERCIAL,,,,66.8,,62.63,81.83,
MRI HUMERUS WO/CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IGG SERUM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IGG SERUM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
MRI HAND WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEROQUEL (QUETIAPINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
SEROQUEL (QUETIAPINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
MRI SCAPULA W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IGG CSF,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IGG CSF,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
MRI SCAPULA W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z OLIGOCLONAL BAND CSF,8391691,CPT,300,RC,91,OUTPATIENT,,,83.5,33.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,66.8,OTHER,62.63,81.83,PERCENT OF CHARGES BASED ON HCPCS CODE
Z OLIGOCLONAL BAND CSF,8391691,CPT,300,RC,91,OUTPATIENT,,,83.5,33.4,MONUMENT,COMMERCIAL,,,,66.8,,62.63,81.83,
MRI CLAVICLE W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALBUMIN SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALBUMIN SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
MRI CLAVICLE W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALBUMIN SPINAL FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.2,OTHER,50.81,66.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALBUMIN SPINAL FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,MONUMENT,COMMERCIAL,,,,54.2,,50.81,66.4,
MRI CLAVICLE W/WO RT,73218,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTICERCUS ANTIBODY CFS,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTICERCUS ANTIBODY CFS,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,,2669,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
BRAF GENE ANALYSIS,81210,CPT,300,RC,,OUTPATIENT,,,661.5,264.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,529.2,OTHER,496.13,648.27,PERCENT OF CHARGES BASED ON HCPCS CODE
BRAF GENE ANALYSIS,81210,CPT,300,RC,,OUTPATIENT,,,661.5,264.6,MONUMENT,COMMERCIAL,,,,529.2,,496.13,648.27,
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,,2669,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
CERULOPLASMIN,82390,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CERULOPLASMIN,82390,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
MRI FOREARM W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOMEGALOVIRUS QUAL BY PCR,87496,CPT,300,RC,,OUTPATIENT,,,204.5,81.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.6,OTHER,153.38,200.41,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOMEGALOVIRUS QUAL BY PCR,87496,CPT,300,RC,,OUTPATIENT,,,204.5,81.8,MONUMENT,COMMERCIAL,,,,163.6,,153.38,200.41,
MRI HUMERUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOMEGALOVIRUS ANTIBODY IGM,86645,CPT,300,RC,,OUTPATIENT,,,159.25,63.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.4,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOMEGALOVIRUS ANTIBODY IGM,86645,CPT,300,RC,,OUTPATIENT,,,159.25,63.7,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
MRI HAND W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HERPES SIMPLEX NON SPEC TYPE,86694,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.4,OTHER,27.56,36.02,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HERPES SIMPLEX NON SPEC TYPE,86694,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,MONUMENT,COMMERCIAL,,,,29.4,,27.56,36.02,
MRI SCAPULA W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RUBELLA IGM,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RUBELLA IGM,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
MRI SCAPULA W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CMV IGM,86645,CPT,300,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CMV IGM,86645,CPT,300,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
MRI CLAVICLE W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEPTIN LEVEL,83520,CPT,300,RC,,OUTPATIENT,,,263.75,105.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,211,OTHER,197.81,258.48,PERCENT OF CHARGES BASED ON HCPCS CODE
LEPTIN LEVEL,83520,CPT,300,RC,,OUTPATIENT,,,263.75,105.5,MONUMENT,COMMERCIAL,,,,211,,197.81,258.48,
MRI CLAVICLE W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOLOGY SPUTUM/FLUIDS,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOLOGY SPUTUM/FLUIDS,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
BRACHIAL PLEXUS W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2847.925,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
POSACONAZOLE,80187,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.8,OTHER,238.88,312.13,PERCENT OF CHARGES BASED ON HCPCS CODE
POSACONAZOLE,80187,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,MONUMENT,COMMERCIAL,,,,254.8,,238.88,312.13,
BRACHIAL PLEXUS W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2847.925,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
CYTOLOGY URINE,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOLOGY URINE,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
MRI FOREARM W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA B5701 GENOTY PHARMACOGENOM,81381,CPT,300,RC,,OUTPATIENT,,,405,162,BLUE CROSS ANTHEM,COMMERCIAL,,,,324,OTHER,303.75,396.9,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA B5701 GENOTY PHARMACOGENOM,81381,CPT,300,RC,,OUTPATIENT,,,405,162,MONUMENT,COMMERCIAL,,,,324,,303.75,396.9,
MRI HUMERUS W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CD20 TOTAL COUNT,86356,CPT,300,RC,,OUTPATIENT,,,272.25,108.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.8,OTHER,204.19,266.81,PERCENT OF CHARGES BASED ON HCPCS CODE
CD20 TOTAL COUNT,86356,CPT,300,RC,,OUTPATIENT,,,272.25,108.9,MONUMENT,COMMERCIAL,,,,217.8,,204.19,266.81,
MRI HAND W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABSOLUTE CD4 & CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.2,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSOLUTE CD4 & CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
MRI SCAPULA W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYSE CELLS FOR NUCLEIC EXTRACT,83907,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,111,OTHER,104.06,135.98,PERCENT OF CHARGES BASED ON HCPCS CODE
LYSE CELLS FOR NUCLEIC EXTRACT,83907,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,MONUMENT,COMMERCIAL,,,,111,,104.06,135.98,
MRI SCAPULA W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z T CELLS  TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.368,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
Z T CELLS  TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
MRI CLAVICLE W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CD4 & CD8 ABSOLUTE COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.2,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CD4 & CD8 ABSOLUTE COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
MRI WRIST WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
PROPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
MRI ELBOW WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NORPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
NORPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
MRI SHOULDER WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXTROSTIX,82948,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXTROSTIX,82948,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
WRIST BILAT W/O MRI,73221,CPT,610,RC,,OUTPATIENT,,,3408.64,1363.456,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2556.5,3340.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE PCX REAGENT STRIP,82962,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE PCX REAGENT STRIP,82962,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
MRI WRIST W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLORIDE,82435,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLORIDE,82435,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
MRI ELBOW W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,,,,60,OTHER,56.25,73.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,MONUMENT,COMMERCIAL,,,,60,,56.25,73.5,
MRI SHOULDER W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
MRI WRIST W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
MRI ELBOW W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
MRI SHOULDER W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
HIP/PELVIS CHILD 2 VIEWS,73502,CPT,320,RC,,OUTPATIENT,,,273.75,109.5,UNITED HEALTH,UNITED COMMERCIAL,,,,232.6875,OTHER,205.31,268.28,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
HIP BILATERAL WITH PELVIS,73522,CPT,320,RC,,OUTPATIENT,,,550,220,UNITED HEALTH,UNITED COMMERCIAL,,,,467.5,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
HIP INJECTION,73525,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,BLUE CROSS ANTHEM,COMMERCIAL,,,,24,OTHER,22.5,29.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,MONUMENT,COMMERCIAL,,,,24,,22.5,29.4,
FEMUR 2 VIEWS BILATERAL,73552,CPT,320,RC,,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,,425,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
CSF CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,,,,60,OTHER,56.25,73.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,MONUMENT,COMMERCIAL,,,,60,,56.25,73.5,
TIB/FIB BILATERAL,73590,CPT,320,RC,,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,,425,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METABOLITES,82542,CPT,301,RC,,OUTPATIENT,,,465.75,186.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,372.6,OTHER,349.31,456.44,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOPURINE METABOLITES,82542,CPT,301,RC,,OUTPATIENT,,,465.75,186.3,MONUMENT,COMMERCIAL,,,,372.6,,349.31,456.44,
LOWER EXTREMITY INFANT,73592,CPT,320,RC,,OUTPATIENT,,,229,91.6,UNITED HEALTH,UNITED COMMERCIAL,,,,194.65,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z THIOPURINE METABOLITES,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
ANKLE BILATERAL 4 VIEWS,73600,CPT,,,,OUTPATIENT,,,350.16,140.064,UNITED HEALTH,UNITED COMMERCIAL,,,,297.636,OTHER,262.6,343.2,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,8249191,CPT,300,RC,91,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z THIOPURINE METABOLITES,8249191,CPT,300,RC,91,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
FEET TWO VIEWS BILATERAL,73620,CPT,,,,OUTPATIENT,,,427.5,171,UNITED HEALTH,UNITED COMMERCIAL,,,,363.375,OTHER,320.6,419,PERCENT OF TOTAL BILLED CHARGES
DIHYDROTESTOSTRONE ASSEY,G0480,HCPCS,300,RC,,BOTH,,,258.75,103.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,235.46,OTHER,194.06,253.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DIHYDROTESTOSTRONE ASSEY,G0480,HCPCS,300,RC,,BOTH,,,258.75,103.5,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
DIHYDROTESTOSTRONE ASSEY,G0480,HCPCS,300,RC,,BOTH,,,258.75,103.5,UNITED HEALTH,UNITED COMMERCIAL,,,,194.06,,194.06,253.58,
DIHYDROPYRIMIDINE DEHYDROGENAS,81400,CPT,300,RC,,OUTPATIENT,,,557.5,223,BLUE CROSS ANTHEM,COMMERCIAL,,,,446,OTHER,418.13,546.35,PERCENT OF CHARGES BASED ON HCPCS CODE
DIHYDROPYRIMIDINE DEHYDROGENAS,81400,CPT,300,RC,,OUTPATIENT,,,557.5,223,MONUMENT,COMMERCIAL,,,,446,,418.13,546.35,
CT LOWER EXT W/O CONT RT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1475.81,1928.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN-LIKE GROWTH FACTOR-2,83519,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.6,OTHER,157.13,205.31,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN-LIKE GROWTH FACTOR-2,83519,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,MONUMENT,COMMERCIAL,,,,167.6,,157.13,205.31,
CT LOWER EXT W/O CONT LT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1190.81,1556,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIPHENHYDRAMINE SERUM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
DIPHENHYDRAMINE SERUM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
CT LOWER EXTREMITY W/CONT RT,73701,CPT,350,RC,,OUTPATIENT,,,2437.25,974.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1827.94,2388.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIPTHERIA ANTIBODY,86648,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
DIPTHERIA ANTIBODY,86648,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
CT ANGIO LWR EXTR W/O&W/DYE LT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,659.8,862.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIPTHERIA TOXOID IGG AB,86317,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
DIPTHERIA TOXOID IGG AB,86317,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
CT ANGIO LWR EXTR W/O&W/DYE RT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,659.8,862.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHENOTHIAZINE,82542,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,55,OTHER,51.56,67.38,PERCENT OF CHARGES BASED ON HCPCS CODE
PHENOTHIAZINE,82542,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,MONUMENT,COMMERCIAL,,,,55,,51.56,67.38,
CT ANGIO LWR EXTR W/O&W/DYE BI,73706,CPT,,,,OUTPATIENT,,,1319.61,527.844,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,989.7,1293.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHOLESTEROL,82465,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLESTEROL,82465,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
MRI FOOT WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIOPURINE METABOLITES,80299,CPT,300,RC,,OUTPATIENT,,,417,166.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,333.6,OTHER,312.75,408.66,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOPURINE METABOLITES,80299,CPT,300,RC,,OUTPATIENT,,,417,166.8,MONUMENT,COMMERCIAL,,,,333.6,,312.75,408.66,
MRI TIB/FIB WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPOPROTEINS  BLOOD,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPOPROTEINS  BLOOD,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
MRI FEMUR WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTEIN ELECTROPHORESIS BDY FL,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,123,OTHER,115.31,150.68,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN ELECTROPHORESIS BDY FL,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,MONUMENT,COMMERCIAL,,,,123,,115.31,150.68,
MRI FOOT W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PROTEIN ELECTROPHORESIS,84165,CPT,300,RC,,OUTPATIENT,,,20,8,BLUE CROSS ANTHEM,COMMERCIAL,,,,16,OTHER,30.38,39.69,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROTEIN ELECTROPHORESIS,84165,CPT,300,RC,,OUTPATIENT,,,20,8,MONUMENT,COMMERCIAL,,,,32.4,,30.38,39.69,
MRI TIB/FIB W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2800,1120,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2100,2744,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IG PARAPROTEIN QUAL BLD/UR,0077U,HCPCS,300,RC,,INPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.23,OTHER,39.8,51.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IG PARAPROTEIN QUAL BLD/UR,0077U,HCPCS,300,RC,,INPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.8,51.9,
IG PARAPROTEIN QUAL BLD/UR,0077U,HCPCS,300,RC,,INPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,,39.8,,39.8,51.9,
ENCAINIDE,82542,CPT,301,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ENCAINIDE,82542,CPT,301,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS PANEL ACUTE,80074,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,155,OTHER,145.31,189.88,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS PANEL ACUTE,80074,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,MONUMENT,COMMERCIAL,,,,155,,145.31,189.88,
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESTRIOL SERUM,82677,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ESTRIOL SERUM,82677,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
MRI FOOT W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
MRI TIB/FIB W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,2800,1120,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2100,2744,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ETHOSUXIMIDE (ZARONTIN),80168,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ETHOSUXIMIDE (ZARONTIN),80168,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
MRI FEMUR W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COAGULATION FACTOR IX,85250,CPT,305,RC,,OUTPATIENT,,,371.75,148.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,297.4,OTHER,278.81,364.32,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR IX,85250,CPT,305,RC,,OUTPATIENT,,,371.75,148.7,MONUMENT,COMMERCIAL,,,,297.4,,278.81,364.32,
MRI ANKLE W/O CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COAGULATION FACTOR V,85220,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR V,85220,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
MRI HIP WO CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FACTOR V LEIDEN,81241,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.4,OTHER,151.31,197.72,PERCENT OF CHARGES BASED ON HCPCS CODE
FACTOR V LEIDEN,81241,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
MRI HIP W/CONT RT,73722,CPT,610,RC,,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FACTOR VIII INHIBITOR,85335,CPT,300,RC,,OUTPATIENT,,,287.25,114.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,229.8,OTHER,215.44,281.51,PERCENT OF CHARGES BASED ON HCPCS CODE
FACTOR VIII INHIBITOR,85335,CPT,300,RC,,OUTPATIENT,,,287.25,114.9,MONUMENT,COMMERCIAL,,,,229.8,,215.44,281.51,
MRA ANG LWR EXT W OR W/O DYE,73725,CPT,610,RC,,OUTPATIENT,,,1837.5,735,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1378.13,1800.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COAGULATION FACTOR VII,85230,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR VII,85230,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
GASTROGRAFIN ABDOMEN 1 VIEW,74000,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR VIII,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,BLUE CROSS ANTHEM,COMMERCIAL,,,,222,OTHER,208.13,271.95,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR VIII,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,MONUMENT,COMMERCIAL,,,,222,,208.13,271.95,
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR II ACTIVITY,85210,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR II ACTIVITY,85210,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
HAGEMAN COAGULATION FACTOR XII,85280,CPT,305,RC,,OUTPATIENT,,,200.25,80.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.2,OTHER,150.19,196.25,PERCENT OF CHARGES BASED ON HCPCS CODE
HAGEMAN COAGULATION FACTOR XII,85280,CPT,305,RC,,OUTPATIENT,,,200.25,80.1,MONUMENT,COMMERCIAL,,,,160.2,,150.19,196.25,
KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
COLD AGGLUTININ TITER,86156,CPT,302,RC,,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
COLD AGGLUTININ TITER,86156,CPT,302,RC,,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
SITZ MARKER KUB SUBSEQUENT,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
C1 ESTERASE INHIBITOR,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
BABYGRAM,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UNITED HEALTH,UNITED COMMERCIAL,,,,308.975,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C3,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT C3,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
ABDOMEN 2 VIEWS,74019,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UNITED HEALTH,UNITED COMMERCIAL,,,,366.9875,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C1Q,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT C1Q,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
ABDOMEN SERIES 3 VIEWS  ACUTE,74022,CPT,320,RC,,OUTPATIENT,,,494.75,197.9,UNITED HEALTH,UNITED COMMERCIAL,,,,420.5375,OTHER,371.06,484.86,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C2 ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT C2 ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
CT ABDOMEN W/O CONTRAST (ABWO),74150,CPT,350,RC,,OUTPATIENT,,,1705.25,682.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1278.94,1671.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEMENT C4,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT C4,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
CT ABDOMEN W/CONT (ABDW),74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1497.56,1956.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEMENT FACTOR B,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.4,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT FACTOR B,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
CT ABDOMEN W/CONTRAST,74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1497.56,1956.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEMENT TOTAL (CH5O),86162,CPT,300,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEMENT TOTAL (CH5O),86162,CPT,300,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
CT ABDOMEN W/WO CONT (ABDB),74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1716.56,2242.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLAMYDIA ANTIBODY IGG,86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAMYDIA ANTIBODY IGG,86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
CT ABDOMEN W/WO CONTRAST,74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1716.56,2242.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLAM IGG (PANEL TEST),86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGG (PANEL TEST),86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
ABDOMEN/PELVIS ANGIO,74174,CPT,350,RC,,OUTPATIENT,,,2016,806.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1713.6,OTHER,1512,1975.68,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
CT AORTA,74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1512.38,1976.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
CT ABD ANGIO (CTAA),74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1512.38,1976.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COPPER LEVEL,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
COPPER LEVEL,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
CT ABD/PEL W/O,74176,CPT,350,RC,,OUTPATIENT,,,3079.5,1231.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2309.63,3017.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COPPER URINE 24 HR,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
COPPER URINE 24 HR,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
CT ABD/PELVIS W/CONT (ABPE),74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2798.81,3657.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CORTISOL,82533,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.6,OTHER,45.56,59.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CORTISOL,82533,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
CT ABD AND PELVIS W CONTRAST,74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2798.81,3657.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CPK TOTAL ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.8,OTHER,73.88,96.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CPK TOTAL ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,MONUMENT,COMMERCIAL,,,,78.8,,73.88,96.53,
CT ABD & PELVIS W/WO CONTRAST,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,3197.06,4177.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CPK MB FRACTION,82553,CPT,301,RC,,OUTPATIENT,,,281,112.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,224.8,OTHER,210.75,275.38,PERCENT OF CHARGES BASED ON HCPCS CODE
CPK MB FRACTION,82553,CPT,301,RC,,OUTPATIENT,,,281,112.4,MONUMENT,COMMERCIAL,,,,224.8,,210.75,275.38,
CT ABD/PEL W/WO HEMATURIA(APWW,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,3197.06,4177.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CPK ISO,82552,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CPK ISO,82552,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2518.5,3290.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CK ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.8,OTHER,73.88,96.53,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CK ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,MONUMENT,COMMERCIAL,,,,78.8,,73.88,96.53,
MRI ABDOMEN W/CONTRAST,74182,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2827.69,3694.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLAM IGM (PANEL TEST),86632,CPT,300,RC,,OUTPATIENT,,,35.75,14.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.6,OTHER,26.81,35.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGM (PANEL TEST),86632,CPT,300,RC,,OUTPATIENT,,,35.75,14.3,MONUMENT,COMMERCIAL,,,,28.6,,26.81,35.04,
MRI ABDOMEN W/WO CONTRAST,74183,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2978.06,3891.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.6,OTHER,26.81,35.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,MONUMENT,COMMERCIAL,,,,28.6,,26.81,35.04,
ESOPHAGRAM,74220,CPT,320,RC,,OUTPATIENT,,,496.25,198.5,UNITED HEALTH,UNITED COMMERCIAL,,,,421.8125,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.6,OTHER,26.81,35.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,MONUMENT,COMMERCIAL,,,,28.6,,26.81,35.04,
X-RAY XM SWLNG FUNCJ C+,74230,CPT,320,RC,,OUTPATIENT,,,363.42,145.368,UNITED HEALTH,UNITED COMMERCIAL,,,,308.907,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
CREATININE ASSAY,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
CREATININE ASSAY,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
UPPER GI SERIES,74240,CPT,320,RC,,OUTPATIENT,,,694.75,277.9,UNITED HEALTH,UNITED COMMERCIAL,,,,590.5375,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,OUTPATIENT,,,239,95.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,191.2,OTHER,179.25,234.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,OUTPATIENT,,,239,95.6,MONUMENT,COMMERCIAL,,,,191.2,,179.25,234.22,
UGI/SMALL BOWEL-NO AIR,74240,CPT,320,RC,,OUTPATIENT,,,743.25,297.3,UNITED HEALTH,UNITED COMMERCIAL,,,,631.7625,OTHER,557.44,728.39,PERCENT OF TOTAL BILLED CHARGES
CRP HIGH SENSITIVITY,86141,CPT,302,RC,,OUTPATIENT,,,125.75,50.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.6,OTHER,94.31,123.24,PERCENT OF CHARGES BASED ON HCPCS CODE
CRP HIGH SENSITIVITY,86141,CPT,302,RC,,OUTPATIENT,,,125.75,50.3,MONUMENT,COMMERCIAL,,,,100.6,,94.31,123.24,
UPPER GI W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,760.75,304.3,UNITED HEALTH,UNITED COMMERCIAL,,,,646.6375,OTHER,570.56,745.54,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA SSA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
UPPER GI/SMALL BOWEL W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,785.75,314.3,UNITED HEALTH,UNITED COMMERCIAL,,,,667.8875,OTHER,589.31,770.04,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSB,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA SSB,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
X-RAY SM INT F-THRU STD,74248,CPT,320,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,,170,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
Z ENA SM,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA SM,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
SMALL BOWEL SERIES,74250,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,UNITED HEALTH,UNITED COMMERCIAL,,,,641.9625,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
Z ENA RNP,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA RNP,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
CT COLONOSCOPY SCREENING,74263,CPT,350,RC,,OUTPATIENT,,,1719.75,687.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1289.81,1685.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENA SCL 70,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA SCL 70,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
BARIUM ENEMA SINGLE CONTRAST,74270,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,UNITED HEALTH,UNITED COMMERCIAL,,,,641.9625,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
Z ENA JO1,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENA JO1,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
BARIUM ENEMA W/AIR CONTRAST,74280,CPT,320,RC,,OUTPATIENT,,,910.75,364.3,UNITED HEALTH,UNITED COMMERCIAL,,,,774.1375,OTHER,683.06,892.54,PERCENT OF TOTAL BILLED CHARGES
URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.2,OTHER,48.94,63.95,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,MONUMENT,COMMERCIAL,,,,52.2,,48.94,63.95,
CHOLANGIOGRAM OPERATIVE,74300,CPT,320,RC,,OUTPATIENT,,,279,111.6,UNITED HEALTH,UNITED COMMERCIAL,,,,237.15,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
Z URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
CHOLANGIOGRAM ADD SET,74301,CPT,320,RC,,OUTPATIENT,,,150.75,60.3,UNITED HEALTH,UNITED COMMERCIAL,,,,128.1375,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
URINE KETONES,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE KETONES,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
TUBE PLACEMENT FLUORO/FILM,74340,CPT,320,RC,,OUTPATIENT,,,440,176,UNITED HEALTH,UNITED COMMERCIAL,,,,374,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
URINE COCAINE CONFIRMATORY,80353,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,63,OTHER,59.06,77.18,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE COCAINE CONFIRMATORY,80353,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
NEPHROSTOGRAM,74425,CPT,320,RC,,OUTPATIENT,,,814.25,325.7,UNITED HEALTH,UNITED COMMERCIAL,,,,692.1125,OTHER,610.69,797.97,PERCENT OF TOTAL BILLED CHARGES
CRYOFIBRINOGEN,82585,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.4,OTHER,27.56,36.02,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYOFIBRINOGEN,82585,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,MONUMENT,COMMERCIAL,,,,29.4,,27.56,36.02,
CYSTOGRAPHY 3 VIEWS,74430,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,408,533.12,PERCENT OF TOTAL BILLED CHARGES
CRYOGLOBULIN,82595,CPT,300,RC,,OUTPATIENT,,,32,12.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.6,OTHER,24,31.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYOGLOBULIN,82595,CPT,300,RC,,OUTPATIENT,,,32,12.8,MONUMENT,COMMERCIAL,,,,25.6,,24,31.36,
URETHROCYSTOGRAM,74450,CPT,320,RC,,OUTPATIENT,,,537,214.8,UNITED HEALTH,UNITED COMMERCIAL,,,,456.45,OTHER,402.75,526.26,PERCENT OF TOTAL BILLED CHARGES
FATS URINE STAIN,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.6,OTHER,51.19,66.89,PERCENT OF CHARGES BASED ON HCPCS CODE
FATS URINE STAIN,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,MONUMENT,COMMERCIAL,,,,54.6,,51.19,66.89,
URETHROCYSTOGRAPH,74450,CPT,320,RC,,OUTPATIENT,,,474.25,189.7,UNITED HEALTH,UNITED COMMERCIAL,,,,403.1125,OTHER,355.69,464.77,PERCENT OF TOTAL BILLED CHARGES
FATS URINE QUALITATIVE,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.6,OTHER,51.19,66.89,PERCENT OF CHARGES BASED ON HCPCS CODE
FATS URINE QUALITATIVE,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,MONUMENT,COMMERCIAL,,,,54.6,,51.19,66.89,
URETHRA/BLADDER,74455,CPT,320,RC,,OUTPATIENT,,,1399,559.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1189.15,OTHER,1049.25,1371.02,PERCENT OF TOTAL BILLED CHARGES
NMR LIPOPROTEIN PROFILE,83704,CPT,301,RC,,OUTPATIENT,,,100,40,BLUE CROSS ANTHEM,COMMERCIAL,,,,80,OTHER,75,98,PERCENT OF CHARGES BASED ON HCPCS CODE
NMR LIPOPROTEIN PROFILE,83704,CPT,301,RC,,OUTPATIENT,,,100,40,MONUMENT,COMMERCIAL,,,,80,,75,98,
HYSTEROSALPINGOGRAM,74740,CPT,320,RC,,OUTPATIENT,,,458.69,183.476,UNITED HEALTH,UNITED COMMERCIAL,,,,389.8865,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
FELBATOL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
FELBATOL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
CT CALCIUM SCORING,75571,CPT,,,,OUTPATIENT,,,172,68.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,129,168.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIROLIMUS,8019559,CPT,,,59,OUTPATIENT,,,402.25,160.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,321.8,OTHER,301.69,394.21,PERCENT OF CHARGES BASED ON HCPCS CODE
SIROLIMUS,8019559,CPT,,,59,OUTPATIENT,,,402.25,160.9,MONUMENT,COMMERCIAL,,,,321.8,,301.69,394.21,
CT ABD/PELVIS ANGIO W/RUNOFF,75635,CPT,350,RC,,OUTPATIENT,,,3501.5,1400.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2626.13,3431.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
CYSTOSTOMY TUBE CHNG IMAGE GD,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,UNITED HEALTH,UNITED COMMERCIAL,,,,875.7125,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,8718191,CPT,306,RC,91,OUTPATIENT,,,101.75,40.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.4,OTHER,76.31,99.72,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANAEROBIC SENSITIVITY,8718191,CPT,306,RC,91,OUTPATIENT,,,101.75,40.7,MONUMENT,COMMERCIAL,,,,81.4,,76.31,99.72,
NEPHROSTOMY TUBE REPLACEMENT,75984,CPT,320,RC,,OUTPATIENT,,,1100,440,UNITED HEALTH,UNITED COMMERCIAL,,,,935,OTHER,2333.81,3049.52,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
GASTROSTOMY TUBE CHANGE,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,UNITED HEALTH,UNITED COMMERCIAL,,,,875.7125,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
DNA RNA SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,361,144.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,288.8,OTHER,270.75,353.78,PERCENT OF CHARGES BASED ON HCPCS CODE
DNA RNA SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,361,144.4,MONUMENT,COMMERCIAL,,,,288.8,,270.75,353.78,
CT ABSCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,558,729.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANAEROBIC ISOLATE  ID,87076,CPT,306,RC,,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
ANAEROBIC ISOLATE  ID,87076,CPT,306,RC,,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
ABSCESS DRAIN W/CATH ST,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UNITED HEALTH,UNITED COMMERCIAL,,,,632.4,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTES STOOL,83630,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
LEUKOCYTES STOOL,83630,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
US ABCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,558,729.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOZAPINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOZAPINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
FLUROSCOPY,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UNITED HEALTH,UNITED COMMERCIAL,,,,571.8375,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
CULTURE SPECIMEN BACTERIA,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE SPECIMEN BACTERIA,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
FLUORO LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UNITED HEALTH,UNITED COMMERCIAL,,,,571.8375,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
CLOTEST,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOTEST,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
FLUORO MORE THAN 1HR EXTENSIVE,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UNITED HEALTH,UNITED COMMERCIAL,,,,571.8375,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
"MYCOBACTERIAL CULTURE, BLOOD",87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.2,OTHER,130.5,170.52,PERCENT OF CHARGES BASED ON HCPCS CODE
"MYCOBACTERIAL CULTURE, BLOOD",87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
C-ARM LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,UNITED HEALTH,UNITED COMMERCIAL,,,,743.325,OTHER,655.88,857.01,PERCENT OF TOTAL BILLED CHARGES
TB TEST,3003032,CDM,,,,INPATIENT,,,36.75,14.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.44,OTHER,27.56,36.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TB TEST,3003032,CDM,,,,INPATIENT,,,36.75,14.7,MONUMENT,COMMERCIAL,,,,29.4,,27.56,36.02,
TB TEST,3003032,CDM,,,,INPATIENT,,,36.75,14.7,UNITED HEALTH,UNITED COMMERCIAL,,,,27.56,,27.56,36.02,
VECTRA,3003033,CDM,,,,OUTPATIENT,,,29.25,11.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.4,OTHER,21.94,28.67,PERCENT OF CHARGES BASED ON HCPCS CODE
VECTRA,3003033,CDM,,,,OUTPATIENT,,,29.25,11.7,MONUMENT,COMMERCIAL,,,,23.4,,21.94,28.67,
C-ARM PAIN CLINIC,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,UNITED HEALTH,UNITED COMMERCIAL,,,,743.325,OTHER,655.9,857,PERCENT OF TOTAL BILLED CHARGES
CULTURE SMEAR GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE SMEAR GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
FOREIGN BODY EVALUATION  CHILD,76010,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UNITED HEALTH,UNITED COMMERCIAL,,,,227.1625,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.6,OTHER,173.06,226.14,PERCENT OF CHARGES BASED ON HCPCS CODE
VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,MONUMENT,COMMERCIAL,,,,184.6,,173.06,226.14,
ABCESS O GRAM,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,UNITED HEALTH,UNITED COMMERCIAL,,,,818.108,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
VIRUS ISO/TISS CUL/OBSV/ID(SO),87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.6,OTHER,173.06,226.14,PERCENT OF CHARGES BASED ON HCPCS CODE
VIRUS ISO/TISS CUL/OBSV/ID(SO),87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,MONUMENT,COMMERCIAL,,,,184.6,,173.06,226.14,
FISTULA SINUS W/CONTRAST,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,UNITED HEALTH,UNITED COMMERCIAL,,,,818.108,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
VIRUS EA ISO ID  TISS CUL  SO,87253,CPT,300,RC,,OUTPATIENT,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,,,,60,OTHER,56.25,73.5,PERCENT OF CHARGES BASED ON HCPCS CODE
VIRUS EA ISO ID  TISS CUL  SO,87253,CPT,300,RC,,OUTPATIENT,,,75,30,MONUMENT,COMMERCIAL,,,,60,,56.25,73.5,
ABSCESSOGRAM,76080,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1300.7125,OTHER,1147.69,1499.65,PERCENT OF TOTAL BILLED CHARGES
HANTA VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
HANTA VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
MAMM SPECIMEN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,466.31,609.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HANTA VIRUS IGM,8679091,CPT,300,RC,91,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
HANTA VIRUS IGM,8679091,CPT,300,RC,91,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
US SURGICAL SPECIMAN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,466.31,609.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JC VIRUS,87799,CPT,300,RC,,OUTPATIENT,,,543,217.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,434.4,OTHER,407.25,532.14,PERCENT OF CHARGES BASED ON HCPCS CODE
JC VIRUS,87799,CPT,300,RC,,OUTPATIENT,,,543,217.2,MONUMENT,COMMERCIAL,,,,434.4,,407.25,532.14,
CT MPR/3D RECONSTRUCTION (MPRS,76377,CPT,350,RC,,OUTPATIENT,,,534,213.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,400.5,523.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ST LOUIS ENCEPHALITIS IGG,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
ST LOUIS ENCEPHALITIS IGG,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
CT SHOULDER DISLOCATION RT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,876,1144.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ST LOUIS ENCEPHALITIS IGM,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
ST LOUIS ENCEPHALITIS IGM,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
CT SHOULDER DISLOCATION LT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,876,1144.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC (X28),8600391,CPT,300,RC,91,OUTPATIENT,,,994.25,397.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,795.4,OTHER,745.69,974.37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC (X28),8600391,CPT,300,RC,91,OUTPATIENT,,,994.25,397.7,MONUMENT,COMMERCIAL,,,,795.4,,745.69,974.37,
CT SINUS LIMITED,76380,CPT,350,RC,,OUTPATIENT,,,776.5,310.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,582.38,760.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
FLUOROSCOPIC PROCEDURE,76496,CPT,320,RC,,OUTPATIENT,,,347.5,139,UNITED HEALTH,UNITED COMMERCIAL,,,,295.375,OTHER,260.63,340.55,PERCENT OF TOTAL BILLED CHARGES
Z VIRUS IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z VIRUS IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
MRI WHOLE BODY LIM 1-4 AREAS,76498,CPT,610,RC,,OUTPATIENT,,,3496,1398.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2622,3426.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUID CRYSTALS EXAM,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,68.8,OTHER,64.5,84.28,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUID CRYSTALS EXAM,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,MONUMENT,COMMERCIAL,,,,68.8,,64.5,84.28,
US HEAD NEONATAL,76506,CPT,402,RC,,OUTPATIENT,,,525.5,210.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,394.13,514.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
B PERTUSSIS SMEAR BY DFA,87265,CPT,306,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
B PERTUSSIS SMEAR BY DFA,87265,CPT,306,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
BEDSIDE ULTRASOUND OF THE EYE,76512,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UNITED HEALTH,UNITED COMMERCIAL,,,,400.775,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
SMEAR BLOOD-PARASITES,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,BLUE CROSS ANTHEM,COMMERCIAL,,,,86,OTHER,80.63,105.35,PERCENT OF CHARGES BASED ON HCPCS CODE
SMEAR BLOOD-PARASITES,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,MONUMENT,COMMERCIAL,,,,86,,80.63,105.35,
US THYROID,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,596.25,779.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE AFB,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.2,OTHER,130.5,170.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE AFB,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
US HEAD/NECK SOFT TISSUE,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,457.69,598.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMEAR INTER ONLY  W/WO CELL CT,85097,CPT,310,RC,,OUTPATIENT,,,1307.81,523.124,BLUE CROSS ANTHEM,COMMERCIAL,,,,1046.248,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
SMEAR INTER ONLY  W/WO CELL CT,85097,CPT,310,RC,,OUTPATIENT,,,1307.81,523.124,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,457.69,598.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYCLOSPORA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
CYCLOSPORA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
US CHEST BSCAN INC MEDIASTINUM,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,298.88,390.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,BLUE CROSS ANTHEM,COMMERCIAL,,,,86,OTHER,80.63,105.35,PERCENT OF CHARGES BASED ON HCPCS CODE
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,MONUMENT,COMMERCIAL,,,,86,,80.63,105.35,
US CHEST LIMITED,76604,CPT,402,RC,,OUTPATIENT,,,217.19,86.876,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,141.75,185.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICROSPORIDIA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROSPORIDIA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
US CHEST REAL TIME W/IMAGE DOC,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,298.88,390.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,BLUE CROSS ANTHEM,COMMERCIAL,,,,86,OTHER,80.63,105.35,PERCENT OF CHARGES BASED ON HCPCS CODE
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,MONUMENT,COMMERCIAL,,,,86,,80.63,105.35,
US BREAST LIMITED UNILAT,76642,CPT,402,RC,,OUTPATIENT,,,196.25,78.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,147.19,192.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMITH (ENA) ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
SMITH (ENA) ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
US BREAST/BILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,463.5,605.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JO 1 ANTIBODY   IGG,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
JO 1 ANTIBODY   IGG,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
US BREAST/UNILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,463.5,605.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEPARTN BY GEL ELECTROPHORESIS,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
SEPARTN BY GEL ELECTROPHORESIS,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
US ABDOMINAL COMPLETE,76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,454.13,593.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENTROVIRUS PANEL II,86658,CPT,300,RC,,OUTPATIENT,,,1295.25,518.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1036.2,OTHER,971.44,1269.35,PERCENT OF CHARGES BASED ON HCPCS CODE
ENTROVIRUS PANEL II,86658,CPT,300,RC,,OUTPATIENT,,,1295.25,518.1,MONUMENT,COMMERCIAL,,,,1036.2,,971.44,1269.35,
"BEDSIDE US ABDOMEN, COMPLETE",76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,454.13,593.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FIBRINOLYSINS/COAG SCR REPORT,85390,CPT,300,RC,,OUTPATIENT,,,57,22.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.6,OTHER,42.75,55.86,PERCENT OF CHARGES BASED ON HCPCS CODE
FIBRINOLYSINS/COAG SCR REPORT,85390,CPT,300,RC,,OUTPATIENT,,,57,22.8,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
US ABDOMINAL  LIMITED,76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,353.63,462.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE AEROBIC,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE AEROBIC,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
"BEDSIDE ABDOMEN, LIMITED",76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UNITED HEALTH,UNITED COMMERCIAL,,,,400.775,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS TOTAL AB,0064U,CPT,300,RC,,OUTPATIENT,,,120,48,BLUE CROSS ANTHEM,COMMERCIAL,,,,96,OTHER,90,117.6,PERCENT OF CHARGES BASED ON HCPCS CODE
SYPHILIS TOTAL AB,0064U,CPT,300,RC,,OUTPATIENT,,,120,48,MONUMENT,COMMERCIAL,,,,96,,90,117.6,
LIVER ONLY,76705,CPT,402,RC,,OUTPATIENT,,,620.9,248.36,UNITED HEALTH,UNITED COMMERCIAL,,,,527.765,OTHER,465.7,608.5,PERCENT OF TOTAL BILLED CHARGES
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.2,OTHER,130.5,170.52,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
US AAA SCREENING,76706,CPT,402,RC,,OUTPATIENT,,,344.25,137.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,258.19,337.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.2,OTHER,130.5,170.52,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
US RENAL,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,701.81,917.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE ANAEROBIC,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.6,OTHER,138.38,180.81,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE ANAEROBIC,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,MONUMENT,COMMERCIAL,,,,147.6,,138.38,180.81,
RETROPERITONEAL COMPLETE,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,UNITED HEALTH,UNITED COMMERCIAL,,,,795.3875,OTHER,701.81,917.04,PERCENT OF TOTAL BILLED CHARGES
CULTURE AFB W/DEFINITIVE ID,87118,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.2,OTHER,132.38,172.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE AFB W/DEFINITIVE ID,87118,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,MONUMENT,COMMERCIAL,,,,141.2,,132.38,172.97,
US AORTA,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,418.88,547.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE BLOOD,8704091,CPT,306,RC,91,OUTPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.6,OTHER,159,207.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE BLOOD,8704091,CPT,306,RC,91,OUTPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
US RETROPERITONEAL LIMITED,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,418.88,547.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z WEST NILE IGG,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.6,OTHER,60.56,79.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z WEST NILE IGG,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
"US RETROPERITONEAL, LIMITED",76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,418.88,547.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z WEST NILE IGM,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.2,OTHER,84.56,110.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z WEST NILE IGM,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,MONUMENT,COMMERCIAL,,,,90.2,,84.56,110.5,
US RENAL TRANSPLANT,76776,CPT,402,RC,,OUTPATIENT,,,484.75,193.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,363.56,475.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE BLOOD MULTIPLE SITES,8704059,CPT,306,RC,59,OUTPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.6,OTHER,159,207.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE BLOOD MULTIPLE SITES,8704059,CPT,306,RC,59,OUTPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
US SPINAL CANAL,76800,CPT,402,RC,,OUTPATIENT,,,526.75,210.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,395.06,516.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENTEROVIRUS DETECTION RT-PCR,87498,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.2,OTHER,132.38,172.97,PERCENT OF CHARGES BASED ON HCPCS CODE
ENTEROVIRUS DETECTION RT-PCR,87498,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,MONUMENT,COMMERCIAL,,,,141.2,,132.38,172.97,
US TRANSABD OB <14 WKS,76801,CPT,402,RC,,OUTPATIENT,,,682.25,272.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,511.69,668.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z WEST NILE VIRUS AB IGM CSF,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.2,OTHER,84.56,110.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z WEST NILE VIRUS AB IGM CSF,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,MONUMENT,COMMERCIAL,,,,90.2,,84.56,110.5,
US TRANSABD OB <14 WKS E/GEST,76802,CPT,402,RC,,OUTPATIENT,,,274.75,109.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,206.06,269.26,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z WEST NILE VIRUS AB IGG CSF,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.6,OTHER,60.56,79.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z WEST NILE VIRUS AB IGG CSF,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
US OB TRAB>14 WKS DETAILED,76805,CPT,402,RC,,OUTPATIENT,,,770.75,308.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,578.06,755.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENTEROVIRUS RNA QUAL RT PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
ENTEROVIRUS RNA QUAL RT PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
US OB TRAB 14-20 WKS EA GEST,76810,CPT,402,RC,,OUTPATIENT,,,328.25,131.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,246.19,321.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPSTEIN-BARR VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
EPSTEIN-BARR VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
US TRANSABD OB >14 WKS EA/GEST,76810,CPT,402,RC,,OUTPATIENT,,,296.5,118.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,222.38,290.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WEST NILE VIRUS  RNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,395,158,BLUE CROSS ANTHEM,COMMERCIAL,,,,316,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
WEST NILE VIRUS  RNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,395,158,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
US OB AFI/PLACENTA/HR/POS/E.G.,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHEUMOCYSTIS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
PHEUMOCYSTIS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
US OB VERSION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CREATININE BODY FLUID,82570,CPT,301,RC,,OUTPATIENT,,,102.5,41,BLUE CROSS ANTHEM,COMMERCIAL,,,,82,OTHER,76.88,100.45,PERCENT OF CHARGES BASED ON HCPCS CODE
CREATININE BODY FLUID,82570,CPT,301,RC,,OUTPATIENT,,,102.5,41,MONUMENT,COMMERCIAL,,,,82,,76.88,100.45,
US OB CERVIX LENGTH,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BK VIRUS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
BK VIRUS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
US OB AFI/PLACENTA/HR/POSITION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CREATININE OTHER SOURCE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.2,OTHER,48.94,63.95,PERCENT OF CHARGES BASED ON HCPCS CODE
CREATININE OTHER SOURCE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,MONUMENT,COMMERCIAL,,,,52.2,,48.94,63.95,
OB LIMITED,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
BK VIRUS PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
BK VIRUS PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
OB US LIMITED FETUS(S),76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MALARIA MODLECULAR DETECT PCR,87798,CPT,306,RC,,OUTPATIENT,,,255.75,102.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.6,OTHER,191.81,250.64,PERCENT OF CHARGES BASED ON HCPCS CODE
MALARIA MODLECULAR DETECT PCR,87798,CPT,306,RC,,OUTPATIENT,,,255.75,102.3,MONUMENT,COMMERCIAL,,,,204.6,,191.81,250.64,
US OB LIMITED SIZE,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,314.06,410.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AFB SMEAR,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB SMEAR,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
OB LIMITED TWINS,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,,355.9375,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
AFB SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
OB LIMITED POST PARTUM,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UNITED HEALTH,UNITED COMMERCIAL,,,,355.9375,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
SIGNAL RECOGNITION PROTEIN,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
SIGNAL RECOGNITION PROTEIN,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
"BEDSIDE US, PREGNANT UTERUS",76815,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,353.63,462.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
OB US LIMITED FETUS(S) BEDSIDE,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,162.9,212.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
OB FOLLOW UP,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.2,OTHER,233.63,305.27,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS ANALYSIS,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,MONUMENT,COMMERCIAL,,,,249.2,,233.63,305.27,
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,8827591,CPT,310,RC,91,OUTPATIENT,,,311.5,124.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.2,OTHER,233.63,305.27,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS ANALYSIS,8827591,CPT,310,RC,91,OUTPATIENT,,,311.5,124.6,MONUMENT,COMMERCIAL,,,,249.2,,233.63,305.27,
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UNITED HEALTH,UNITED COMMERCIAL,,,,184.62,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS FRAGILE X,88248,CPT,310,RC,,OUTPATIENT,,,1778.75,711.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1423,OTHER,1334.06,1743.18,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME ANALYSIS FRAGILE X,88248,CPT,310,RC,,OUTPATIENT,,,1778.75,711.5,MONUMENT,COMMERCIAL,,,,1423,,1334.06,1743.18,
US OB FETAL RE-EVAL SZ  FLUID,76816,CPT,402,RC,,OUTPATIENT,,,402.25,160.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,301.69,394.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE BODY FLUID,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE BODY FLUID,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
US TRANSVAGINAL OB,76817,CPT,402,RC,,OUTPATIENT,,,616.25,246.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,462.19,603.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROM & DNA ANAL FRAGILE-X,81243,CPT,310,RC,,OUTPATIENT,,,375,150,BLUE CROSS ANTHEM,COMMERCIAL,,,,300,OTHER,281.25,367.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROM & DNA ANAL FRAGILE-X,81243,CPT,310,RC,,OUTPATIENT,,,375,150,MONUMENT,COMMERCIAL,,,,300,,281.25,367.5,
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,OUTPATIENT,,,489.75,195.9,UNITED HEALTH,UNITED COMMERCIAL,,,,416.2875,OTHER,367.31,479.96,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETICS - DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
UMBILICAL CORD DOPPLER,76820,CPT,402,RC,,OUTPATIENT,,,215.38,86.152,UNITED HEALTH,UNITED COMMERCIAL,,,,183.073,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETICS - DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
US TRANSVAGINAL,76830,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,285.19,372.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOGENETICS ANALY 100-300,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.2,OTHER,233.63,305.27,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETICS ANALY 100-300,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,MONUMENT,COMMERCIAL,,,,249.2,,233.63,305.27,
US SONOHYSTOGRAPHY,76831,CPT,402,RC,,OUTPATIENT,,,1027.25,410.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,770.44,1006.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOGENETICS/MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETICS/MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
US PELVIC,76856,CPT,402,RC,,OUTPATIENT,,,854,341.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,640.5,836.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOGENECTICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,272.4,OTHER,255.38,333.69,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENECTICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,MONUMENT,COMMERCIAL,,,,272.4,,255.38,333.69,
PELVIS LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,UNITED HEALTH,UNITED COMMERCIAL,,,,543.3625,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANLY TISSUE CULT,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,532.6,OTHER,499.31,652.44,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME ANLY TISSUE CULT,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,MONUMENT,COMMERCIAL,,,,532.6,,499.31,652.44,
PELVIC LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,UNITED HEALTH,UNITED COMMERCIAL,,,,543.3625,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
G-6 PD,82955,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
G-6 PD,82955,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
US TESTICULAR,76870,CPT,402,RC,,OUTPATIENT,,,732,292.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,549,717.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTICERCOSIS IGG SERUM,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTICERCOSIS IGG SERUM,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
EXTREMITY NON VASCULAR,76881,CPT,402,RC,,OUTPATIENT,,,798.75,319.5,UNITED HEALTH,UNITED COMMERCIAL,,,,678.9375,OTHER,599.06,782.78,PERCENT OF TOTAL BILLED CHARGES
QUANTITATION THERAPY DRUG,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
QUANTITATION THERAPY DRUG,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
EXTREMITY NON VASCULAR LIMITED,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW ANALYSIS,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE MARROW ANALYSIS,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
AXILLA ULTRASOUND,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR ANTIBODIES IGA&IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
GLOMERULAR ANTIBODIES IGA&IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
"BEDSIDE US,LIMITED NONVAS EXTR",76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,207.94,271.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLIAD ANTIBODY - IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
GLIAD ANTIBODY - IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
US HIPS INFANT,76885,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,285.19,372.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GLIADIN IGG ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GLIADIN IGG ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,426.5,170.6,UNITED HEALTH,UNITED COMMERCIAL,,,,362.525,OTHER,319.88,417.97,PERCENT OF TOTAL BILLED CHARGES
Z GLIADIN IGA ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GLIADIN IGA ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
US PSEUDOANEURYSM REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,527.09,210.836,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,319.88,417.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 1,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 1,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US GUIDED NEEDLE PLACEMENT LT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1206.38,1576.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 2,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 2,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US BIOPSY LIVER,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1323,1728.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 3,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 3,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 4,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 4,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US BIOPSY MUSCLE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 5,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 5,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US BIOPSY RENAL,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1323,1728.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GANGLIOSIDE ANTIBODY PANEL 6,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GANGLIOSIDE ANTIBODY PANEL 6,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US BIOPSY PELVIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US BIOPSY THYROID,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERLEUKIN 8,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERLEUKIN 8,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
US THORACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERLEUKIN 6,83520,CPT,300,RC,,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERLEUKIN 6,83520,CPT,300,RC,,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
US GUIDED NEEDLE PLACEMENT RT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1206.38,1576.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREP A ANTIGEN,87880,CPT,300,RC,,OUTPATIENT,,,38.75,15.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,31,OTHER,29.06,37.98,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP A ANTIGEN,87880,CPT,300,RC,,OUTPATIENT,,,38.75,15.5,MONUMENT,COMMERCIAL,,,,31,,29.06,37.98,
BREAST NEEDLE LOC LT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,,779.2375,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
CULTURE FUNGAL,87101,CPT,306,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE FUNGAL,87101,CPT,306,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
BREAST NEEDLE LOC RT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,,779.2375,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
GROUP B STREP ANTIGEN - SERUM,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
GROUP B STREP ANTIGEN - SERUM,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
US CYST ASPIRATION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CRYPTOCOCCUS ANTIGEN CSF,87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.8,OTHER,105.75,138.18,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYPTOCOCCUS ANTIGEN CSF,87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,MONUMENT,COMMERCIAL,,,,112.8,,105.75,138.18,
US GUIDED BIOPSY,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CULTURE BLOOD FUNGUS,87103,CPT,300,RC,,OUTPATIENT,,,127,50.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.6,OTHER,95.25,124.46,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CULTURE BLOOD FUNGUS,87103,CPT,300,RC,,OUTPATIENT,,,127,50.8,MONUMENT,COMMERCIAL,,,,101.6,,95.25,124.46,
US MARKING FOR NEEDLE PLACEMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
US GUIDANCE BI NEEDLE 1ST PLCM,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1206.38,1576.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CRYPTOCOCCUS ANTIGEN LTX AGGLU,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.4,OTHER,116.63,152.39,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYPTOCOCCUS ANTIGEN LTX AGGLU,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,MONUMENT,COMMERCIAL,,,,124.4,,116.63,152.39,
US PARACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
US NEEDLE PLACEMENT PER LESION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CULTURE GENITAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE GENITAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CADMIUM,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.4,OTHER,46.31,60.52,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CADMIUM,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,MONUMENT,COMMERCIAL,,,,49.4,,46.31,60.52,
US GUIDANCE NEEDLE PLCMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ARSENIC,82175,CPT,301,RC,,OUTPATIENT,,,54.75,21.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.8,OTHER,41.06,53.66,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ARSENIC,82175,CPT,301,RC,,OUTPATIENT,,,54.75,21.9,MONUMENT,COMMERCIAL,,,,43.8,,41.06,53.66,
US GUIDANCE FOR AMNIOCENTESIS,76946,CPT,402,RC,,OUTPATIENT,,,1081.25,432.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,810.94,1059.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MERCURY  QUANTITATIVE,83825,CPT,301,RC,,OUTPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.8,OTHER,35.44,46.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MERCURY  QUANTITATIVE,83825,CPT,301,RC,,OUTPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
FOLLOW UP (NOT FOR OB),76970,CPT,402,RC,,OUTPATIENT,,,264.5,105.8,UNITED HEALTH,UNITED COMMERCIAL,,,,224.825,OTHER,198.38,259.21,PERCENT OF TOTAL BILLED CHARGES
Z LEAD,83655,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LEAD,83655,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
US SOFT TISSUE MISC,76999,CPT,402,RC,,OUTPATIENT,,,334.5,133.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,250.88,327.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HELICOBACTER PYLORI (DCMH),86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.4,OTHER,83.81,109.52,PERCENT OF CHARGES BASED ON HCPCS CODE
HELICOBACTER PYLORI (DCMH),86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,MONUMENT,COMMERCIAL,,,,89.4,,83.81,109.52,
C-ARM CENTRAL VENOUS ACCESS,77001,CPT,320,RC,,OUTPATIENT,,,350,140,UNITED HEALTH,UNITED COMMERCIAL,,,,297.5,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI ANTIGEN,87338,CPT,306,RC,,OUTPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.2,OTHER,167.06,218.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HELICOBACTER PYLORI ANTIGEN,87338,CPT,306,RC,,OUTPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
FLUORO GUIDED NEEDLE PLACEMENT,77002,CPT,320,RC,,OUTPATIENT,,,709,283.6,UNITED HEALTH,UNITED COMMERCIAL,,,,602.65,OTHER,531.8,694.8,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI IGM,86677,CPT,302,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
HELICOBACTER PYLORI IGM,86677,CPT,302,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
NEEDLE LOCALIZATION BY XRAY,77002,CPT,320,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2017.05,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CADASIL,81406,CPT,300,RC,,OUTPATIENT,,,3619,1447.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2895.2,OTHER,2714.25,3546.62,PERCENT OF CHARGES BASED ON HCPCS CODE
CADASIL,81406,CPT,300,RC,,OUTPATIENT,,,3619,1447.6,MONUMENT,COMMERCIAL,,,,2895.2,,2714.25,3546.62,
FLUORO GUIDED NEEDLE PLCMNT,77002,CPT,320,RC,,OUTPATIENT,,,295,118,UNITED HEALTH,UNITED COMMERCIAL,,,,250.75,OTHER,221.25,289.1,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG ISO/EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR DIAG ISO/EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
FLUOROSCOPIC GUIDANCE INJ PROC,77003,CPT,320,RC,,OUTPATIENT,,,296.5,118.6,UNITED HEALTH,UNITED COMMERCIAL,,,,252.025,OTHER,222.38,290.57,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGG,86677,CPT,302,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HELICOBACTER PYLORI IGG,86677,CPT,302,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
CT ADRENAL CORE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HELICOBACTER PYLORI IGA,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HELICOBACTER PYLORI IGA,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
CT NEPHROSTOMY TUBE GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HELICOBACTER PYLORI IGM,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HELICOBACTER PYLORI IGM,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
CT RENAL CORE BX (RNBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMAGLOBIN PLASMA,83051,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMAGLOBIN PLASMA,83051,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPSTEIN BARR VIRUS IGG ERLY AG,86663,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.4,OTHER,83.81,109.52,PERCENT OF CHARGES BASED ON HCPCS CODE
EPSTEIN BARR VIRUS IGG ERLY AG,86663,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,MONUMENT,COMMERCIAL,,,,89.4,,83.81,109.52,
CT ASPIRATION GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMEAR EXAM W/MANUAL DIFF,85007,CPT,305,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
SMEAR EXAM W/MANUAL DIFF,85007,CPT,305,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
CT GUIDANCE FOR INJECTION,77012,CPT,350,RC,,OUTPATIENT,,,1062,424.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,796.5,1040.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPSTEIN-BARR VIRUS PANEL 2,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
EPSTEIN-BARR VIRUS PANEL 2,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
CT GUIDANCE NEEDLE PLMNT,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGRAM,85027,CPT,305,RC,,OUTPATIENT,,,58.75,23.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,47,OTHER,44.06,57.58,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGRAM,85027,CPT,305,RC,,OUTPATIENT,,,58.75,23.5,MONUMENT,COMMERCIAL,,,,47,,44.06,57.58,
CT NEEDLE CYST ASPIRATION,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPSTEIN BARR VIRUS AB VIRAL,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
EPSTEIN BARR VIRUS AB VIRAL,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
CT NEEDLE BIOPSY (NDBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLATELET  AUTO,85049,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.6,OTHER,18.38,24.01,PERCENT OF CHARGES BASED ON HCPCS CODE
PLATELET  AUTO,85049,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
CT LIVER NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLATELET NEUTRALIZATION,85597,CPT,300,RC,,OUTPATIENT,,,178,71.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,142.4,OTHER,133.5,174.44,PERCENT OF CHARGES BASED ON HCPCS CODE
PLATELET NEUTRALIZATION,85597,CPT,300,RC,,OUTPATIENT,,,178,71.2,MONUMENT,COMMERCIAL,,,,142.4,,133.5,174.44,
CT LUNG/MEDIASTINUM NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLATELET ANTIBODIES SERUM,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,266.8,OTHER,250.13,326.83,PERCENT OF CHARGES BASED ON HCPCS CODE
PLATELET ANTIBODIES SERUM,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,MONUMENT,COMMERCIAL,,,,266.8,,250.13,326.83,
CT MUSCLE NEEDLE BX (MSBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIV 1-2 AG AB EVAL,G0475,HCPCS,300,RC,,BOTH,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.87,OTHER,38.63,50.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIV 1-2 AG AB EVAL,G0475,HCPCS,300,RC,,BOTH,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
HIV 1-2 AG AB EVAL,G0475,HCPCS,300,RC,,BOTH,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,,38.63,,38.63,50.47,
HIV 1 ANTIBODY RAPID SCREEN,86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV 1 ANTIBODY RAPID SCREEN,86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIV 1 ANTIBODY DIFFERENTIATION,86701,CPT,300,RC,,OUTPATIENT,,,174.5,69.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.6,OTHER,130.88,171.01,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV 1 ANTIBODY DIFFERENTIATION,86701,CPT,300,RC,,OUTPATIENT,,,174.5,69.8,MONUMENT,COMMERCIAL,,,,139.6,,130.88,171.01,
CT THYROID BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MONO SCREEN,86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.4,OTHER,83.81,109.52,PERCENT OF CHARGES BASED ON HCPCS CODE
MONO SCREEN,86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,MONUMENT,COMMERCIAL,,,,89.4,,83.81,109.52,
CT GUIDED GASTROSTOMY TUBE PLC,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HERPES SIMPLEX VIRUS BY PCR,87529,CPT,300,RC,,OUTPATIENT,,,105,42,BLUE CROSS ANTHEM,COMMERCIAL,,,,84,OTHER,78.75,102.9,PERCENT OF CHARGES BASED ON HCPCS CODE
HERPES SIMPLEX VIRUS BY PCR,87529,CPT,300,RC,,OUTPATIENT,,,105,42,MONUMENT,COMMERCIAL,,,,84,,78.75,102.9,
CT SCAN FOR NEEDLE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HERPES SIMPLEX VIRUS TYPE 2,86696,CPT,300,RC,,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
HERPES SIMPLEX VIRUS TYPE 2,86696,CPT,300,RC,,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
CT BONE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HERPES SIMPLEX VIRUS TYPE 1,86695,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.25,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HERPES SIMPLEX VIRUS TYPE 1,86695,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
CT PANCREAS CORE BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1779.75,2325.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HERPES SIMPLEX AMPLIFIED PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,BLUE CROSS ANTHEM,COMMERCIAL,,,,84,OTHER,78.75,102.9,PERCENT OF CHARGES BASED ON HCPCS CODE
HERPES SIMPLEX AMPLIFIED PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,MONUMENT,COMMERCIAL,,,,84,,78.75,102.9,
MR GUIDANCE FOR NEEDLE PLACE,77021,CPT,610,RC,,OUTPATIENT,,,2378.75,951.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2021.9375,OTHER,1784.06,2331.18,PERCENT OF TOTAL BILLED CHARGES
HSV AB IGM BY IFA,86694,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
HSV AB IGM BY IFA,86694,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
STEREOTACTIC CORE BX GUIDANCE,77031,CPT,320,RC,,OUTPATIENT,,,1744.75,697.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1483.0375,OTHER,1308.56,1709.86,PERCENT OF TOTAL BILLED CHARGES
AMPLIFIED PROBE TECHE EA ORGNS,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFIED PROBE TECHE EA ORGNS,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
MAMMOGRAPHY GUIDANCE,77032,CPT,320,RC,,OUTPATIENT,,,419,167.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,314.25,410.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HISTONE ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HISTONE ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
MRI BREAST BILAT W/O CONTRAST,77047,CPT,610,RC,,OUTPATIENT,,,3180,1272,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2385,3116.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
US MAM UNILATERAL LT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
US MAM UNILATERAL RT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
DIGITAL BREAST TOMO SCRN BIL,77063,CPT,403,RC,,OUTPATIENT,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,,73.95,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HISTOPLASMA ANTIBODY,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
DIGITAL MAM SCREENING CAD,77065,CPT,,,,OUTPATIENT,,,20.75,8.3,UNITED HEALTH,UNITED COMMERCIAL,,,,17.6375,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.4,OTHER,22.88,29.89,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HISTOPLASMA ANTIBODY,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,MONUMENT,COMMERCIAL,,,,24.4,,22.88,29.89,
DIGITAL MAMM BILATERAL DIAG,77066,CPT,401,RC,,OUTPATIENT,,,244.58,97.832,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,176.63,230.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TYSABRI IMMUNOGENICITY,83516,CPT,300,RC,,OUTPATIENT,,,547,218.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,437.6,OTHER,410.25,536.06,PERCENT OF CHARGES BASED ON HCPCS CODE
TYSABRI IMMUNOGENICITY,83516,CPT,300,RC,,OUTPATIENT,,,547,218.8,MONUMENT,COMMERCIAL,,,,437.6,,410.25,536.06,
DIGITAL MAM BILAT SCREENING,77067,CPT,403,RC,,OUTPATIENT,,,217.5,87,UNITED HEALTH,UNITED COMMERCIAL,,,,184.875,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION DIAGNOS,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.9,151.4,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV 1/2 AB. EVALUATION DIAGNOS,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.9,151.4,
DIGITAL MAM SCREENING CAD,77067,CPT,403,RC,,OUTPATIENT,,,20.75,8.3,UNITED HEALTH,UNITED COMMERCIAL,,,,17.6375,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION,G0432,HCPCS,300,RC,,BOTH,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,115.88,151.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HIV 1/2 AB. EVALUATION,G0432,HCPCS,300,RC,,BOTH,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
HIV 1/2 AB. EVALUATION,G0432,HCPCS,300,RC,,BOTH,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,,115.88,,115.88,151.41,
HIV-1 GENOTYPE REFLEX TO PHENO,87901,CPT,300,RC,,OUTPATIENT,,,1378.75,551.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1103,OTHER,1034.06,1351.18,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV-1 GENOTYPE REFLEX TO PHENO,87901,CPT,300,RC,,OUTPATIENT,,,1378.75,551.5,MONUMENT,COMMERCIAL,,,,1103,,1034.06,1351.18,
BONE AGE STUDIES,77072,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,UNITED HEALTH,UNITED COMMERCIAL,,,,211.8625,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
HIV-1 PHENOTYPIC RESIST PRE,87900,CPT,300,RC,,OUTPATIENT,,,673.5,269.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,538.8,OTHER,505.13,660.03,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV-1 PHENOTYPIC RESIST PRE,87900,CPT,300,RC,,OUTPATIENT,,,673.5,269.4,MONUMENT,COMMERCIAL,,,,538.8,,505.13,660.03,
ORTHO ROENT,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,UNITED HEALTH,UNITED COMMERCIAL,,,,300.9,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
HIV-1,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV-1,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
CT BONE LENGTH SCANOGRAM,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,265.5,346.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIV ANTIBODY TYPE 2 SCREEN,86702,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV ANTIBODY TYPE 2 SCREEN,86702,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
BONE SURVEY LIMITED,77074,CPT,320,RC,,OUTPATIENT,,,679.25,271.7,UNITED HEALTH,UNITED COMMERCIAL,,,,577.3625,OTHER,509.44,665.67,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE HEALTH HIV (SOURCE),86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
EMPLOYEE HEALTH HIV (SOURCE),86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
BONE SURVEY COMPLETE,77075,CPT,320,RC,,OUTPATIENT,,,1182,472.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1004.7,OTHER,886.5,1158.36,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1/2 CONFIRMATORY EVAL,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.2,OTHER,138.94,181.55,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV TYPE 1/2 CONFIRMATORY EVAL,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,MONUMENT,COMMERCIAL,,,,148.2,,138.94,181.55,
BONE SURVEY INFANT,77076,CPT,320,RC,,OUTPATIENT,,,598,239.2,UNITED HEALTH,UNITED COMMERCIAL,,,,508.3,OTHER,448.5,586.04,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE SGPT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
EMPLOYEE SGPT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
DEXA W/O WRIST,77080,CPT,320,RC,,OUTPATIENT,,,428,171.2,UNITED HEALTH,UNITED COMMERCIAL,,,,363.8,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1 CONFIRMATION BY IFA,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.2,OTHER,138.94,181.55,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV TYPE 1 CONFIRMATION BY IFA,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,MONUMENT,COMMERCIAL,,,,148.2,,138.94,181.55,
DEXA/ARM W/WRIST RT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,UNITED HEALTH,UNITED COMMERCIAL,,,,177.65,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
CULTURE STOOL,87045,CPT,306,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE STOOL,87045,CPT,306,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
DEXA/ARM W/WRIST LT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,UNITED HEALTH,UNITED COMMERCIAL,,,,177.65,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
HIV RNA QUANT BY PCR,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,358.6,OTHER,336.19,439.29,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV RNA QUANT BY PCR,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,MONUMENT,COMMERCIAL,,,,358.6,,336.19,439.29,
DEXA RADIUS/WRIST/HEEL,77081,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,137.0625,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
MOLECU DIAG ISOLATION/EXTRACTI,83890,CPT,301,RC,,OUTPATIENT,,,1153,461.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,922.4,OTHER,864.75,1129.94,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECU DIAG ISOLATION/EXTRACTI,83890,CPT,301,RC,,OUTPATIENT,,,1153,461.2,MONUMENT,COMMERCIAL,,,,922.4,,864.75,1129.94,
DEXA BONE DENSITY/IVA,77082,CPT,320,RC,,OUTPATIENT,,,246.75,98.7,UNITED HEALTH,UNITED COMMERCIAL,,,,209.7375,OTHER,185.06,241.82,PERCENT OF TOTAL BILLED CHARGES
HIV ULTRA SENSITIVE RNA QNT,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,358.6,OTHER,336.19,439.29,PERCENT OF CHARGES BASED ON HCPCS CODE
HIV ULTRA SENSITIVE RNA QNT,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,MONUMENT,COMMERCIAL,,,,358.6,,336.19,439.29,
BONE MARROW,77084,CPT,610,RC,,OUTPATIENT,,,2587.5,1035,UNITED HEALTH,UNITED COMMERCIAL,,,,2199.375,OTHER,1940.63,2535.75,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID BACTERIA,87077,CPT,306,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE ID BACTERIA,87077,CPT,306,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
THYROID UPTAKE W/MULT DETE,78012,CPT,341,RC,,OUTPATIENT,,,1586,634.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1348.1,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
HLA-A&B PHENOTYPE,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,516.6,OTHER,484.31,632.84,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA-A&B PHENOTYPE,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,MONUMENT,COMMERCIAL,,,,516.6,,484.31,632.84,
THYROID IMAGING ONLY (THYI),78013,CPT,341,RC,,OUTPATIENT,,,751.66,300.664,UNITED HEALTH,UNITED COMMERCIAL,,,,638.911,OTHER,491.81,642.64,PERCENT OF TOTAL BILLED CHARGES
CULTURE URINE,87088,CPT,306,RC,,OUTPATIENT,,,130.5,52.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.4,OTHER,97.88,127.89,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE URINE,87088,CPT,306,RC,,OUTPATIENT,,,130.5,52.2,MONUMENT,COMMERCIAL,,,,104.4,,97.88,127.89,
THYROID CARCINOMA MET IMAGING,78018,CPT,340,RC,,OUTPATIENT,,,1658,663.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1409.3,OTHER,1243.5,1624.84,PERCENT OF TOTAL BILLED CHARGES
HLA B 5701,81381,CPT,300,RC,,OUTPATIENT,,,755.25,302.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,604.2,OTHER,566.44,740.15,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA B 5701,81381,CPT,300,RC,,OUTPATIENT,,,755.25,302.1,MONUMENT,COMMERCIAL,,,,604.2,,566.44,740.15,
PARATHYROID IMAGING,78070,CPT,341,RC,,OUTPATIENT,,,1799,719.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1529.15,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
CULTURE VIRUS NON RESPIRATORY,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.6,OTHER,173.06,226.14,PERCENT OF CHARGES BASED ON HCPCS CODE
CULTURE VIRUS NON RESPIRATORY,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,MONUMENT,COMMERCIAL,,,,184.6,,173.06,226.14,
PARATHYROID IMAGING WITH SPECT,78071,CPT,341,RC,,OUTPATIENT,,,1984.5,793.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1686.825,OTHER,1488.38,1944.81,PERCENT OF TOTAL BILLED CHARGES
HLA TYPING  DR/DQ,86817,CPT,300,RC,,OUTPATIENT,,,485.25,194.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,388.2,OTHER,363.94,475.55,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA TYPING  DR/DQ,86817,CPT,300,RC,,OUTPATIENT,,,485.25,194.1,MONUMENT,COMMERCIAL,,,,388.2,,363.94,475.55,
LYMPH GLAND INJECTION,78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1507.475,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
HOMOCYSTINE TOTAL,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,BLUE CROSS ANTHEM,COMMERCIAL,,,,150,OTHER,140.63,183.75,PERCENT OF CHARGES BASED ON HCPCS CODE
HOMOCYSTINE TOTAL,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,MONUMENT,COMMERCIAL,,,,150,,140.63,183.75,
LYMPHOSCINTIGRAPHY (LYSC),78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1507.475,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
HOMOVANILLIC ACID URINE,83150,CPT,300,RC,,OUTPATIENT,,,167.25,66.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,133.8,OTHER,125.44,163.91,PERCENT OF CHARGES BASED ON HCPCS CODE
HOMOVANILLIC ACID URINE,83150,CPT,300,RC,,OUTPATIENT,,,167.25,66.9,MONUMENT,COMMERCIAL,,,,133.8,,125.44,163.91,
LIVER (SPECT) (LIVS),78205,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1177.8875,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
BENZENE BLOOD,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
BENZENE BLOOD,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
LIVER IMAGING SPECT W/FLOW,78206,CPT,340,RC,,OUTPATIENT,,,1589.75,635.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1351.2875,OTHER,1192.31,1557.96,PERCENT OF TOTAL BILLED CHARGES
HYPOGLYCEMIC AGENT SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
HYPOGLYCEMIC AGENT SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
LIVER/SPLEEN IMAGING W/FLOW,78216,CPT,341,RC,,OUTPATIENT,,,1237.5,495,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.875,OTHER,928.13,1212.75,PERCENT OF TOTAL BILLED CHARGES
PM SCL ANTIBODY ID,86331,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PM SCL ANTIBODY ID,86331,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
HIDA W/O,78226,CPT,341,RC,,OUTPATIENT,,,952.25,380.9,UNITED HEALTH,UNITED COMMERCIAL,,,,809.4125,OTHER,714.19,933.21,PERCENT OF TOTAL BILLED CHARGES
CYCLOSPORINE ASSAY,80158,CPT,300,RC,,OUTPATIENT,,,330,132,BLUE CROSS ANTHEM,COMMERCIAL,,,,264,OTHER,247.5,323.4,PERCENT OF CHARGES BASED ON HCPCS CODE
CYCLOSPORINE ASSAY,80158,CPT,300,RC,,OUTPATIENT,,,330,132,MONUMENT,COMMERCIAL,,,,264,,247.5,323.4,
HIDA W/CCK,78227,CPT,341,RC,,OUTPATIENT,,,1721.75,688.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1463.4875,OTHER,1291.31,1687.32,PERCENT OF TOTAL BILLED CHARGES
IMMUNOELECTRO-SERUM (IFE),86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,BLUE CROSS ANTHEM,COMMERCIAL,,,,174,OTHER,163.13,213.15,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOELECTRO-SERUM (IFE),86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,MONUMENT,COMMERCIAL,,,,174,,163.13,213.15,
GASTRO EMPTYING STUDY (GASE),78264,CPT,341,RC,,OUTPATIENT,,,1586,634.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1348.1,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
INHIBIN A TUMOR MARKER,86336,CPT,300,RC,,OUTPATIENT,,,117,46.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.6,OTHER,87.75,114.66,PERCENT OF CHARGES BASED ON HCPCS CODE
INHIBIN A TUMOR MARKER,86336,CPT,300,RC,,OUTPATIENT,,,117,46.8,MONUMENT,COMMERCIAL,,,,93.6,,87.75,114.66,
TAGGED RBC GI BLEED (TRBC),78278,CPT,341,RC,,OUTPATIENT,,,2035,814,UNITED HEALTH,UNITED COMMERCIAL,,,,1729.75,OTHER,1526.25,1994.3,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,BLUE CROSS ANTHEM,COMMERCIAL,,,,174,OTHER,163.13,213.15,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOFIXATION,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,MONUMENT,COMMERCIAL,,,,174,,163.13,213.15,
MECKLES IMAGING (MECK),78290,CPT,341,RC,,OUTPATIENT,,,1462,584.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1242.7,OTHER,1096.5,1432.76,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION CRYOGLOBULIN,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,BLUE CROSS ANTHEM,COMMERCIAL,,,,174,OTHER,163.13,213.15,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOFIXATION CRYOGLOBULIN,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,MONUMENT,COMMERCIAL,,,,174,,163.13,213.15,
BONE IMAGING LIMITED (BONL),78300,CPT,341,RC,,OUTPATIENT,,,1688.25,675.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1435.0125,OTHER,1266.19,1654.49,PERCENT OF TOTAL BILLED CHARGES
IGA,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IGA,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
BONE WHOLE BODY (BONW),78306,CPT,341,RC,,OUTPATIENT,,,1814.25,725.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1542.1125,OTHER,1360.69,1777.97,PERCENT OF TOTAL BILLED CHARGES
DHEA-S,82627,CPT,301,RC,,OUTPATIENT,,,216.5,86.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.2,OTHER,162.38,212.17,PERCENT OF CHARGES BASED ON HCPCS CODE
DHEA-S,82627,CPT,301,RC,,OUTPATIENT,,,216.5,86.6,MONUMENT,COMMERCIAL,,,,173.2,,162.38,212.17,
BONE IMAGING 3 PHASE (BON3),78315,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1420.9875,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
IGD,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IGD,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
BONE SPECT (BNSP),78320,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1177.8875,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
DHEA,82626,CPT,300,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
DHEA,82626,CPT,300,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
MYOCARDIAL PERFUSION,78452,CPT,341,RC,,OUTPATIENT,,,3980.75,1592.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3383.6375,OTHER,2985.56,3901.14,PERCENT OF TOTAL BILLED CHARGES
DESIPRAMINE (NORPRAMINE),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
DESIPRAMINE (NORPRAMINE),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
MYOCARDIAL PERF WALL MOTION,78453,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,UNITED HEALTH,UNITED COMMERCIAL,,,,2212.5075,OTHER,931.69,1217.41,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM,80177,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
LEVETIRACETAM,80177,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
MUGA SCAN,78472,CPT,341,RC,,OUTPATIENT,,,2449,979.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2081.65,OTHER,1836.75,2400.02,PERCENT OF TOTAL BILLED CHARGES
ANCA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
ANCA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
MYOCARDIAL PERF EJECTION FRACT,78496,CPT,341,RC,,OUTPATIENT,,,811.25,324.5,UNITED HEALTH,UNITED COMMERCIAL,,,,689.5625,OTHER,608.44,795.03,PERCENT OF TOTAL BILLED CHARGES
MUMPS VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.6,OTHER,173.06,226.14,PERCENT OF CHARGES BASED ON HCPCS CODE
MUMPS VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,MONUMENT,COMMERCIAL,,,,184.6,,173.06,226.14,
LUNG PERFUSION,78580,CPT,341,RC,,OUTPATIENT,,,1403.5,561.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1192.975,OTHER,1052.63,1375.43,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM (VALIUM),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
DIAZEPAM (VALIUM),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
LUNG VENTILATION,78582,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1420.9875,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
IGG,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IGG,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
VQ SCAN VENT/PERFUSION,78598,CPT,341,RC,,OUTPATIENT,,,1837,734.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1561.45,OTHER,1377.75,1800.26,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.6,OTHER,41.81,54.64,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SPOTTED FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,MONUMENT,COMMERCIAL,,,,44.6,,41.81,54.64,
BRAIN IMAGINE WITH FLOW,78606,CPT,341,RC,,OUTPATIENT,,,1544.75,617.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1313.0375,OTHER,1158.56,1513.86,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.6,OTHER,41.81,54.64,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SPOTTED FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,MONUMENT,COMMERCIAL,,,,44.6,,41.81,54.64,
CEREBROSPINAL FLUID FLOW IMAGE,78630,CPT,340,RC,,OUTPATIENT,,,3353,1341.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2850.05,OTHER,2514.75,3285.94,PERCENT OF TOTAL BILLED CHARGES
DIGITOXIN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITOXIN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
CAPTOPRIL RENAL,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1420.9875,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
IGM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IGM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
RENAL FLOW/FUNCTION,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UNITED HEALTH,UNITED COMMERCIAL,,,,1420.9875,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
ALPRAZOLAM (XANAX),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPRAZOLAM (XANAX),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
CYSTOGRAM,78740,CPT,340,RC,,OUTPATIENT,,,1170.75,468.3,UNITED HEALTH,UNITED COMMERCIAL,,,,995.1375,OTHER,878.06,1147.34,PERCENT OF TOTAL BILLED CHARGES
IBUPROFEN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
IBUPROFEN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
TUMOR LOCAL (LTD) (TLLT),78800,CPT,341,RC,,OUTPATIENT,,,1799,719.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1529.15,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
LORAZAPAM SERUM,80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
LORAZAPAM SERUM,80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
LOCAL TUMOR ONCOSCENT IN 111,78802,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,UNITED HEALTH,UNITED COMMERCIAL,,,,2212.5075,OTHER,1386.75,1812.02,PERCENT OF TOTAL BILLED CHARGES
DULOXETINE (CYMBALTA),G0480,HCPCS,300,RC,,BOTH,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.9,OTHER,102.94,134.51,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DULOXETINE (CYMBALTA),G0480,HCPCS,300,RC,,BOTH,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
DULOXETINE (CYMBALTA),G0480,HCPCS,300,RC,,BOTH,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,,102.94,,102.94,134.51,
Z GAMMA GLOBULIN ASSAY (IGA),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GAMMA GLOBULIN ASSAY (IGA),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
TUMOR LOCAL WHOLE BODY,78804,CPT,341,RC,,OUTPATIENT,,,2752,1100.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2339.2,OTHER,2064,2696.96,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGG),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GAMMA GLOBULIN ASSAY (IGG),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
TAGGED WBC (LTD) (TWBL),78805,CPT,341,RC,,OUTPATIENT,,,3635,1454,UNITED HEALTH,UNITED COMMERCIAL,,,,3089.75,OTHER,2726.25,3562.3,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGM),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GAMMA GLOBULIN ASSAY (IGM),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
TAGGED WBC WHOLE BODY (TWBW),78806,CPT,341,RC,,OUTPATIENT,,,3823,1529.2,UNITED HEALTH,UNITED COMMERCIAL,,,,3249.55,OTHER,2867.25,3746.54,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN,80162,CPT,301,RC,,OUTPATIENT,,,150.75,60.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.6,OTHER,113.06,147.74,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGOXIN,80162,CPT,301,RC,,OUTPATIENT,,,150.75,60.3,MONUMENT,COMMERCIAL,,,,120.6,,113.06,147.74,
SPECT,78807,CPT,340,RC,,OUTPATIENT,,,2279.5,911.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1937.575,OTHER,1709.63,2233.91,PERCENT OF TOTAL BILLED CHARGES
Z ANTITHROMBIN III ACTIVITY,85300,CPT,300,RC,,OUTPATIENT,,,88.75,35.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,71,OTHER,66.56,86.98,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANTITHROMBIN III ACTIVITY,85300,CPT,300,RC,,OUTPATIENT,,,88.75,35.5,MONUMENT,COMMERCIAL,,,,71,,66.56,86.98,
TAGGED WBC SPECT (TWBS),78807,CPT,340,RC,,OUTPATIENT,,,4529,1811.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3849.65,OTHER,3396.75,4438.42,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,159.75,63.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.8,OTHER,119.81,156.56,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,159.75,63.9,MONUMENT,COMMERCIAL,,,,127.8,,119.81,156.56,
PET SCAN PROSTATE,78815,CPT,404,RC,,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.8,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S ANTIGEN  FREE,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.6,OTHER,176.81,231.04,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROTEIN S ANTIGEN  FREE,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,MONUMENT,COMMERCIAL,,,,188.6,,176.81,231.04,
ABDOMINAL SCINTIGRAPHY,78999,CPT,341,RC,,OUTPATIENT,,,1575,630,UNITED HEALTH,UNITED COMMERCIAL,,,,1338.75,OTHER,1181.25,1543.5,PERCENT OF TOTAL BILLED CHARGES
Z D DIMER,85379,CPT,300,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z D DIMER,85379,CPT,300,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,96.25,38.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.19,94.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PLASMINOGEN ACTIVITY,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PLASMINOGEN ACTIVITY,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
Z BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,16.92,6.768,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.7,16.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PT (PROTIME),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.8,OTHER,35.44,46.31,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PT (PROTIME),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
GENERAL HEALTH PANEL,80050,CPT,301,RC,,OUTPATIENT,,,324.75,129.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,243.6,318.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DRVVT MIX,85613,CPT,305,RC,,OUTPATIENT,,,70.75,28.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.6,OTHER,53.06,69.34,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DRVVT MIX,85613,CPT,305,RC,,OUTPATIENT,,,70.75,28.3,MONUMENT,COMMERCIAL,,,,56.6,,53.06,69.34,
ELECTROLYTE PANEL,80051,CPT,301,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.25,97.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,89,OTHER,83.44,109.03,PERCENT OF CHARGES BASED ON HCPCS CODE
Z THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
COMPREHENSIVE METABOLIC PANEL,80053,CPT,301,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z APTT,85730,CPT,300,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z APTT,85730,CPT,300,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
PRENATAL PANEL,80055,CPT,300,RC,,OUTPATIENT,,,484.25,193.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,363.19,474.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
Z LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.5,135.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.5,135.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
RENAL FUNCTION PANEL,80069,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.88,182.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
HEPATITIS PANEL ACUTE,80074,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,145.31,189.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
HEPATIC FUNCTION PANEL (LIVER),80076,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION SCANNING,8390391,CPT,300,RC,91,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION SCANNING,8390391,CPT,300,RC,91,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
OBSTETRIC PROFILE,80081,CPT,301,RC,,OUTPATIENT,,,149.72,59.888,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.3,146.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
AMIKACIN - TROUGH,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETATION & REPORT,8391291,CPT,300,RC,91,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,8391291,CPT,300,RC,91,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
AMIKACIN PEAK,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
CARBAMAZEPINE (TEGRETOL),80156,CPT,301,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAEMOPHILUS INFLUENZA B IGG,86684,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.4,OTHER,81.94,107.07,PERCENT OF CHARGES BASED ON HCPCS CODE
HAEMOPHILUS INFLUENZA B IGG,86684,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,MONUMENT,COMMERCIAL,,,,87.4,,81.94,107.07,
CYCLOSPORINE ASSAY,80158,CPT,300,RC,,OUTPATIENT,,,330,132,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,247.5,323.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INFLUENZA A&B VIRUS ANTIBODIES,86710,CPT,302,RC,,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
INFLUENZA A&B VIRUS ANTIBODIES,86710,CPT,302,RC,,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
DIGOXIN,80162,CPT,301,RC,,OUTPATIENT,,,150.75,60.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,113.06,147.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NORPACE (DISOPRYAMIDE),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
NORPACE (DISOPRYAMIDE),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
VALPROIC ACID (DEPAKENE),80164,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
QUANTITATION THERAPEUTIC DRUG,80299,CPT,300,RC,,OUTPATIENT,,,382.25,152.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,305.8,OTHER,286.69,374.61,PERCENT OF CHARGES BASED ON HCPCS CODE
QUANTITATION THERAPEUTIC DRUG,80299,CPT,300,RC,,OUTPATIENT,,,382.25,152.9,MONUMENT,COMMERCIAL,,,,305.8,,286.69,374.61,
DOXEPINE SERUM,80166,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,162.38,212.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN GROWTH BINDING,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN GROWTH BINDING,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
ETHOSUXIMIDE (ZARONTIN),80168,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN GROWTH FACTOR I,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,157.2,OTHER,147.38,192.57,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN GROWTH FACTOR I,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,MONUMENT,COMMERCIAL,,,,157.2,,147.38,192.57,
EVEROLIMUS,80169,CPT,300,RC,,OUTPATIENT,,,433.25,173.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,324.94,424.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DOXEPINE SERUM,80166,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.2,OTHER,162.38,212.17,PERCENT OF CHARGES BASED ON HCPCS CODE
DOXEPINE SERUM,80166,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,MONUMENT,COMMERCIAL,,,,173.2,,162.38,212.17,
GENTAMYCIN PEAK,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN  TOTAL,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN  TOTAL,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
GENTAMICIN TROUGH,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN  FREE,83527,CPT,301,RC,,OUTPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.6,OTHER,45.56,59.54,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN  FREE,83527,CPT,301,RC,,OUTPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
HALDOL (HALOPERIDOL),80173,CPT,300,RC,,OUTPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.13,115.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CALCIUM IONIZED,82330,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
CALCIUM IONIZED,82330,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
LIDOCAINE,80176,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.88,104.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ISLET CELL ANITBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.6,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
ISLET CELL ANITBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
LEVETIRACETAM,80177,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DNASE-B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
DNASE-B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
LITHIUM,80178,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.31,99.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DNASE B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,39.5,15.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.6,OTHER,29.63,38.71,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DNASE B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,39.5,15.8,MONUMENT,COMMERCIAL,,,,31.6,,29.63,38.71,
OXYCARBAZAPINE (TRILIPTAL),80183,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCR PRESCRIP/OTC GASTRIC,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCR PRESCRIP/OTC GASTRIC,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
Z ASSAY OF PHENOBARBITAL,80184,CPT,300,RC,,OUTPATIENT,,,52.5,21,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.4,51.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCR PRESCRIP/OTC PLASMA,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCR PRESCRIP/OTC PLASMA,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
PHENOBARBITOL,80184,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
L/S FETAL LUNG,83661,CPT,301,RC,,OUTPATIENT,,,101,40.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.8,OTHER,75.75,98.98,PERCENT OF CHARGES BASED ON HCPCS CODE
L/S FETAL LUNG,83661,CPT,301,RC,,OUTPATIENT,,,101,40.4,MONUMENT,COMMERCIAL,,,,80.8,,75.75,98.98,
Z PHENOBARB,80184,CPT,300,RC,,OUTPATIENT,,,54.75,21.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.06,53.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG MISC MED TOX LABORATORIES,99999,CPT,300,RC,,OUTPATIENT,,,286,114.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,228.8,OTHER,214.5,280.28,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG MISC MED TOX LABORATORIES,99999,CPT,300,RC,,OUTPATIENT,,,286,114.4,MONUMENT,COMMERCIAL,,,,228.8,,214.5,280.28,
DILANTIN (PHENYTOIN),80185,CPT,301,RC,,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120.94,158.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCREEN URINE (MEDTOX),3003900,CDM,,,,INPATIENT,,,42,16.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.22,OTHER,31.5,41.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRUG SCREEN URINE (MEDTOX),3003900,CDM,,,,INPATIENT,,,42,16.8,MONUMENT,COMMERCIAL,,,,33.6,,31.5,41.16,
DRUG SCREEN URINE (MEDTOX),3003900,CDM,,,,INPATIENT,,,42,16.8,UNITED HEALTH,UNITED COMMERCIAL,,,,31.5,,31.5,41.16,
DRUG SCR PRESCRIPTION/OTC URIN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCR PRESCRIPTION/OTC URIN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
DILANTIN FREE (PHENYTOIN),80186,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCREENING ETOH,80320,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,63,OTHER,59.06,77.18,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCREENING ETOH,80320,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
POSACONAZOLE,80187,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,238.88,312.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG SCREENING BARBITURATES,80345,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,63,OTHER,59.06,77.18,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG SCREENING BARBITURATES,80345,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
Z PRIMIDONE (MYSOLINE),80188,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAWING FEE-SPEC KIT,36415,CPT,300,RC,,OUTPATIENT,,,50.75,20.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.6,OTHER,38.06,49.74,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAWING FEE-SPEC KIT,36415,CPT,300,RC,,OUTPATIENT,,,50.75,20.3,MONUMENT,COMMERCIAL,,,,40.6,,38.06,49.74,
Z ASSAY OF PRIMIDONE,80188,CPT,300,RC,,OUTPATIENT,,,52.5,21,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.4,51.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B DNA QUALITATIVE,87516,CPT,306,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B DNA QUALITATIVE,87516,CPT,306,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
PROCAINAMIDE ASSAY,80190,CPT,300,RC,,OUTPATIENT,,,130,52,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.5,127.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LDH TOTAL DIRECT,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
LDH TOTAL DIRECT,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
NAPA,80192,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EOSINOPHIL COUNT,85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
EOSINOPHIL COUNT,85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
QUINIDINE,80194,CPT,300,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,110.4,OTHER,103.5,135.24,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,MONUMENT,COMMERCIAL,,,,110.4,,103.5,135.24,
TACROLIMUS,80197,CPT,300,RC,,OUTPATIENT,,,433.75,173.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,325.31,425.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EOSINOPHILS URINE,87205,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
EOSINOPHILS URINE,87205,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
THEOPHYLLINE,80198,CPT,301,RC,,OUTPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159,207.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPOPROTEIN ELECTROPHORESIS,83700,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,293.2,OTHER,274.88,359.17,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPOPROTEIN ELECTROPHORESIS,83700,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,MONUMENT,COMMERCIAL,,,,293.2,,274.88,359.17,
TOBRAMYCIN PEAK,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57,74.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPOPROTEIN WITH LDL HDL PART,83704,CPT,301,RC,,OUTPATIENT,,,212.75,85.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,170.2,OTHER,159.56,208.5,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPOPROTEIN WITH LDL HDL PART,83704,CPT,301,RC,,OUTPATIENT,,,212.75,85.1,MONUMENT,COMMERCIAL,,,,170.2,,159.56,208.5,
TOBRAMYCIN TROUGH,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57,74.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LOW DENSITY LIPOPROTEIN,83721,CPT,301,RC,,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
LOW DENSITY LIPOPROTEIN,83721,CPT,301,RC,,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
TOPIRIMATE,80201,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LH LUTEINIZING HORMONE,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.4,OTHER,131.63,171.99,PERCENT OF CHARGES BASED ON HCPCS CODE
LH LUTEINIZING HORMONE,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,MONUMENT,COMMERCIAL,,,,140.4,,131.63,171.99,
VANCOMYCIN PEAK/TROUGH,80202,CPT,301,RC,,OUTPATIENT,,,314.75,125.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,236.06,308.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUTEINIZING HORMONE BY ICMA,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.4,OTHER,131.63,171.99,PERCENT OF CHARGES BASED ON HCPCS CODE
LUTEINIZING HORMONE BY ICMA,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,MONUMENT,COMMERCIAL,,,,140.4,,131.63,171.99,
ZONISAMIDE,80203,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"HLA CLASS II TYPING, LOW RESOL",81376,CPT,300,RC,,OUTPATIENT,,,244.44,97.776,BLUE CROSS ANTHEM,COMMERCIAL,,,,195.552,OTHER,155.63,203.35,PERCENT OF CHARGES BASED ON HCPCS CODE
"HLA CLASS II TYPING, LOW RESOL",81376,CPT,300,RC,,OUTPATIENT,,,244.44,97.776,MONUMENT,COMMERCIAL,,,,166,,155.63,203.35,
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,OUTPATIENT,,,258.4,103.36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,193.8,253.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,OUTPATIENT,,,521.25,208.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,417,OTHER,390.94,510.83,PERCENT OF CHARGES BASED ON HCPCS CODE
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,OUTPATIENT,,,521.25,208.5,MONUMENT,COMMERCIAL,,,,417,,390.94,510.83,
ITRACONAZOLE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASCORBIC ACID BLOOD,82180,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.2,OTHER,105.19,137.45,PERCENT OF CHARGES BASED ON HCPCS CODE
ASCORBIC ACID BLOOD,82180,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,MONUMENT,COMMERCIAL,,,,112.2,,105.19,137.45,
UR FENTANYL CON,80299,CPT,300,RC,,OUTPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,222.94,291.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHYLENETETRAHYDROFOLATE REDC,81291,CPT,300,RC,,OUTPATIENT,,,571,228.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,456.8,OTHER,428.25,559.58,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLENETETRAHYDROFOLATE REDC,81291,CPT,300,RC,,OUTPATIENT,,,571,228.4,MONUMENT,COMMERCIAL,,,,456.8,,428.25,559.58,
VENLAFAXINE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,129.75,51.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.31,127.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
PROPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
NORPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
THIOPURINE METABOLITES,80299,CPT,300,RC,,OUTPATIENT,,,417,166.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,312.75,408.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
FELBATOL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
CLOZAPINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
QUANTITATION THERAPY DRUG,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
DIGITOXIN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION SCREEN,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION SCREEN,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
IBUPROFEN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHYLMALONIC ACID URINE,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.4,OTHER,139.13,181.79,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLMALONIC ACID URINE,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,MONUMENT,COMMERCIAL,,,,148.4,,139.13,181.79,
NORPACE (DISOPRYAMIDE),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EBNA,86664,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.2,OTHER,34.88,45.57,PERCENT OF CHARGES BASED ON HCPCS CODE
EBNA,86664,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,MONUMENT,COMMERCIAL,,,,37.2,,34.88,45.57,
QUANTITATION THERAPEUTIC DRUG,80299,CPT,300,RC,,OUTPATIENT,,,382.25,152.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,286.69,374.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHYLMALONIC ACID  SERUM,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.4,OTHER,139.13,181.79,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLMALONIC ACID  SERUM,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,MONUMENT,COMMERCIAL,,,,148.4,,139.13,181.79,
FLECAINIDE (TAMBOCOR),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SIGNAL AMPLIFICATION,83908,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.6,OTHER,45.56,59.54,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SIGNAL AMPLIFICATION,83908,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
FLUOXETINE (PROZAC),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SIGNAL AMPLIFICATION,8390891,CPT,300,RC,91,OUTPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.6,OTHER,45.56,59.54,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SIGNAL AMPLIFICATION,8390891,CPT,300,RC,91,OUTPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
METHOTREXATE,80299,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EBV IGG,86665,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.4,OTHER,33.19,43.37,PERCENT OF CHARGES BASED ON HCPCS CODE
EBV IGG,86665,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,MONUMENT,COMMERCIAL,,,,35.4,,33.19,43.37,
OLANZAPINE (ZYPREXA),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EBV IGM,8666591,CPT,300,RC,91,OUTPATIENT,,,44.25,17.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.4,OTHER,33.19,43.37,PERCENT OF CHARGES BASED ON HCPCS CODE
EBV IGM,8666591,CPT,300,RC,91,OUTPATIENT,,,44.25,17.7,MONUMENT,COMMERCIAL,,,,35.4,,33.19,43.37,
PROPAFENONE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EBV DNA DETECTION BY PCR,87799,CPT,300,RC,,OUTPATIENT,,,270.25,108.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,216.2,OTHER,202.69,264.85,PERCENT OF CHARGES BASED ON HCPCS CODE
EBV DNA DETECTION BY PCR,87799,CPT,300,RC,,OUTPATIENT,,,270.25,108.1,MONUMENT,COMMERCIAL,,,,216.2,,202.69,264.85,
THC CONFIRMATION URINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EBV BY PCR QUALITATIVE,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
EBV BY PCR QUALITATIVE,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
LAMOTRIGINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ERYTHROPOIETIN,82668,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
ERYTHROPOIETIN,82668,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
LEFLUNOMIDE METABOLITE S,80299,CPT,300,RC,,OUTPATIENT,,,318.75,127.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,239.06,312.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
MAPROTILINE (LUDIOMIL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
MYCOPHENOLIC ACID,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESTRADIOL,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.2,OTHER,154.88,202.37,PERCENT OF CHARGES BASED ON HCPCS CODE
ESTRADIOL,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,MONUMENT,COMMERCIAL,,,,165.2,,154.88,202.37,
VORICONAZOLE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,147.5,59,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.63,144.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HER-2/NEU QUANTITATIVE,83950,CPT,300,RC,,OUTPATIENT,,,482.75,193.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,386.2,OTHER,362.06,473.1,PERCENT OF CHARGES BASED ON HCPCS CODE
HER-2/NEU QUANTITATIVE,83950,CPT,300,RC,,OUTPATIENT,,,482.75,193.1,MONUMENT,COMMERCIAL,,,,386.2,,362.06,473.1,
TRICYCLIC ANTIDEPRESSANT,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPOPROTEN ASSOC PHOSPLIPSE A2,83698,CPT,300,RC,,OUTPATIENT,,,280.5,112.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,224.4,OTHER,210.38,274.89,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPOPROTEN ASSOC PHOSPLIPSE A2,83698,CPT,300,RC,,OUTPATIENT,,,280.5,112.2,MONUMENT,COMMERCIAL,,,,224.4,,210.38,274.89,
AMNIODARONE LEVEL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALCOHOL ETHANOL,80307,CPT,301,RC,,OUTPATIENT,,,182.75,73.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.2,OTHER,137.06,179.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ALCOHOL ETHANOL,80307,CPT,301,RC,,OUTPATIENT,,,182.75,73.1,MONUMENT,COMMERCIAL,,,,146.2,,137.06,179.1,
TOCAINIDE QUANT SERUM,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEDATIVE HYPNOTIC PANEL URINE,80301,CPT,301,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
SEDATIVE HYPNOTIC PANEL URINE,80301,CPT,301,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
TRAZODONE (DESYREL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MERCURY QUANTITATIVE BLOOD,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.2,OTHER,83.63,109.27,PERCENT OF CHARGES BASED ON HCPCS CODE
MERCURY QUANTITATIVE BLOOD,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,MONUMENT,COMMERCIAL,,,,89.2,,83.63,109.27,
DEXAMETHASONE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,160.24,64.096,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120.2,157,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PANCREATIC ELASTASE,82656,CPT,300,RC,,OUTPATIENT,,,342.75,137.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,274.2,OTHER,257.06,335.9,PERCENT OF CHARGES BASED ON HCPCS CODE
PANCREATIC ELASTASE,82656,CPT,300,RC,,OUTPATIENT,,,342.75,137.1,MONUMENT,COMMERCIAL,,,,274.2,,257.06,335.9,
Z DRUG ABUSE SURVEY  URINE 1,80301,CPT,301,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FECAL FATS QUAL,82705,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
FECAL FATS QUAL,82705,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
CORD DRUG SCREEN,80301,CPT,301,RC,,OUTPATIENT,,,379.75,151.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,284.81,372.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRUCELLA AB SCREEN CONFIRM,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.6,OTHER,54.94,71.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BRUCELLA AB SCREEN CONFIRM,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,MONUMENT,COMMERCIAL,,,,58.6,,54.94,71.79,
SEDATIVE HYPNOTIC PANEL URINE,80301,CPT,301,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRUCELLA AB,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.6,OTHER,54.94,71.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BRUCELLA AB,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,MONUMENT,COMMERCIAL,,,,58.6,,54.94,71.79,
DRUG SCREEN SINGLE DRUG CLASS,80302,CPT,301,RC,,OUTPATIENT,,,109.5,43.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,82.13,107.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRUCELLA AB,86622,CPT,300,RC,,OUTPATIENT,,,73.25,29.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.6,OTHER,54.94,71.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BRUCELLA AB,86622,CPT,300,RC,,OUTPATIENT,,,73.25,29.3,MONUMENT,COMMERCIAL,,,,58.6,,54.94,71.79,
URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FERN TEST,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,68.8,OTHER,64.5,84.28,PERCENT OF CHARGES BASED ON HCPCS CODE
FERN TEST,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,MONUMENT,COMMERCIAL,,,,68.8,,64.5,84.28,
Z URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,25.2,10.08,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,15.56,20.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,300,RC,,OUTPATIENT,,,17.92,7.168,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,13.4,17.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHADONE ASSAY,80358,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
METHADONE ASSAY,80358,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
URINE TOXIC SCREEN,80306,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEAVY METAL-QUANTITATIVE,83018,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
HEAVY METAL-QUANTITATIVE,83018,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
DRUGS OF ABUSE SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,293.5,117.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,220.13,287.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NICKEL SERUM,83885,CPT,300,RC,,OUTPATIENT,,,221.5,88.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,177.2,OTHER,166.13,217.07,PERCENT OF CHARGES BASED ON HCPCS CODE
NICKEL SERUM,83885,CPT,300,RC,,OUTPATIENT,,,221.5,88.6,MONUMENT,COMMERCIAL,,,,177.2,,166.13,217.07,
ACETAMINOPHEN,80307,CPT,301,RC,,OUTPATIENT,,,124.28,49.712,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TITANIUM SERUM,83018,CPT,300,RC,,OUTPATIENT,,,258.75,103.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,207,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
TITANIUM SERUM,83018,CPT,300,RC,,OUTPATIENT,,,258.75,103.5,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
HYPOGLYCEMIC AGENT SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROMIUM SERUM,82495,CPT,300,RC,,OUTPATIENT,,,181.25,72.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,145,OTHER,135.94,177.63,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMIUM SERUM,82495,CPT,300,RC,,OUTPATIENT,,,181.25,72.5,MONUMENT,COMMERCIAL,,,,145,,135.94,177.63,
DRUG SCR PRESCRIP/OTC GASTRIC,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHANOL LEVEL,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
METHANOL LEVEL,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
DRUG SCR PRESCRIP/OTC PLASMA,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHEMAGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
METHEMAGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
DRUG SCR PRESCRIPTION/OTC URIN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOCHROME P450 2D6,81226,CPT,300,RC,,OUTPATIENT,,,942.25,376.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,753.8,OTHER,706.69,923.41,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOCHROME P450 2D6,81226,CPT,300,RC,,OUTPATIENT,,,942.25,376.9,MONUMENT,COMMERCIAL,,,,753.8,,706.69,923.41,
ALCOHOL ETHANOL,80307,CPT,301,RC,,OUTPATIENT,,,182.75,73.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.06,179.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CTTICGRINE P450 3A4V GENOTYPE,81230,CPT,300,RC,,OUTPATIENT,,,787.5,315,BLUE CROSS ANTHEM,COMMERCIAL,,,,630,OTHER,590.63,771.75,PERCENT OF CHARGES BASED ON HCPCS CODE
CTTICGRINE P450 3A4V GENOTYPE,81230,CPT,300,RC,,OUTPATIENT,,,787.5,315,MONUMENT,COMMERCIAL,,,,630,,590.63,771.75,
SALICYLATE,80307,CPT,301,RC,,OUTPATIENT,,,290.75,116.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,218.06,284.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
MECONIUM DRUG PANEL,80307,CPT,301,RC,,OUTPATIENT,,,224.25,89.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,168.19,219.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
R FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
R FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
UR SYNTHETIC THC METABOLITE SC,80307,CPT,301,RC,,OUTPATIENT,,,206.56,82.624,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,154.9,202.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FETAL FIBRONECTIN,82731,CPT,300,RC,,OUTPATIENT,,,427.5,171,BLUE CROSS ANTHEM,COMMERCIAL,,,,342,OTHER,320.63,418.95,PERCENT OF CHARGES BASED ON HCPCS CODE
FETAL FIBRONECTIN,82731,CPT,300,RC,,OUTPATIENT,,,427.5,171,MONUMENT,COMMERCIAL,,,,342,,320.63,418.95,
DRUG SCREENING ETOH,80320,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.06,77.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FETOMATERNAL BLEED FLOW CYTO,88184,CPT,300,RC,,OUTPATIENT,,,851.25,340.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,681,OTHER,638.44,834.23,PERCENT OF CHARGES BASED ON HCPCS CODE
FETOMATERNAL BLEED FLOW CYTO,88184,CPT,300,RC,,OUTPATIENT,,,851.25,340.5,MONUMENT,COMMERCIAL,,,,681,,638.44,834.23,
PHOSPHATIDYLETHANOL CONFIRM B,80321,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHYLPHENIDATE (RITALIN),82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLPHENIDATE (RITALIN),82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.31,99.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FETAL HEMOGLOBIN APT,83033,CPT,300,RC,,OUTPATIENT,,,23.25,9.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.6,OTHER,17.44,22.79,PERCENT OF CHARGES BASED ON HCPCS CODE
FETAL HEMOGLOBIN APT,83033,CPT,300,RC,,OUTPATIENT,,,23.25,9.3,MONUMENT,COMMERCIAL,,,,18.6,,17.44,22.79,
DESIPRAMINE (NORPRAMINE),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLECAINIDE (TAMBOCOR),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
FLECAINIDE (TAMBOCOR),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
IMIPRAMINE (TROFANIL),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUOXETINE (PROZAC),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUOXETINE (PROZAC),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.31,99.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUNITRAZEPAM (ROHYPNOL),82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUNITRAZEPAM (ROHYPNOL),82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
CLOBAZAM,80339,CPT,301,RC,,OUTPATIENT,,,158,63.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,118.5,154.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SERTRALINE ZOLOFT,82542,CPT,301,RC,,OUTPATIENT,,,181.75,72.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.4,OTHER,136.31,178.12,PERCENT OF CHARGES BASED ON HCPCS CODE
SERTRALINE ZOLOFT,82542,CPT,301,RC,,OUTPATIENT,,,181.75,72.7,MONUMENT,COMMERCIAL,,,,145.4,,136.31,178.12,
CLOBAZAM AND METABOLITE,80339,CPT,301,RC,,OUTPATIENT,,,228.86,91.544,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,171.6,224.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASYMMETRIC DIMETHYL ARGININE,82542,CPT,301,RC,,OUTPATIENT,,,230.5,92.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,184.4,OTHER,172.88,225.89,PERCENT OF CHARGES BASED ON HCPCS CODE
ASYMMETRIC DIMETHYL ARGININE,82542,CPT,301,RC,,OUTPATIENT,,,230.5,92.2,MONUMENT,COMMERCIAL,,,,184.4,,172.88,225.89,
DRUG SCREENING BARBITURATES,80345,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.06,77.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUPHENAZINE,84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,55,OTHER,51.56,67.38,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUPHENAZINE,84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,MONUMENT,COMMERCIAL,,,,55,,51.56,67.38,
DIAZEPAM (VALIUM),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOLATE,82746,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.6,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLATE,82746,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
ALPRAZOLAM (XANAX),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOLATE RBC,82747,CPT,301,RC,,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,108,141.12,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLATE RBC,82747,CPT,301,RC,,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.12,
LORAZAPAM SERUM,80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHYLENE BLUE,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLENE BLUE,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
THC SCREEN AND CONFIRMATION,80349,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,201.56,263.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FREE T3,84481,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
FREE T3,84481,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
Z CANNABINOIDS,80349,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.56,55.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
T3 REVERSE,84482,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
T3 REVERSE,84482,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
URINE COCAINE CONFIRMATORY,80353,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.06,77.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARNITINE FREE  TOTAL QUANT,82379,CPT,301,RC,,OUTPATIENT,,,382,152.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,305.6,OTHER,286.5,374.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CARNITINE FREE  TOTAL QUANT,82379,CPT,301,RC,,OUTPATIENT,,,382,152.8,MONUMENT,COMMERCIAL,,,,305.6,,286.5,374.36,
Z COCAINE & METABOLITES,80353,CPT,301,RC,,OUTPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.56,55.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALBUMIN-URINE-QUANT,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.6,OTHER,68.06,88.94,PERCENT OF CHARGES BASED ON HCPCS CODE
ALBUMIN-URINE-QUANT,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,MONUMENT,COMMERCIAL,,,,72.6,,68.06,88.94,
HEROIN METOBOLITC,80356,CPT,300,RC,,OUTPATIENT,,,285,114,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,213.75,279.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICROSCOPIC EXAM URINE,81015,CPT,307,RC,,OUTPATIENT,,,38.5,15.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.8,OTHER,28.88,37.73,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROSCOPIC EXAM URINE,81015,CPT,307,RC,,OUTPATIENT,,,38.5,15.4,MONUMENT,COMMERCIAL,,,,30.8,,28.88,37.73,
METHADONE ASSAY,80358,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICROALBUMINURIA 24HR,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.6,OTHER,68.06,88.94,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROALBUMINURIA 24HR,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,MONUMENT,COMMERCIAL,,,,72.6,,68.06,88.94,
OPIATE CONFIRM MECONIUM,80361,CPT,300,RC,,OUTPATIENT,,,219.75,87.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,164.81,215.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COXSACKIE B VIRUS ANTIBODIES,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.4,OTHER,51.94,67.87,PERCENT OF CHARGES BASED ON HCPCS CODE
COXSACKIE B VIRUS ANTIBODIES,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,MONUMENT,COMMERCIAL,,,,55.4,,51.94,67.87,
Z OPIATES,80361,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.56,55.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z Q FEVER AB IGG,86638,CPT,300,RC,,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.75,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z Q FEVER AB IGG,86638,CPT,300,RC,,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
PREGABALIN (LYRICA),80366,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z Q FEVER AB IGM,8663891,CPT,300,RC,91,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.75,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z Q FEVER AB IGM,8663891,CPT,300,RC,91,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,300,RC,,OUTPATIENT,,,110.25,44.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,82.69,108.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Q FEVER PCR,87798,CPT,306,RC,,OUTPATIENT,,,603.75,241.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,483,OTHER,452.81,591.68,PERCENT OF CHARGES BASED ON HCPCS CODE
Q FEVER PCR,87798,CPT,306,RC,,OUTPATIENT,,,603.75,241.5,MONUMENT,COMMERCIAL,,,,483,,452.81,591.68,
URINE TRAMADOL AND METABOLITE,80373,CPT,300,RC,,OUTPATIENT,,,100.6,40.24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.45,98.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FSH FOLLICLE STIMULATING HARMO,83001,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
FSH FOLLICLE STIMULATING HARMO,83001,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
CLINICAL PATHOLOGY CONSULT,80500,CPT,,,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARBAPENEMASE TEST,87185,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,215,OTHER,201.56,263.38,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBAPENEMASE TEST,87185,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,MONUMENT,COMMERCIAL,,,,215,,201.56,263.38,
URINALYSIS/COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,71.25,28.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,53.44,69.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GGT GLUTAMYLTRANSFERASE ASSAY,82977,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
GGT GLUTAMYLTRANSFERASE ASSAY,82977,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
URINALYSIS COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,9,3.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,6.8,8.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTRIN,82941,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTRIN,82941,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
UA  NON AUTOMATED  NO MICRO,81002,CPT,307,RC,,OUTPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.81,42.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROCULT,82271,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROCULT,82271,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
URINE DIP,81002,CPT,307,RC,,OUTPATIENT,,,38.25,15.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.69,37.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROINTESTINAL PATHOGENS,87507,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,BLUE CROSS ANTHEM,COMMERCIAL,,,,666.848,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROINTESTINAL PATHOGENS,87507,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
"URINALYSIS, NON AUTOMATED",81002,CPT,307,RC,,OUTPATIENT,,,9,3.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,6.75,8.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TOLERANCE TEST (GTT) 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.2,OTHER,102.38,133.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TOLERANCE TEST (GTT) 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,MONUMENT,COMMERCIAL,,,,109.2,,102.38,133.77,
URINE KETONES,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRSA NASAL SURVEILLANCE CULT,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRSA NASAL SURVEILLANCE CULT,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
PH  URINE,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GENTAMYCIN PEAK,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
GENTAMYCIN PEAK,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
URINE CHEM STRIP AUTO,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GENTAMICIN TROUGH,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
GENTAMICIN TROUGH,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
MICROSCOPIC EXAM URINE,81015,CPT,307,RC,,OUTPATIENT,,,38.5,15.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.88,37.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE SCREENING 1 HOUR,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.8,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE SCREENING 1 HOUR,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
HCG URINE QUALATATIVE,81025,CPT,300,RC,,OUTPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.75,44.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE TOLERANCE 2 HOUR,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.2,OTHER,102.38,133.77,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE TOLERANCE 2 HOUR,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,MONUMENT,COMMERCIAL,,,,109.2,,102.38,133.77,
URINE PREGNANCY TEST,81025,CPT,300,RC,,OUTPATIENT,,,22,8.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,16.5,21.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GTT EACH ADD BEYOND 3 SPECIMEN,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GTT EACH ADD BEYOND 3 SPECIMEN,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
VOLUME MEASUREMENT TIMED COLL,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.31,33.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCAGON,82943,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,145,OTHER,135.94,177.63,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCAGON,82943,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,MONUMENT,COMMERCIAL,,,,145,,135.94,177.63,
URINE VOLUME MEASUREMENT,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.31,33.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE 2HR POST/GLUCOSE,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.8,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE 2HR POST/GLUCOSE,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
BRCA1/BRACA2 FULL GENE ANALYSI,81162,CPT,300,RC,,OUTPATIENT,,,3649.76,1459.904,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1546.31,2020.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GTT EACH ADDITIONAL (2),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GTT EACH ADDITIONAL (2),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
BRCA1 2 GENE ANALYSIS,81162,CPT,300,RC,,OUTPATIENT,,,3017.9,1207.16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2263.4,2957.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
SPINOCEREBELLAR ATAXIA TYPE 1,81178,CPT,300,RC,,OUTPATIENT,,,716,286.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,537,701.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,OUTPATIENT,,,327.92,131.168,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,245.9,321.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
BCR/ABL RNA QUANT MONITOR CML,81206,CPT,310,RC,,OUTPATIENT,,,600.25,240.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,450.19,588.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
BRAF GENE ANALYSIS,81210,CPT,300,RC,,OUTPATIENT,,,661.5,264.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,496.13,648.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GTT EACH ADDITIONAL (3),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GTT EACH ADDITIONAL (3),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
CALR MUTATION ANALYSIS MPN,81219,CPT,300,RC,,OUTPATIENT,,,864,345.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,648,846.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GTT EACH ADDITIONAL (4),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GTT EACH ADDITIONAL (4),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
MYELODYSPLASTIC SYNDROME,81219,CPT,300,RC,,OUTPATIENT,,,243.26,97.304,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,182.4,238.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BFL AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
BFL AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
CYSTIC FIBROSIS MUTATION ANALY,81220,CPT,300,RC,,OUTPATIENT,,,1113.2,445.28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,301.88,394.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BFL GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
BFL GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
CYTOCHROME P450 2D6,81226,CPT,300,RC,,OUTPATIENT,,,942.25,376.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,706.69,923.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BFL LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
BFL LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
CYP2C9 GENE COM VARIANTS,81227,CPT,300,RC,,OUTPATIENT,,,1059.5,423.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,794.63,1038.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BFL TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
BFL TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
ARRAY COMP GENOMIC HYBRID,81228,CPT,300,RC,,OUTPATIENT,,,1800,720,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,884.06,1155.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CSF LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
"CHROMOSOMAL MICROARRAY,CONGEN",81229,CPT,300,RC,,OUTPATIENT,,,3083,1233.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2312.25,3021.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GTT EACH ADDITIONAL (5),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GTT EACH ADDITIONAL (5),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
CHROMO MICRO AUTO STILL,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2575.5,3365.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE TEST ADD SAMPLE,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE TEST ADD SAMPLE,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
CHROMO MICRO AUTO STILL FFPE,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2575.5,3365.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TOLERANCE TEST 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.2,OTHER,102.38,133.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TOLERANCE TEST 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,MONUMENT,COMMERCIAL,,,,109.2,,102.38,133.77,
CTTICGRINE P450 3A4V GENOTYPE,81230,CPT,300,RC,,OUTPATIENT,,,787.5,315,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,590.63,771.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TOLERANCE TEST EA ADD'L SPEC,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TOLERANCE TEST EA ADD'L SPEC,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
DPYD GENE ANALYSIS,81232,CPT,300,RC,,OUTPATIENT,,,1123,449.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,842.25,1100.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CSF GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
EPIDERMAL GROWTH FACTOR RCPTR,81235,CPT,312,RC,,OUTPATIENT,,,905.25,362.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,678.94,887.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE RANDOM,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE RANDOM,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
PROTROMBIN G20210A MUTATION B,81240,CPT,300,RC,,OUTPATIENT,,,246,98.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,184.5,241.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE FASTING,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE FASTING,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
FACTOR V LEIDEN,81241,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,151.31,197.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE - INSULIN RATIO,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE - INSULIN RATIO,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
CHROM & DNA ANAL FRAGILE-X,81243,CPT,310,RC,,OUTPATIENT,,,375,150,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,281.25,367.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MUCOPOLYSACCHARIDES  QUAL,83866,CPT,301,RC,,OUTPATIENT,,,236,94.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.8,OTHER,177,231.28,PERCENT OF CHARGES BASED ON HCPCS CODE
MUCOPOLYSACCHARIDES  QUAL,83866,CPT,301,RC,,OUTPATIENT,,,236,94.4,MONUMENT,COMMERCIAL,,,,188.8,,177,231.28,
FLT3 GENE,81245,CPT,310,RC,,OUTPATIENT,,,331.02,132.408,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,248.3,324.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE 2HR POST/MEAL,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE 2HR POST/MEAL,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
HEMOCHROMATOSIS HFE GENE,81256,CPT,300,RC,,OUTPATIENT,,,545.75,218.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,409.31,534.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEUROMYELITIS OPTICA EVAL,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUROMYELITIS OPTICA EVAL,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
SOMATIC HYPERMUTATION IN BCLL,81263,CPT,300,RC,,OUTPATIENT,,,948,379.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,711,929.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEURONAL CELL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
NEURONAL CELL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
IGH VARI REGIONAL MUTATION,81263,CPT,300,RC,,OUTPATIENT,,,1682.14,672.856,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1261.6,1648.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEURON SPECIFIC ENOLASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
NEURON SPECIFIC ENOLASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
ALPHA-GLOBIN GENE ANALYSIS,81269,CPT,300,RC,,OUTPATIENT,,,502,200.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,376.5,491.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TUMOR NECROSIS FACTOR - ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
TUMOR NECROSIS FACTOR - ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
JAK2 V617F MUTATION DETECTION,81270,CPT,300,RC,,OUTPATIENT,,,613.25,245.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,459.94,600.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLASMINOGEN ACTIVATOR INH ANTI,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PLASMINOGEN ACTIVATOR INH ANTI,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
HUNTINGTON DISEASE,81271,CPT,300,RC,,OUTPATIENT,,,592,236.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,444,580.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VASCULAR ENDOTHELIAL GROWTH,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
VASCULAR ENDOTHELIAL GROWTH,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
KIT MUTATION EX 811&17,81272,CPT,300,RC,,OUTPATIENT,,,659.02,263.608,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,494.3,645.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRYPTASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
TRYPTASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
KIT GENE ANALYS D816 VARIANT,81273,CPT,300,RC,,OUTPATIENT,,,1125.75,450.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,844.31,1103.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METHOTREXATE,80299,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
METHOTREXATE,80299,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
KRAS GENE 7 MUTATION PANEL TMR,81275,CPT,300,RC,,OUTPATIENT,,,1314.75,525.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,986.06,1288.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SULFATIDE AUTOANTIBODY,83520,CPT,300,RC,,OUTPATIENT,,,443,177.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,354.4,OTHER,332.25,434.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SULFATIDE AUTOANTIBODY,83520,CPT,300,RC,,OUTPATIENT,,,443,177.2,MONUMENT,COMMERCIAL,,,,354.4,,332.25,434.14,
KRAS ADDITIONAL VARIANT,81276,CPT,300,RC,,OUTPATIENT,,,386.5,154.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,230.25,300.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SULFATIDE AUTOANTIBODY,8352091,CPT,300,RC,91,OUTPATIENT,,,443,177.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,354.4,OTHER,332.25,434.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SULFATIDE AUTOANTIBODY,8352091,CPT,300,RC,91,OUTPATIENT,,,443,177.2,MONUMENT,COMMERCIAL,,,,354.4,,332.25,434.14,
METHYLENETETRAHYDROFOLATE REDC,81291,CPT,300,RC,,OUTPATIENT,,,571,228.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,428.25,559.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEUTROPHIL CYTOLOGY ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUTROPHIL CYTOLOGY ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
MTHFR MUTATION DETECTION,81291,CPT,300,RC,,OUTPATIENT,,,447.5,179,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,335.63,438.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIOLIPIN AB IGA,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,125,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOLIPIN AB IGA,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
MSHG GENE FULL ANALYSIS,81298,CPT,300,RC,,OUTPATIENT,,,1499.5,599.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1124.63,1469.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NORTRIPTYLINE LEVEL,G0480,HCPCS,300,RC,,BOTH,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.38,OTHER,88.5,115.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NORTRIPTYLINE LEVEL,G0480,HCPCS,300,RC,,BOTH,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
NORTRIPTYLINE LEVEL,G0480,HCPCS,300,RC,,BOTH,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,,88.5,,88.5,115.64,
OLANZAPINE (ZYPREXA),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
OLANZAPINE (ZYPREXA),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
MICROSATELLITE INSTABILITY,81301,CPT,312,RC,,OUTPATIENT,,,697.12,278.848,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,304.13,397.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ORGANIC ACIDS  PLASMA,83918,CPT,301,RC,,OUTPATIENT,,,527.75,211.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,422.2,OTHER,395.81,517.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ORGANIC ACIDS  PLASMA,83918,CPT,301,RC,,OUTPATIENT,,,527.75,211.1,MONUMENT,COMMERCIAL,,,,422.2,,395.81,517.2,
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,OUTPATIENT,,,350.8,140.32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,263.1,343.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PANCREATIC POLYPEPTIDE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
PANCREATIC POLYPEPTIDE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
NPM1 GENE,81310,CPT,310,RC,,OUTPATIENT,,,493.04,197.216,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,369.8,483.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SECRETIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
SECRETIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
NRAS GENE VARIANTS EXON 2&3,81311,CPT,300,RC,,OUTPATIENT,,,622.5,249,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,466.88,610.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPREHENSIVE METABOLIC PANEL,80053,CPT,301,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPREHENSIVE METABOLIC PANEL,80053,CPT,301,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
PRADER-WILLI/ANGELMAN SYN,81331,CPT,300,RC,,OUTPATIENT,,,500.5,200.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,375.38,490.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPREHENSIVE ANTIBODY ASSMNT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPREHENSIVE ANTIBODY ASSMNT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
ALPHA-1 ANTITRYPSIN GENOTYPING,81332,CPT,300,RC,,OUTPATIENT,,,435.25,174.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,326.44,426.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPREHENSIVE DIGESTIVE STOOL,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.6,OTHER,138.38,180.81,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPREHENSIVE DIGESTIVE STOOL,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,MONUMENT,COMMERCIAL,,,,147.6,,138.38,180.81,
MYELODYSPLASTIC SYNDROME,81338,CPT,310,RC,,OUTPATIENT,,,300.66,120.264,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,225.5,294.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
T CELL ANTIGEN RECEPTOR GAMMA,81342,CPT,312,RC,,OUTPATIENT,,,870.75,348.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,653.06,853.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PRENATAL PANEL,80055,CPT,300,RC,,OUTPATIENT,,,484.25,193.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,387.4,OTHER,363.19,474.57,PERCENT OF CHARGES BASED ON HCPCS CODE
PRENATAL PANEL,80055,CPT,300,RC,,OUTPATIENT,,,484.25,193.7,MONUMENT,COMMERCIAL,,,,387.4,,363.19,474.57,
UPD GLUCURONOSYLTRANSFERASE,81350,CPT,300,RC,,OUTPATIENT,,,1251.25,500.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,938.44,1226.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HGB UNSTABLE SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,25.75,10.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.6,OTHER,19.31,25.24,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HGB UNSTABLE SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,25.75,10.3,MONUMENT,COMMERCIAL,,,,20.6,,19.31,25.24,
CHRONIC LYMPHOCYTIC LEUKEMIA,81351,CPT,,,,OUTPATIENT,,,2141.85,856.74,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1606.4,2099,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HCG URINE QUALATATIVE,81025,CPT,300,RC,,OUTPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,36,OTHER,33.75,44.1,PERCENT OF CHARGES BASED ON HCPCS CODE
HCG URINE QUALATATIVE,81025,CPT,300,RC,,OUTPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.75,44.1,
VKORC1 GENE,81355,CPT,300,RC,,OUTPATIENT,,,176.4,70.56,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1.31,1.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,96.25,38.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,77,OTHER,72.19,94.33,PERCENT OF CHARGES BASED ON HCPCS CODE
BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,96.25,38.5,MONUMENT,COMMERCIAL,,,,77,,72.19,94.33,
BETA-GLOBIN GENE SEQUENCING B,81364,CPT,300,RC,,OUTPATIENT,,,797,318.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,597.75,781.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FRANCISELLA TULARENSIS DFA,87299,CPT,306,RC,,OUTPATIENT,,,273.75,109.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,219,OTHER,205.31,268.28,PERCENT OF CHARGES BASED ON HCPCS CODE
FRANCISELLA TULARENSIS DFA,87299,CPT,306,RC,,OUTPATIENT,,,273.75,109.5,MONUMENT,COMMERCIAL,,,,219,,205.31,268.28,
HLA I&II TYPING LR,81370,CPT,300,RC,,OUTPATIENT,,,1000,400,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,750,980,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GRAM STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
GRAM STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
HLA CLASS I MOLECULAR TYPING,81372,CPT,300,RC,,OUTPATIENT,,,807.18,322.872,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,386.44,504.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HALDOL (HALOPERIDOL),80173,CPT,300,RC,,OUTPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,94,OTHER,88.13,115.15,PERCENT OF CHARGES BASED ON HCPCS CODE
HALDOL (HALOPERIDOL),80173,CPT,300,RC,,OUTPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
HLA-B TYPING LOW RESOLUTION,81373,CPT,300,RC,,OUTPATIENT,,,254.86,101.944,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159.19,208.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CRYPTOCOCCAL AG,87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYPTOCOCCAL AG,87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
HLA I LOW RESOLUTION ONE ANTI,81374,CPT,300,RC,,OUTPATIENT,,,255,102,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.3,249.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COAGULATION FACTOR X,85260,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
COAGULATION FACTOR X,85260,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
HLA CLASS II MOLECULAR TYPING,81375,CPT,300,RC,,OUTPATIENT,,,483,193.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,362.25,473.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COAG FACTOR X1 ACTIVITY,85270,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.4,OTHER,127.88,167.09,PERCENT OF CHARGES BASED ON HCPCS CODE
COAG FACTOR X1 ACTIVITY,85270,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,MONUMENT,COMMERCIAL,,,,136.4,,127.88,167.09,
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.7,119.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADENOSINE DEAMINASE FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ADENOSINE DEAMINASE FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.7,119.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADENOSINE DEAMINASE BLOOD,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,102.2,OTHER,95.81,125.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ADENOSINE DEAMINASE BLOOD,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,MONUMENT,COMMERCIAL,,,,102.2,,95.81,125.2,
"HLA CLASS II TYPING, LOW RESOL",81376,CPT,300,RC,,OUTPATIENT,,,244.44,97.776,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,155.63,203.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHYMOTRYSIN FECAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CHYMOTRYSIN FECAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
HLA A HIGH RES BY DNA,81380,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,564.56,737.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHOLESTEROL BODY FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLESTEROL BODY FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
HLA B5701 GENOTY PHARMACOGENOM,81381,CPT,300,RC,,OUTPATIENT,,,405,162,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,303.75,396.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAPTOGLOBIN,83010,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
HAPTOGLOBIN,83010,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
HLA B 5701,81381,CPT,300,RC,,OUTPATIENT,,,755.25,302.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,566.44,740.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELECTROLYTE PANEL,80051,CPT,301,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
ELECTROLYTE PANEL,80051,CPT,301,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
DIHYDROPYRIMIDINE DEHYDROGENAS,81400,CPT,300,RC,,OUTPATIENT,,,557.5,223,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,418.13,546.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARVOVIRUS B19 AG IGG,8674791,CPT,300,RC,91,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PARVOVIRUS B19 AG IGG,8674791,CPT,300,RC,91,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
GENE POLYMORPHISM,81400,CPT,300,RC,,OUTPATIENT,,,653.4,261.36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,490.1,640.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARVOVIRUS B19 AB IGM,86747,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PARVOVIRUS B19 AB IGM,86747,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
LACTOTYPE,81400,CPT,300,RC,,OUTPATIENT,,,531.75,212.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,398.81,521.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARVOVIRUS B-19 PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
PARVOVIRUS B-19 PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
MYH GENETIC MOLECUALR ANALYSIS,81401,CPT,300,RC,,OUTPATIENT,,,398,159.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,298.5,390.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN LATEX,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN LATEX,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
PROMETHEUS TPMT GENETICS,81401,CPT,300,RC,,OUTPATIENT,,,372.25,148.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,279.19,364.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LATEX TYPING FOR SALMONELLA,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.2,OTHER,38.63,50.47,PERCENT OF CHARGES BASED ON HCPCS CODE
LATEX TYPING FOR SALMONELLA,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
TPMT GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,716.75,286.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,537.56,702.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN PECAN-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN PECAN-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
MOLECULAR PATHOLOGY PROC,81401,CPT,300,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,431.25,563.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN DOG DANDER IGG,86001,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN DOG DANDER IGG,86001,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
APO E GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,313.25,125.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,234.94,306.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN COCONUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN COCONUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
GALACTOSEMIA GALT GENE PANEL,81401,CPT,300,RC,,OUTPATIENT,,,1259,503.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,944.3,1233.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
MOPATH PROCEDURE LEVEL 4,81403,CPT,300,RC,,OUTPATIENT,,,1365,546,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1023.75,1337.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
MPL EXON 10 MUTATION DETECT,81403,CPT,300,RC,,OUTPATIENT,,,797.75,319.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,598.31,781.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
FBNA GENE KM,81403,CPT,300,RC,,OUTPATIENT,,,938.75,375.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,704.06,919.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
TGFBR1 GENE KNOWN MUTATION,81403,CPT,300,RC,,OUTPATIENT,,,1361.75,544.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1021.31,1334.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
JAK2 EX12 NON-V617F MUT DETECT,81403,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,564.56,737.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN FOOD & GRAIN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN FOOD & GRAIN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
HCG SERUM-QUAL,84703,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
HCG SERUM-QUAL,84703,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,OUTPATIENT,,,2730,1092,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2047.5,2675.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMYLASE PERITONEAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AMYLASE PERITONEAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
CADASIL,81406,CPT,300,RC,,OUTPATIENT,,,3619,1447.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2714.25,3546.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALPHA GALACTOSIDASE,82657,CPT,300,RC,,OUTPATIENT,,,255.75,102.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,204.6,OTHER,191.81,250.64,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA GALACTOSIDASE,82657,CPT,300,RC,,OUTPATIENT,,,255.75,102.3,MONUMENT,COMMERCIAL,,,,204.6,,191.81,250.64,
ZMOPATH PROCEDURE LEVEL 7,81406,CPT,300,RC,,OUTPATIENT,,,1650,660,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1237.5,1617,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERITONEAL FLUID  LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
PERITONEAL FLUID  LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
Z HHTGG GENEIC PANEL 1,81406,CPT,300,RC,,OUTPATIENT,,,3779.96,1511.984,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2835,3704.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALPHA-GLOBIN GENE ANALYSIS,81269,CPT,300,RC,,OUTPATIENT,,,502,200.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,401.6,OTHER,376.5,491.96,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA-GLOBIN GENE ANALYSIS,81269,CPT,300,RC,,OUTPATIENT,,,502,200.8,MONUMENT,COMMERCIAL,,,,401.6,,376.5,491.96,
MOPATH PROCEDURE LEVEL 9,81408,CPT,300,RC,,OUTPATIENT,,,4000,1600,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2155.69,2816.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERITONEAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
PERITONEAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
TGSAP SO NEO 5-50DNA/DNA&RNA,81445,CPT,310,RC,,OUTPATIENT,,,1195.82,478.328,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,896.9,1171.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMYLASE PANCREATIC,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AMYLASE PANCREATIC,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
PT MIX 1:1,81448,CPT,300,RC,,OUTPATIENT,,,1169.8,467.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,877.4,1146.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN WALNUT-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN WALNUT-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
GENOMIC SEQ HEMATOLYMPHOID DNA,81450,CPT,310,RC,,OUTPATIENT,,,1519.06,607.624,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,975,1274,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC X20,8600391,CPT,300,RC,91,OUTPATIENT,,,710,284,BLUE CROSS ANTHEM,COMMERCIAL,,,,568,OTHER,532.5,695.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC X20,8600391,CPT,300,RC,91,OUTPATIENT,,,710,284,MONUMENT,COMMERCIAL,,,,568,,532.5,695.8,
TARGETED GENOMIC SEQ ANALYS,81450,CPT,310,RC,,OUTPATIENT,,,1080,432,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,810,1058.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HDL CHOLESTEROL,83718,CPT,301,RC,,OUTPATIENT,,,130.5,52.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.4,OTHER,97.88,127.89,PERCENT OF CHARGES BASED ON HCPCS CODE
HDL CHOLESTEROL,83718,CPT,301,RC,,OUTPATIENT,,,130.5,52.2,MONUMENT,COMMERCIAL,,,,104.4,,97.88,127.89,
MOLECULAR PATH PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,957.75,383.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,718.31,938.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NASAL EOSINOPHIL SMEAR,89190,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.4,OTHER,40.69,53.17,PERCENT OF CHARGES BASED ON HCPCS CODE
NASAL EOSINOPHIL SMEAR,89190,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
MOLECULAR PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,786.75,314.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,590.06,771.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN DAIRY & GRAIN PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN DAIRY & GRAIN PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
BIRT HOGG DUB SYNDROME,81479,CPT,300,RC,,OUTPATIENT,,,1896.79,758.716,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1422.6,1858.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN DAIRY & GRAIN,8600391,CPT,300,RC,91,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN DAIRY & GRAIN,8600391,CPT,300,RC,91,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
ZUNLISTED MOLECULAR PATHOLOGY,81479,CPT,300,RC,,OUTPATIENT,,,550,220,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,412.5,539,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
R LEUKEMIA IMMUNOTYPING,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
R LEUKEMIA IMMUNOTYPING,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
Z HHTGG GENEIC PANEL 2,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,3316.2,4333.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEUKOCYTE HISTAMINE RELEASE,86343,CPT,300,RC,,OUTPATIENT,,,240,96,BLUE CROSS ANTHEM,COMMERCIAL,,,,192,OTHER,180,235.2,PERCENT OF CHARGES BASED ON HCPCS CODE
LEUKOCYTE HISTAMINE RELEASE,86343,CPT,300,RC,,OUTPATIENT,,,240,96,MONUMENT,COMMERCIAL,,,,192,,180,235.2,
NCDA GENE PANEL,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,3316.2,4333.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTO CELL SURF 1ST MRK,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTO CELL SURF 1ST MRK,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
QUAD SCREEN (SECOND TRIMESTER),81511,CPT,300,RC,,OUTPATIENT,,,307,122.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.75,193.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTO EA ADD'L MARKER,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTO EA ADD'L MARKER,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
HEPATITIS C FIBRO,81596,CPT,300,RC,,OUTPATIENT,,,390,156,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,292.5,382.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
PARALDEHYDE PLASMA,82000,CPT,300,RC,,OUTPATIENT,,,169.75,67.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.31,166.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ACETONE SERUM QUAL,82009,CPT,301,RC,,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
BETA-HYDROXYBUTYRIC ACID,82010,CPT,300,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ACETYLOCHOLINESTERASE ASSAY,82013,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ACYLCARNITINE QUANTITATIVE,82017,CPT,301,RC,,OUTPATIENT,,,176.5,70.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132.38,172.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ACTH LEVEL,82024,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.69,111.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,563.75,225.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,451,OTHER,422.81,552.48,PERCENT OF CHARGES BASED ON HCPCS CODE
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,563.75,225.5,MONUMENT,COMMERCIAL,,,,451,,422.81,552.48,
CYCLIC AMP URINARY EXCRETAION,82030,CPT,300,RC,,OUTPATIENT,,,213.5,85.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,160.13,209.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FIBRIN SPLIT PRODUCTS,85362,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
FIBRIN SPLIT PRODUCTS,85362,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
ALBUMIN  SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
Z ALBUMIN SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
C FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
ALBUMIN BODY FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.81,66.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
Z ALBUMIN SPINAL FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.81,66.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
BODY FLUID ALBUMIN,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.81,66.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ALBUMIN-URINE-QUANT,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.06,88.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.6,OTHER,39.94,52.19,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,MONUMENT,COMMERCIAL,,,,42.6,,39.94,52.19,
MICROALBUMINURIA 24HR,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.06,88.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.6,OTHER,39.94,52.19,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,MONUMENT,COMMERCIAL,,,,42.6,,39.94,52.19,
UR ALBUMIN SEMIQUANTITATIVE,82044,CPT,,,,OUTPATIENT,,,16,6.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12,15.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,130.75,52.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.6,OTHER,98.06,128.14,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,130.75,52.3,MONUMENT,COMMERCIAL,,,,104.6,,98.06,128.14,
ALDOLASE,82085,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FATTY ACID PROFILE ESSENTIAL,82542,CPT,301,RC,,OUTPATIENT,,,233.25,93.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,186.6,OTHER,174.94,228.59,PERCENT OF CHARGES BASED ON HCPCS CODE
FATTY ACID PROFILE ESSENTIAL,82542,CPT,301,RC,,OUTPATIENT,,,233.25,93.3,MONUMENT,COMMERCIAL,,,,186.6,,174.94,228.59,
ALDOSTERONE SERUM,82088,CPT,300,RC,,OUTPATIENT,,,255,102,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.25,249.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
ALDOSTERONE URINE,82088,CPT,300,RC,,OUTPATIENT,,,255,102,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.25,249.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
ALPHA-1-ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.75,122.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
Z ALPHA 1 ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.75,122.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
A1A,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.75,122.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
A1A PHENOTYPE,82104,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.19,43.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN FOOD MEAT PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN FOOD MEAT PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
ALPHA FETO PROTEIN,82105,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,124.88,163.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN PEANUT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN PEANUT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
Z AFP,82105,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN FLAXSEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN FLAXSEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
AFP,82106,CPT,300,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN PISTACHIO,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN PISTACHIO,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
AFP L3% TOTAL AFP,82107,CPT,300,RC,,OUTPATIENT,,,422.75,169.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,317.06,414.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN SESAME SEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN SESAME SEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
ALUMINUM SERUM,82108,CPT,300,RC,,OUTPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.63,50.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALLERGEN SOYBEAN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ALLERGEN SOYBEAN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
AMINO ACID SCREEN  PLASMA QUAL,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,175.31,229.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOSIDERIN,83070,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOSIDERIN,83070,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
AMINO ACID SCRN URINE QUALIT,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,175.31,229.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHENCYCLIDINE LEVEL,83992,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,63,OTHER,59.06,77.18,PERCENT OF CHARGES BASED ON HCPCS CODE
PHENCYCLIDINE LEVEL,83992,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
PHENYLALANINE,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHENYLALANINE,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PHENYLALANINE,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
TYROSINE ASSAY,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAAB IGM ANTIBODY,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.4,OTHER,95.06,124.22,PERCENT OF CHARGES BASED ON HCPCS CODE
HAAB IGM ANTIBODY,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,MONUMENT,COMMERCIAL,,,,101.4,,95.06,124.22,
AMINOLEVULENIC ACID 24 HR URIN,82135,CPT,301,RC,,OUTPATIENT,,,101.25,40.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.94,99.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHLEBOTOMY  THERAPEUTIC,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.8,OTHER,199.5,260.68,PERCENT OF CHARGES BASED ON HCPCS CODE
PHLEBOTOMY  THERAPEUTIC,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,MONUMENT,COMMERCIAL,,,,212.8,,199.5,260.68,
AMINOLEVULENIC ACID (ALA),82135,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.2,OTHER,89.25,116.62,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,MONUMENT,COMMERCIAL,,,,95.2,,89.25,116.62,
"CRYSTINURIA PROFILE,QUANT",82136,CPT,301,RC,,OUTPATIENT,,,235,94,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,176.25,230.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,57,22.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.6,OTHER,42.75,55.86,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,57,22.8,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
AMINO ACID SCRN  URINE QUANIT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,348.75,455.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,14.25,5.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,11.4,OTHER,10.69,13.97,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,14.25,5.7,MONUMENT,COMMERCIAL,,,,11.4,,10.69,13.97,
AMINO ACID SCRN  PLASMA QUANT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,348.75,455.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHATIDYLSERINE AB A,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.8,OTHER,107.63,140.63,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHATIDYLSERINE AB A,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,MONUMENT,COMMERCIAL,,,,114.8,,107.63,140.63,
AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,306,122.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,229.5,299.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHATIDYLSERINE AB G,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.8,OTHER,107.63,140.63,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHATIDYLSERINE AB G,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,MONUMENT,COMMERCIAL,,,,114.8,,107.63,140.63,
Z AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FETAL LUNG MATURITY,83663,CPT,300,RC,,OUTPATIENT,,,293.5,117.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,234.8,OTHER,220.13,287.63,PERCENT OF CHARGES BASED ON HCPCS CODE
FETAL LUNG MATURITY,83663,CPT,300,RC,,OUTPATIENT,,,293.5,117.4,MONUMENT,COMMERCIAL,,,,234.8,,220.13,287.63,
UR AMMONIUM RANDOM,82140,CPT,301,RC,,OUTPATIENT,,,538.66,215.464,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,404,527.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PHOSPHATIDYLGLYCEROL,84081,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PHOSPHATIDYLGLYCEROL,84081,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
AMNIOTIC FLUID SCAN,82143,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHATIDYLSERINE AB M,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.8,OTHER,107.63,140.63,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHATIDYLSERINE AB M,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,MONUMENT,COMMERCIAL,,,,114.8,,107.63,140.63,
AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
AMYLASE (SO),82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPITITIS B ANTIGEN CONFIRMATN,87341,CPT,300,RC,,OUTPATIENT,,,102.5,41,BLUE CROSS ANTHEM,COMMERCIAL,,,,82,OTHER,76.88,100.45,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPITITIS B ANTIGEN CONFIRMATN,87341,CPT,300,RC,,OUTPATIENT,,,102.5,41,MONUMENT,COMMERCIAL,,,,82,,76.88,100.45,
BFL AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FILARIA IGG 4 ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
FILARIA IGG 4 ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
AMYLASE PERITONEAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT METHOD CULT TYPING,87158,CPT,300,RC,,OUTPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.8,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT METHOD CULT TYPING,87158,CPT,300,RC,,OUTPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
AMYLASE PANCREATIC,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS BE ANTIGEN,87350,CPT,306,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS BE ANTIGEN,87350,CPT,306,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
AMYLASE PLEURAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BAND 3 FLUORESCENCE STAIN RBC,88184,CPT,300,RC,,OUTPATIENT,,,837.25,334.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,669.8,OTHER,627.94,820.51,PERCENT OF CHARGES BASED ON HCPCS CODE
BAND 3 FLUORESCENCE STAIN RBC,88184,CPT,300,RC,,OUTPATIENT,,,837.25,334.9,MONUMENT,COMMERCIAL,,,,669.8,,627.94,820.51,
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.9,28.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B VIRAL DNA  QUANT,87517,CPT,300,RC,,OUTPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,354,OTHER,331.88,433.65,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B VIRAL DNA  QUANT,87517,CPT,300,RC,,OUTPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.9,28.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS BE ANTIBODY,86707,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS BE ANTIBODY,86707,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
ANDROSTENEDIONE,82157,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.19,121.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B CORE ANTIBODY,86704,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.4,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B CORE ANTIBODY,86704,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
ANGIOTENSIN CONVERTING ENZYME,82164,CPT,300,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS B CORE AB IGM,86705,CPT,300,RC,,OUTPATIENT,,,180.5,72.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,144.4,OTHER,135.38,176.89,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS B CORE AB IGM,86705,CPT,300,RC,,OUTPATIENT,,,180.5,72.2,MONUMENT,COMMERCIAL,,,,144.4,,135.38,176.89,
Z APOLIPOROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS C VIRUS AB,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C VIRUS AB,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
LIPOPROTEINS  BLOOD,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS C VIRUS RNA QUANT,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,371.2,OTHER,348,454.72,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C VIRUS RNA QUANT,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,MONUMENT,COMMERCIAL,,,,371.2,,348,454.72,
APOLIPOPROTEIN A1,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS C VIRUS RNA QUAL PCR,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,261,OTHER,244.69,319.73,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C VIRUS RNA QUAL PCR,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,MONUMENT,COMMERCIAL,,,,261,,244.69,319.73,
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,122,48.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.5,119.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS D ANTIGEN,87380,CPT,300,RC,,OUTPATIENT,,,321.75,128.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,257.4,OTHER,241.31,315.32,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS D ANTIGEN,87380,CPT,300,RC,,OUTPATIENT,,,321.75,128.7,MONUMENT,COMMERCIAL,,,,257.4,,241.31,315.32,
APOLIPOPROTEIN B SINGLE,82172,CPT,301,RC,,OUTPATIENT,,,42.18,16.872,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.6,41.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS D TOTAL AB,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS D TOTAL AB,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
APOLIPOPROTEIN B PLASMA,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS D VIRUS AB IGM,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS D VIRUS AB IGM,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
Z ARSENIC,82175,CPT,301,RC,,OUTPATIENT,,,54.75,21.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.06,53.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS E ANTIBODY IGM,86790,CPT,300,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS E ANTIBODY IGM,86790,CPT,300,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
ARSENIC LEVEL,82175,CPT,301,RC,,OUTPATIENT,,,129,51.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.75,126.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLEURAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
PLEURAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
ASCORBIC ACID BLOOD,82180,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.19,137.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS E ANTIBODY IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS E ANTIBODY IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
BETA-2-MICROGLOBULIN,82232,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMYLASE PLEURAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
AMYLASE PLEURAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SYNOVIAL FLUID T.P.,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
SYNOVIAL FLUID T.P.,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
BILIRUBIN  NEONATAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SYNOVIAL FLUID GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
SYNOVIAL FLUID GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
Z BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PORPHOBILINGEN QUANT,84110,CPT,301,RC,,OUTPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.6,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
PORPHOBILINGEN QUANT,84110,CPT,301,RC,,OUTPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
BODY FLUID BILIRUBIN,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATITIS C FIBRO,81596,CPT,300,RC,,OUTPATIENT,,,390,156,BLUE CROSS ANTHEM,COMMERCIAL,,,,312,OTHER,292.5,382.2,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATITIS C FIBRO,81596,CPT,300,RC,,OUTPATIENT,,,390,156,MONUMENT,COMMERCIAL,,,,312,,292.5,382.2,
"Z BILIRUBIN,TOTAL",82247,CPT,301,RC,,OUTPATIENT,,,10.04,4.016,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.5,9.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HCV-RIBA SUPP,86804,CPT,300,RC,,OUTPATIENT,,,348.5,139.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,278.8,OTHER,261.38,341.53,PERCENT OF CHARGES BASED ON HCPCS CODE
HCV-RIBA SUPP,86804,CPT,300,RC,,OUTPATIENT,,,348.5,139.4,MONUMENT,COMMERCIAL,,,,278.8,,261.38,341.53,
BILIRUBIN DIRECT,82248,CPT,301,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEP C RNA NSC DRUG RESISTANCE,87902,CPT,300,RC,,OUTPATIENT,,,1007.25,402.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,805.8,OTHER,755.44,987.11,PERCENT OF CHARGES BASED ON HCPCS CODE
HEP C RNA NSC DRUG RESISTANCE,87902,CPT,300,RC,,OUTPATIENT,,,1007.25,402.9,MONUMENT,COMMERCIAL,,,,805.8,,755.44,987.11,
BIOTINIDASE SERUM,82261,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.94,130.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBLIN ELECTRO(EVALUATION,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.4,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBLIN ELECTRO(EVALUATION,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
P BIOTINIDASE,82261,CPT,300,RC,,OUTPATIENT,,,33.74,13.496,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,6.94,9.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUNTINGTON DISEASE,81271,CPT,300,RC,,OUTPATIENT,,,592,236.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,473.6,OTHER,444,580.16,PERCENT OF CHARGES BASED ON HCPCS CODE
HUNTINGTON DISEASE,81271,CPT,300,RC,,OUTPATIENT,,,592,236.8,MONUMENT,COMMERCIAL,,,,473.6,,444,580.16,
OCCULT BLOOD SCREENING,82270,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.94,44.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
H PYLORI BREATH TEST,83013,CPT,300,RC,,OUTPATIENT,,,279.75,111.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,223.8,OTHER,209.81,274.16,PERCENT OF CHARGES BASED ON HCPCS CODE
H PYLORI BREATH TEST,83013,CPT,300,RC,,OUTPATIENT,,,279.75,111.9,MONUMENT,COMMERCIAL,,,,223.8,,209.81,274.16,
GASTROCULT,82271,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"HB VARIANT BY MASS SPEC, B",83789,CPT,300,RC,,OUTPATIENT,,,261.5,104.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,209.2,OTHER,196.13,256.27,PERCENT OF CHARGES BASED ON HCPCS CODE
"HB VARIANT BY MASS SPEC, B",83789,CPT,300,RC,,OUTPATIENT,,,261.5,104.6,MONUMENT,COMMERCIAL,,,,209.2,,196.13,256.27,
OCCULT BLOOD DIAGNOSTIC,82272,CPT,301,RC,,OUTPATIENT,,,47,18.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.25,46.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA-B27,86812,CPT,300,RC,,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,120.94,158.03,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA-B27,86812,CPT,300,RC,,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,OUTPATIENT,,,11,4.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,8.3,10.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUMAN GROWTH HORMONE,83003,CPT,301,RC,,OUTPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.4,OTHER,49.13,64.19,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMAN GROWTH HORMONE,83003,CPT,301,RC,,OUTPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
CADMIUM BLOOD,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.31,60.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEX HORMONE BINDING GLOBULIN,84270,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
SEX HORMONE BINDING GLOBULIN,84270,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
Z CADMIUM,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.31,60.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUMAN PAPILLOMAVIRUS HIGH RISK,87624,CPT,300,RC,,OUTPATIENT,,,256.5,102.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,205.2,OTHER,192.38,251.37,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMAN PAPILLOMAVIRUS HIGH RISK,87624,CPT,300,RC,,OUTPATIENT,,,256.5,102.6,MONUMENT,COMMERCIAL,,,,205.2,,192.38,251.37,
VIT D  HYDROXY,82306,CPT,300,RC,,OUTPATIENT,,,103.25,41.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,77.44,101.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMIPRAMINE (TROFANIL),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
IMIPRAMINE (TROFANIL),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
CALCITONIN,82308,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.69,111.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHELOMETRY EA ANALYTE,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.8,OTHER,98.25,128.38,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHELOMETRY EA ANALYTE,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,MONUMENT,COMMERCIAL,,,,104.8,,98.25,128.38,
CALCIUM TOTAL,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.88,41.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IGE,82785,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
IGE,82785,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
Z CALCIUM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.88,41.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTI PLATELET DIRECT ASSAY,86023,CPT,300,RC,,OUTPATIENT,,,196,78.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.8,OTHER,147,192.08,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI PLATELET DIRECT ASSAY,86023,CPT,300,RC,,OUTPATIENT,,,196,78.4,MONUMENT,COMMERCIAL,,,,156.8,,147,192.08,
URINE CALCIUM  RANDOM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.88,41.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,175,70,BLUE CROSS ANTHEM,COMMERCIAL,,,,140,OTHER,131.25,171.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,175,70,MONUMENT,COMMERCIAL,,,,140,,131.25,171.5,
CALCIUM IONIZED,82330,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
Z URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.38,74.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
URINE QUANTITATIVE TIMED SPEC,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.38,74.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOB LIGHT CHAINS,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.8,OTHER,98.25,128.38,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOB LIGHT CHAINS,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,MONUMENT,COMMERCIAL,,,,104.8,,98.25,128.38,
CALCULUS (STONE),82365,CPT,300,RC,,OUTPATIENT,,,82.25,32.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,61.69,80.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOGLOB LIGHT CHAINS,8388391,CPT,300,RC,91,OUTPATIENT,,,131,52.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.8,OTHER,98.25,128.38,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOGLOB LIGHT CHAINS,8388391,CPT,300,RC,91,OUTPATIENT,,,131,52.4,MONUMENT,COMMERCIAL,,,,104.8,,98.25,128.38,
CARBOHYDRATE DEF TRANSFERRIN,82373,CPT,300,RC,,OUTPATIENT,,,101.25,40.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.94,99.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INDIA INK,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
INDIA INK,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
CARBON DIOXIDE (CO2),82374,CPT,301,RC,,OUTPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60,78.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.88,96.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.88,96.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INDIRECT COOMBS,86885,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
INDIRECT COOMBS,86885,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
CEA,82378,CPT,301,RC,,OUTPATIENT,,,423.71,169.484,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSULIN,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
INSULIN,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
CARNITINE FREE  TOTAL QUANT,82379,CPT,301,RC,,OUTPATIENT,,,382,152.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,286.5,374.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IRON BINDING CAPACITY  TOTAL,83550,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,47,OTHER,44.06,57.58,PERCENT OF CHARGES BASED ON HCPCS CODE
IRON BINDING CAPACITY  TOTAL,83550,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,MONUMENT,COMMERCIAL,,,,47,,44.06,57.58,
CAROTENE,82380,CPT,301,RC,,OUTPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.63,156.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IRON,83540,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.4,OTHER,40.69,53.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IRON,83540,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
CAROTENE BETA,82380,CPT,301,RC,,OUTPATIENT,,,184.13,73.652,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.1,180.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PORPHYRINS QUANT 24 HR,84120,CPT,301,RC,,OUTPATIENT,,,188,75.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,150.4,OTHER,141,184.24,PERCENT OF CHARGES BASED ON HCPCS CODE
PORPHYRINS QUANT 24 HR,84120,CPT,301,RC,,OUTPATIENT,,,188,75.2,MONUMENT,COMMERCIAL,,,,150.4,,141,184.24,
CAROTENE BETA (LS),82380,CPT,301,RC,,OUTPATIENT,,,184,73.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138,180.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BROMIDE  BLOOD,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
BROMIDE  BLOOD,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
CATECHOLAMINES FRAC FREE URINE,82384,CPT,300,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KOH PREP,87220,CPT,306,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
KOH PREP,87220,CPT,306,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
CATECHOLAMINES PLASMA,82384,CPT,300,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA CLASS II MOLECULAR TYPING,81375,CPT,300,RC,,OUTPATIENT,,,483,193.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,386.4,OTHER,362.25,473.34,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA CLASS II MOLECULAR TYPING,81375,CPT,300,RC,,OUTPATIENT,,,483,193.2,MONUMENT,COMMERCIAL,,,,386.4,,362.25,473.34,
CERULOPLASMIN,82390,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA CLASS I MOLECULAR TYPING,81372,CPT,300,RC,,OUTPATIENT,,,807.18,322.872,BLUE CROSS ANTHEM,COMMERCIAL,,,,645.744,OTHER,386.44,504.95,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA CLASS I MOLECULAR TYPING,81372,CPT,300,RC,,OUTPATIENT,,,807.18,322.872,MONUMENT,COMMERCIAL,,,,412.2,,386.44,504.95,
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,OUTPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.88,45.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROINSULIN ASSAY,84206,CPT,301,RC,,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
PROINSULIN ASSAY,84206,CPT,301,RC,,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
PARATHYROID HORMONE RELATED PE,82397,CPT,301,RC,,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROPAFENONE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
PROPAFENONE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
HMG-COA REDUCTASE AB,82397,CPT,301,RC,,OUTPATIENT,,,274,109.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,205.5,268.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THC CONFIRMATION URINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
THC CONFIRMATION URINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
INFLIXIMAB AB S CHARGE,82397,CPT,301,RC,,OUTPATIENT,,,236,94.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,177,231.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PSA-FREE   DIAGNOSTIC,84154,CPT,301,RC,,OUTPATIENT,,,158.25,63.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,126.6,OTHER,118.69,155.09,PERCENT OF CHARGES BASED ON HCPCS CODE
PSA-FREE   DIAGNOSTIC,84154,CPT,301,RC,,OUTPATIENT,,,158.25,63.3,MONUMENT,COMMERCIAL,,,,126.6,,118.69,155.09,
CHLORIDE,82435,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PSA SCREENING,G0103,HCPCS,301,RC,,INPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.65,OTHER,125.81,164.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PSA SCREENING,G0103,HCPCS,301,RC,,INPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
PSA SCREENING,G0103,HCPCS,301,RC,,INPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,,125.81,,125.81,164.4,
PSA COMPLEXED (DIRECT METHOD),84152,CPT,301,RC,,OUTPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,162,OTHER,151.88,198.45,PERCENT OF CHARGES BASED ON HCPCS CODE
PSA COMPLEXED (DIRECT METHOD),84152,CPT,301,RC,,OUTPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PSEUDOCHOLINESTERASE TOTAL,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PSEUDOCHOLINESTERASE TOTAL,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
Z URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PSEUDOCHOLINESTERASE  DIB INH,82638,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
PSEUDOCHOLINESTERASE  DIB INH,82638,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,56.25,73.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LACTIC ACID,83605,CPT,301,RC,,OUTPATIENT,,,130,52,BLUE CROSS ANTHEM,COMMERCIAL,,,,104,OTHER,97.5,127.4,PERCENT OF CHARGES BASED ON HCPCS CODE
LACTIC ACID,83605,CPT,301,RC,,OUTPATIENT,,,130,52,MONUMENT,COMMERCIAL,,,,104,,97.5,127.4,
CSF CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,56.25,73.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LACTIC ACID CSF,83605,CPT,301,RC,,OUTPATIENT,,,130,52,BLUE CROSS ANTHEM,COMMERCIAL,,,,104,OTHER,97.5,127.4,PERCENT OF CHARGES BASED ON HCPCS CODE
LACTIC ACID CSF,83605,CPT,301,RC,,OUTPATIENT,,,130,52,MONUMENT,COMMERCIAL,,,,104,,97.5,127.4,
CHOLESTEROL,82465,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THC SCREEN AND CONFIRMATION,80349,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,215,OTHER,201.56,263.38,PERCENT OF CHARGES BASED ON HCPCS CODE
THC SCREEN AND CONFIRMATION,80349,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,MONUMENT,COMMERCIAL,,,,215,,201.56,263.38,
CHOLINESTERASE SERUM ASSAY,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TOTAL PSA,84153,CPT,301,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TOTAL PSA,84153,CPT,301,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
PSEUDOCHOLINESTERASE TOTAL,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.31,146.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LAMOTRIGINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
LAMOTRIGINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
CHOLINESTERASE  RBC,82482,CPT,301,RC,,OUTPATIENT,,,177.5,71,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,133.13,173.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LAMELLAR BODY COUNT,83664,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.2,OTHER,79.88,104.37,PERCENT OF CHARGES BASED ON HCPCS CODE
LAMELLAR BODY COUNT,83664,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,MONUMENT,COMMERCIAL,,,,85.2,,79.88,104.37,
ESCITALOPRAM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LDH ISOENZYMES,83625,CPT,301,RC,,OUTPATIENT,,,100.75,40.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.6,OTHER,75.56,98.74,PERCENT OF CHARGES BASED ON HCPCS CODE
LDH ISOENZYMES,83625,CPT,301,RC,,OUTPATIENT,,,100.75,40.3,MONUMENT,COMMERCIAL,,,,80.6,,75.56,98.74,
GAMMA HYDROXYBUTYRIC ACID URIN,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LACTATE ENZYME LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
LACTATE ENZYME LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
CHROMOTOGRAPHY QUANT SINGLE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PURKINJE CELL ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
PURKINJE CELL ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
CYLERT (PEMOLINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PYRIDINIUM CROSSLINKS-TOTAL,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PYRIDINIUM CROSSLINKS-TOTAL,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
SEROQUEL (QUETIAPINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PYRIDINIUM CROSSLINKS-T&DEOXY,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PYRIDINIUM CROSSLINKS-T&DEOXY,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
Z THIOPURINE METABOLITES,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINO ACID SCRN  URINE QUANIT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,BLUE CROSS ANTHEM,COMMERCIAL,,,,372,OTHER,348.75,455.7,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINO ACID SCRN  URINE QUANIT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,MONUMENT,COMMERCIAL,,,,372,,348.75,455.7,
DIPHENHYDRAMINE SERUM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SERUM CTX,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
SERUM CTX,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
SINEMET,82491,CPT,300,RC,,OUTPATIENT,,,402.5,161,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,301.88,394.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
R.P.R.,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.6,OTHER,50.25,65.66,PERCENT OF CHARGES BASED ON HCPCS CODE
R.P.R.,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,MONUMENT,COMMERCIAL,,,,53.6,,50.25,65.66,
MEXILETINE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHORIONIC GONAD BETA SUBUNIT,84704,CPT,300,RC,,OUTPATIENT,,,70.75,28.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.6,OTHER,53.06,69.34,PERCENT OF CHARGES BASED ON HCPCS CODE
CHORIONIC GONAD BETA SUBUNIT,84704,CPT,300,RC,,OUTPATIENT,,,70.75,28.3,MONUMENT,COMMERCIAL,,,,56.6,,53.06,69.34,
SOTALOL,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NICOTINE METABOLITES SERUM,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.81,OTHER,139.13,181.79,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NICOTINE METABOLITES SERUM,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,MONUMENT,COMMERCIAL,,,,148.4,,139.13,181.79,
NICOTINE METABOLITES SERUM,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,UNITED HEALTH,UNITED COMMERCIAL,,,,139.13,,139.13,181.79,
HLA-B TYPING LOW RESOLUTION,81373,CPT,300,RC,,OUTPATIENT,,,254.86,101.944,BLUE CROSS ANTHEM,COMMERCIAL,,,,203.888,OTHER,159.19,208.01,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA-B TYPING LOW RESOLUTION,81373,CPT,300,RC,,OUTPATIENT,,,254.86,101.944,MONUMENT,COMMERCIAL,,,,169.8,,159.19,208.01,
THIOTHIXENE (NAVANE),82491,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA TYPING A B C,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,516.6,OTHER,484.31,632.84,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA TYPING A B C,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,MONUMENT,COMMERCIAL,,,,516.6,,484.31,632.84,
CHROMIUM SERUM,82495,CPT,300,RC,,OUTPATIENT,,,181.25,72.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,135.94,177.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ISOLATION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ISOLATION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
CITRATES ASSAY,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.25,167.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PCR PRODUCTS # FOR DETECTION,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PCR PRODUCTS # FOR DETECTION,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
Z URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROBES (96),83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
PROBES (96),83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.25,167.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPLIFICATION (2),83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFICATION (2),83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
PYRIDINIUM CROSSLINKS-TOTAL,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
PYRIDINIUM CROSSLINKS-T&DEOXY,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
SERUM CTX,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
N TELOPEPTIDE URINE,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,3105.75,1242.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2484.6,OTHER,2329.31,3043.64,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,3105.75,1242.3,MONUMENT,COMMERCIAL,,,,2484.6,,2329.31,3043.64,
N TELOPEPTIDE  SERUM,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ROTAVIRUS,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.4,OTHER,112.88,147.49,PERCENT OF CHARGES BASED ON HCPCS CODE
ROTAVIRUS,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,MONUMENT,COMMERCIAL,,,,120.4,,112.88,147.49,
COPPER LEVEL,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ROTAVIRUS AG  EIA,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.4,OTHER,112.88,147.49,PERCENT OF CHARGES BASED ON HCPCS CODE
ROTAVIRUS AG  EIA,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,MONUMENT,COMMERCIAL,,,,120.4,,112.88,147.49,
COPPER URINE 24 HR,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADENOVIRUS AG EIA,87301,CPT,302,RC,,OUTPATIENT,,,130.5,52.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.4,OTHER,97.88,127.89,PERCENT OF CHARGES BASED ON HCPCS CODE
ADENOVIRUS AG EIA,87301,CPT,302,RC,,OUTPATIENT,,,130.5,52.2,MONUMENT,COMMERCIAL,,,,104.4,,97.88,127.89,
CSF P1433 PROTEIN SPINAL FLUID,82528,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.31,150.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADENOVIRUS AB BY CF,86603,CPT,300,RC,,OUTPATIENT,,,496.25,198.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,397,OTHER,372.19,486.33,PERCENT OF CHARGES BASED ON HCPCS CODE
ADENOVIRUS AB BY CF,86603,CPT,300,RC,,OUTPATIENT,,,496.25,198.5,MONUMENT,COMMERCIAL,,,,397,,372.19,486.33,
CORTISOL-FREE,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FUNGAL SENSITIVITY (MAYO),87186,CPT,306,RC,,OUTPATIENT,,,172,68.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.6,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL SENSITIVITY (MAYO),87186,CPT,306,RC,,OUTPATIENT,,,172,68.8,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
CORTISOL SALIVA,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEAD LEVEL BLOOD,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.6,OTHER,69,90.16,PERCENT OF CHARGES BASED ON HCPCS CODE
LEAD LEVEL BLOOD,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,MONUMENT,COMMERCIAL,,,,73.6,,69,90.16,
CORTISOL,82533,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.56,59.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HF LEAD WITH DEMOGRAPHICS,83655,CPT,301,RC,,OUTPATIENT,,,38.75,15.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,31,OTHER,29.06,37.98,PERCENT OF CHARGES BASED ON HCPCS CODE
HF LEAD WITH DEMOGRAPHICS,83655,CPT,301,RC,,OUTPATIENT,,,38.75,15.5,MONUMENT,COMMERCIAL,,,,31,,29.06,37.98,
DEHYDROCHOLESTEROL 7-/8,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,155.06,202.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEAD URINE,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.6,OTHER,69,90.16,PERCENT OF CHARGES BASED ON HCPCS CODE
LEAD URINE,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,MONUMENT,COMMERCIAL,,,,73.6,,69,90.16,
SYNTHETIC CANNABINOIDS,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,155.06,202.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEFLUNOMIDE METABOLITE S,80299,CPT,300,RC,,OUTPATIENT,,,318.75,127.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,255,OTHER,239.06,312.38,PERCENT OF CHARGES BASED ON HCPCS CODE
LEFLUNOMIDE METABOLITE S,80299,CPT,300,RC,,OUTPATIENT,,,318.75,127.5,MONUMENT,COMMERCIAL,,,,255,,239.06,312.38,
PORPHYRINS  FRACTIONATED,82542,CPT,301,RC,,OUTPATIENT,,,136,54.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102,133.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NORWALK LIKE VIRUS (NOROVIRUS),87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,111,OTHER,104.06,135.98,PERCENT OF CHARGES BASED ON HCPCS CODE
NORWALK LIKE VIRUS (NOROVIRUS),87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,MONUMENT,COMMERCIAL,,,,111,,104.06,135.98,
COENZYME Q10,82542,CPT,301,RC,,OUTPATIENT,,,289.5,115.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,217.13,283.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEGIONELLA CULTURE,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
LEGIONELLA CULTURE,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
CLONIDINE,82542,CPT,301,RC,,OUTPATIENT,,,260.75,104.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,195.56,255.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEGIONELLA PNEUMOPHILA,86713,CPT,302,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
LEGIONELLA PNEUMOPHILA,86713,CPT,302,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
DEXAMETHASONE,82542,CPT,301,RC,,OUTPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159,207.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEGIONELLA SPECIES BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
LEGIONELLA SPECIES BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
CLOMIPRAMINE & METABOLITE,82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEGIONELLA PNEUMO AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.6,OTHER,99,129.36,PERCENT OF CHARGES BASED ON HCPCS CODE
LEGIONELLA PNEUMO AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,MONUMENT,COMMERCIAL,,,,105.6,,99,129.36,
NON DRUG ANALYTE MASS SPEC,82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,OUTPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.6,OTHER,90.56,118.34,PERCENT OF CHARGES BASED ON HCPCS CODE
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,OUTPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
THIOPURINE METABOLITES,82542,CPT,301,RC,,OUTPATIENT,,,465.75,186.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,349.31,456.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EHRLICHIA CHAFFEENSIS AB,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.38,110.25,PERCENT OF CHARGES BASED ON HCPCS CODE
EHRLICHIA CHAFFEENSIS AB,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.38,110.25,
PHENOTHIAZINE,82542,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.56,67.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANAPLASMA PHAGOCYTOPHILIUM IGG,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.38,110.25,PERCENT OF CHARGES BASED ON HCPCS CODE
ANAPLASMA PHAGOCYTOPHILIUM IGG,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.38,110.25,
ENCAINIDE,82542,CPT,301,RC,,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,130.2,OTHER,122.06,159.5,PERCENT OF CHARGES BASED ON HCPCS CODE
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,MONUMENT,COMMERCIAL,,,,130.2,,122.06,159.5,
METHYLPHENIDATE (RITALIN),82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,130.2,OTHER,122.06,159.5,PERCENT OF CHARGES BASED ON HCPCS CODE
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,MONUMENT,COMMERCIAL,,,,130.2,,122.06,159.5,
FLUNITRAZEPAM (ROHYPNOL),82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,130.2,OTHER,122.06,159.5,PERCENT OF CHARGES BASED ON HCPCS CODE
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,MONUMENT,COMMERCIAL,,,,130.2,,122.06,159.5,
SERTRALINE ZOLOFT,82542,CPT,301,RC,,OUTPATIENT,,,181.75,72.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,136.31,178.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIBIOTIC SENSITIVITY  MIC,87186XU,CPT,306,RC,XU,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIBIOTIC SENSITIVITY  MIC,87186XU,CPT,306,RC,XU,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
ASYMMETRIC DIMETHYL ARGININE,82542,CPT,301,RC,,OUTPATIENT,,,230.5,92.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,172.88,225.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROME ANALY CLT PROC FEE (AF),88235,CPT,311,RC,,OUTPATIENT,,,569.75,227.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,455.8,OTHER,427.31,558.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROME ANALY CLT PROC FEE (AF),88235,CPT,311,RC,,OUTPATIENT,,,569.75,227.9,MONUMENT,COMMERCIAL,,,,455.8,,427.31,558.36,
FATTY ACID PROFILE ESSENTIAL,82542,CPT,301,RC,,OUTPATIENT,,,233.25,93.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,174.94,228.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEUKOCYTE ALK PHOS,85540,CPT,305,RC,,OUTPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
LEUKOCYTE ALK PHOS,85540,CPT,305,RC,,OUTPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
FAMILIIAL AMYLOIDOSIS REFLEX,82542,CPT,301,RC,,OUTPATIENT,,,332,132.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,249,325.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYOGLOBIN SERUM,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MYOGLOBIN SERUM,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
SEROTONIN RELEASE ASSAY,82542,CPT,301,RC,,OUTPATIENT,,,447,178.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,335.3,438.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIDOCAINE,80176,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.2,OTHER,79.88,104.37,PERCENT OF CHARGES BASED ON HCPCS CODE
LIDOCAINE,80176,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,MONUMENT,COMMERCIAL,,,,85.2,,79.88,104.37,
GLUTERIC ACIDS,82544,CPT,300,RC,,OUTPATIENT,,,379.25,151.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,284.44,371.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPASE,83690,CPT,300,RC,,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPASE,83690,CPT,300,RC,,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
CPK TOTAL ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.88,96.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LITHIUM,80178,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.4,OTHER,76.31,99.72,PERCENT OF CHARGES BASED ON HCPCS CODE
LITHIUM,80178,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,MONUMENT,COMMERCIAL,,,,81.4,,76.31,99.72,
Z CK ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.88,96.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LISTERIA AB,86609,CPT,300,RC,,OUTPATIENT,,,63.75,25.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,51,OTHER,47.81,62.48,PERCENT OF CHARGES BASED ON HCPCS CODE
LISTERIA AB,86609,CPT,300,RC,,OUTPATIENT,,,63.75,25.5,MONUMENT,COMMERCIAL,,,,51,,47.81,62.48,
Z CPK ISO,82552,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPATIC FUNCTION PANEL (LIVER),80076,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPATIC FUNCTION PANEL (LIVER),80076,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
CPK MB FRACTION,82553,CPT,301,RC,,OUTPATIENT,,,281,112.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,210.75,275.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYME DISEASE SEROLOGY SERUM,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
LYME DISEASE SEROLOGY SERUM,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
CREATININE ASSAY,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYME DISEASE ANTIBODY  CSF,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
LYME DISEASE ANTIBODY  CSF,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
Z CREATININE,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SACCHAROMYCES CERERISIAL PANEL,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.8,OTHER,83.25,108.78,PERCENT OF CHARGES BASED ON HCPCS CODE
SACCHAROMYCES CERERISIAL PANEL,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,MONUMENT,COMMERCIAL,,,,88.8,,83.25,108.78,
Z CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,68.85,27.54,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.6,67.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PIGEON BREEDERS DISEASE,86671,CPT,300,RC,,OUTPATIENT,,,60,24,BLUE CROSS ANTHEM,COMMERCIAL,,,,48,OTHER,45,58.8,PERCENT OF CHARGES BASED ON HCPCS CODE
PIGEON BREEDERS DISEASE,86671,CPT,300,RC,,OUTPATIENT,,,60,24,MONUMENT,COMMERCIAL,,,,48,,45,58.8,
URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.94,63.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.4,OTHER,66.94,87.47,PERCENT OF CHARGES BASED ON HCPCS CODE
MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,MONUMENT,COMMERCIAL,,,,71.4,,66.94,87.47,
Z URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,112.5,147,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
CREATININE BODY FLUID,82570,CPT,301,RC,,OUTPATIENT,,,102.5,41,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.88,100.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,112.5,147,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
CREATININE OTHER SOURCE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.94,63.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAGNESIUM URINE,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.4,OTHER,66.94,87.47,PERCENT OF CHARGES BASED ON HCPCS CODE
MAGNESIUM URINE,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,MONUMENT,COMMERCIAL,,,,71.4,,66.94,87.47,
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,OUTPATIENT,,,239,95.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,179.25,234.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
CRYOFIBRINOGEN,82585,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.56,36.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAGNESIUM RBC'S,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.4,OTHER,66.94,87.47,PERCENT OF CHARGES BASED ON HCPCS CODE
MAGNESIUM RBC'S,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,MONUMENT,COMMERCIAL,,,,71.4,,66.94,87.47,
CRYOGLOBULIN,82595,CPT,300,RC,,OUTPATIENT,,,32,12.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24,31.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MALARIAL THICK/THIN SMEAR,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,BLUE CROSS ANTHEM,COMMERCIAL,,,,86,OTHER,80.63,105.35,PERCENT OF CHARGES BASED ON HCPCS CODE
MALARIAL THICK/THIN SMEAR,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,MONUMENT,COMMERCIAL,,,,86,,80.63,105.35,
CYANIDE ASSAY,82600,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.19,121.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAPROTILINE (LUDIOMIL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
MAPROTILINE (LUDIOMIL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
VITAMIN B12,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEXAGONAL PHASE CONFIRM,85597,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.4,OTHER,155.06,202.62,PERCENT OF CHARGES BASED ON HCPCS CODE
HEXAGONAL PHASE CONFIRM,85597,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
PERNICIOUS ANEMIA CASCADE,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRVVT CONFIRM,8559759,CPT,300,RC,59,OUTPATIENT,,,206.75,82.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.4,OTHER,155.06,202.62,PERCENT OF CHARGES BASED ON HCPCS CODE
DRVVT CONFIRM,8559759,CPT,300,RC,59,OUTPATIENT,,,206.75,82.7,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
CYSTATIN C,82610,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,153.56,200.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRVVT 1:1 MIX,8561359,CPT,300,RC,59,OUTPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.2,OTHER,97.69,127.65,PERCENT OF CHARGES BASED ON HCPCS CODE
DRVVT 1:1 MIX,8561359,CPT,300,RC,59,OUTPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
DHEA,82626,CPT,300,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SINEMET,82491,CPT,300,RC,,OUTPATIENT,,,402.5,161,BLUE CROSS ANTHEM,COMMERCIAL,,,,322,OTHER,301.88,394.45,PERCENT OF CHARGES BASED ON HCPCS CODE
SINEMET,82491,CPT,300,RC,,OUTPATIENT,,,402.5,161,MONUMENT,COMMERCIAL,,,,322,,301.88,394.45,
DHEA-S,82627,CPT,301,RC,,OUTPATIENT,,,216.5,86.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,162.38,212.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
B-D GLUCAN,87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,111,OTHER,104.06,135.98,PERCENT OF CHARGES BASED ON HCPCS CODE
B-D GLUCAN,87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,MONUMENT,COMMERCIAL,,,,111,,104.06,135.98,
PSEUDOCHOLINESTERASE  DIB INH,82638,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METANEPHRINES (TOTAL),83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.6,OTHER,157.13,205.31,PERCENT OF CHARGES BASED ON HCPCS CODE
METANEPHRINES (TOTAL),83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,MONUMENT,COMMERCIAL,,,,167.6,,157.13,205.31,
VIT D 1  25 DIHDROXY,82652,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.63,156.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METANEPHRINES PLASMA,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.6,OTHER,157.13,205.31,PERCENT OF CHARGES BASED ON HCPCS CODE
METANEPHRINES PLASMA,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,MONUMENT,COMMERCIAL,,,,167.6,,157.13,205.31,
PANCREATIC ELASTASE,82656,CPT,300,RC,,OUTPATIENT,,,342.75,137.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,257.06,335.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
METANEPHRINES FRACT URINE RNDM,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.6,OTHER,157.13,205.31,PERCENT OF CHARGES BASED ON HCPCS CODE
METANEPHRINES FRACT URINE RNDM,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,MONUMENT,COMMERCIAL,,,,167.6,,157.13,205.31,
THIOPURINE METHYLTRANSFER RBC,82657,CPT,300,RC,,OUTPATIENT,,,479.75,191.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,359.81,470.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMOOTH MUSCLE ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
SMOOTH MUSCLE ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,95.81,125.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CELONTIN (METHSUXIMIDE),83858,CPT,301,RC,,OUTPATIENT,,,175.75,70.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.6,OTHER,131.81,172.24,PERCENT OF CHARGES BASED ON HCPCS CODE
CELONTIN (METHSUXIMIDE),83858,CPT,301,RC,,OUTPATIENT,,,175.75,70.3,MONUMENT,COMMERCIAL,,,,140.6,,131.81,172.24,
PBG DEAMINASE WB,82657,CPT,300,RC,,OUTPATIENT,,,190.25,76.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,142.69,186.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ARRAY COMP GENOMIC HYBRID,81228,CPT,300,RC,,OUTPATIENT,,,1800,720,BLUE CROSS ANTHEM,COMMERCIAL,,,,1440,OTHER,884.06,1155.18,PERCENT OF CHARGES BASED ON HCPCS CODE
ARRAY COMP GENOMIC HYBRID,81228,CPT,300,RC,,OUTPATIENT,,,1800,720,MONUMENT,COMMERCIAL,,,,943,,884.06,1155.18,
ADENOSINE DEAMINASE BLOOD,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,95.81,125.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MEXILETINE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MEXILETINE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
ALPHA GALACTOSIDASE,82657,CPT,300,RC,,OUTPATIENT,,,255.75,102.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.81,250.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SYPHILIS AB IGG,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.6,OTHER,50.25,65.66,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SYPHILIS AB IGG,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,MONUMENT,COMMERCIAL,,,,53.6,,50.25,65.66,
Z ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,431.3,563.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SYPHILIS AB IGM,8659259,CPT,300,RC,59,OUTPATIENT,,,67,26.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.6,OTHER,50.25,65.66,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SYPHILIS AB IGM,8659259,CPT,300,RC,59,OUTPATIENT,,,67,26.8,MONUMENT,COMMERCIAL,,,,53.6,,50.25,65.66,
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,185,74,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.8,181.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SYPHILIS ANTIBODY IGG,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.2,OTHER,79.88,104.37,PERCENT OF CHARGES BASED ON HCPCS CODE
SYPHILIS ANTIBODY IGG,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,MONUMENT,COMMERCIAL,,,,85.2,,79.88,104.37,
ELECTROPHORECTIC TEST,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SYPHILIS AB TP-PA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,85.2,OTHER,79.88,104.37,PERCENT OF CHARGES BASED ON HCPCS CODE
SYPHILIS AB TP-PA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,MONUMENT,COMMERCIAL,,,,85.2,,79.88,104.37,
Z LP(A) CHOLESTEROL ELECTROPHO,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AFB (TUBERCLE BAC) EA DRUG,87190,CPT,306,RC,,OUTPATIENT,,,264.75,105.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,211.8,OTHER,198.56,259.46,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB (TUBERCLE BAC) EA DRUG,87190,CPT,306,RC,,OUTPATIENT,,,264.75,105.9,MONUMENT,COMMERCIAL,,,,211.8,,198.56,259.46,
Z ELECTROPHORETIC TECHNIQUE,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOTALOL,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.8,OTHER,132,172.48,PERCENT OF CHARGES BASED ON HCPCS CODE
SOTALOL,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,MONUMENT,COMMERCIAL,,,,140.8,,132,172.48,
ERYTHROPOIETIN,82668,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FECES PORPHYRINS ASSAY,84126,CPT,301,RC,,OUTPATIENT,,,333,133.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,266.4,OTHER,249.75,326.34,PERCENT OF CHARGES BASED ON HCPCS CODE
FECES PORPHYRINS ASSAY,84126,CPT,301,RC,,OUTPATIENT,,,333,133.2,MONUMENT,COMMERCIAL,,,,266.4,,249.75,326.34,
Z ESTRADIOL ENHANCED,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,154.88,202.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOLUBLE TRANSFERRIN RECEPTOR,84238,CPT,300,RC,,OUTPATIENT,,,200.25,80.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.2,OTHER,150.19,196.25,PERCENT OF CHARGES BASED ON HCPCS CODE
SOLUBLE TRANSFERRIN RECEPTOR,84238,CPT,300,RC,,OUTPATIENT,,,200.25,80.1,MONUMENT,COMMERCIAL,,,,160.2,,150.19,196.25,
ESTRADIOL,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,154.88,202.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOLUBLE LIVER ANTIGEN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
SOLUBLE LIVER ANTIGEN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
ESTRADIOL SERUM,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,154.88,202.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR TITER S,86593,CPT,300,RC,,OUTPATIENT,,,32,12.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.6,OTHER,24,31.36,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR TITER S,86593,CPT,300,RC,,OUTPATIENT,,,32,12.8,MONUMENT,COMMERCIAL,,,,25.6,,24,31.36,
ESTRIOL SERUM,82677,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BARR BODIES (SEX CHROMATIN ID),88130,CPT,311,RC,,OUTPATIENT,,,155.75,62.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.6,OTHER,116.81,152.64,PERCENT OF CHARGES BASED ON HCPCS CODE
BARR BODIES (SEX CHROMATIN ID),88130,CPT,311,RC,,OUTPATIENT,,,155.75,62.3,MONUMENT,COMMERCIAL,,,,124.6,,116.81,152.64,
Z ESTRIOL,82677,CPT,301,RC,,OUTPATIENT,,,66,26.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.5,64.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD BANK PROC DEVIATION,86079,CPT,302,RC,,OUTPATIENT,,,158.25,63.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,126.6,OTHER,118.69,155.09,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD BANK PROC DEVIATION,86079,CPT,302,RC,,OUTPATIENT,,,158.25,63.3,MONUMENT,COMMERCIAL,,,,126.6,,118.69,155.09,
Z ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.94,130.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENTAMOEBA HISTOLYTICA,87337,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
ENTAMOEBA HISTOLYTICA,87337,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.94,130.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STOOL PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
STOOL PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
ETHYLENE GLYCOL LEVEL,82693,CPT,300,RC,,OUTPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.19,106.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MUMPS IGG  SCREEN,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.2,OTHER,91.13,119.07,PERCENT OF CHARGES BASED ON HCPCS CODE
MUMPS IGG  SCREEN,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,MONUMENT,COMMERCIAL,,,,97.2,,91.13,119.07,
FECAL FATS QUAL,82705,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUMPS VIRUS AB  IGG,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.2,OTHER,91.13,119.07,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUMPS VIRUS AB  IGG,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,MONUMENT,COMMERCIAL,,,,97.2,,91.13,119.07,
FECAL FATS QUANT 24 48 72 HR,82710,CPT,301,RC,,OUTPATIENT,,,159,63.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.25,155.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUMPS VIRUS AB IGM,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.2,OTHER,91.13,119.07,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUMPS VIRUS AB IGM,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,MONUMENT,COMMERCIAL,,,,97.2,,91.13,119.07,
Z ASSAY OF FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEP A TOTAL WITH REFLEX,86708,CPT,300,RC,,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.75,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
HEP A TOTAL WITH REFLEX,86708,CPT,300,RC,,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA PNEUMONIAE AB,86738,CPT,300,RC,,OUTPATIENT,,,98,39.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.4,OTHER,73.5,96.04,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA PNEUMONIAE AB,86738,CPT,300,RC,,OUTPATIENT,,,98,39.2,MONUMENT,COMMERCIAL,,,,78.4,,73.5,96.04,
FETAL FIBRONECTIN,82731,CPT,300,RC,,OUTPATIENT,,,427.5,171,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,320.63,418.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA PNEUMONIAE IGM,8673891,CPT,300,RC,91,OUTPATIENT,,,98,39.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.4,OTHER,73.5,96.04,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA PNEUMONIAE IGM,8673891,CPT,300,RC,91,OUTPATIENT,,,98,39.2,MONUMENT,COMMERCIAL,,,,78.4,,73.5,96.04,
FLUORIDE PLASMA,82735,CPT,301,RC,,OUTPATIENT,,,135,54,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.3,132.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA PHEUMONIAC CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,BLUE CROSS ANTHEM,COMMERCIAL,,,,178,OTHER,166.88,218.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA PHEUMONIAC CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,MONUMENT,COMMERCIAL,,,,178,,166.88,218.05,
FOLATE,82746,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.63,156.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA HOMINIS CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,BLUE CROSS ANTHEM,COMMERCIAL,,,,178,OTHER,166.88,218.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA HOMINIS CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,MONUMENT,COMMERCIAL,,,,178,,166.88,218.05,
FOLATE RBC,82747,CPT,301,RC,,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,108,141.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPHENOLIC ACID,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPHENOLIC ACID,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
GALECTIN-3,82777,CPT,300,RC,,OUTPATIENT,,,195,78,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.25,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYOGLOBIN URINE,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MYOGLOBIN URINE,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
Z IGG SERUM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELIN ASSOC GLYCOPROTEIN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELIN ASSOC GLYCOPROTEIN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
Z IGG CSF,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELIN ASSOC GLYCOPROTEIN,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELIN ASSOC GLYCOPROTEIN,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
IGA,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"MYELIN ASSOC GLYCOPROTEIN, IGM",84181,CPT,300,RC,,OUTPATIENT,,,255,102,BLUE CROSS ANTHEM,COMMERCIAL,,,,204,OTHER,191.25,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
"MYELIN ASSOC GLYCOPROTEIN, IGM",84181,CPT,300,RC,,OUTPATIENT,,,255,102,MONUMENT,COMMERCIAL,,,,204,,191.25,249.9,
IGD,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N TELOPEPTIDE URINE,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
N TELOPEPTIDE URINE,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
IGG,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N TELOPEPTIDE  SERUM,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
N TELOPEPTIDE  SERUM,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
IGM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NAPA,80192,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
NAPA,80192,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
Z GAMMA GLOBULIN ASSAY (IGA),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOZYME,86063,CPT,302,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOZYME,86063,CPT,302,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
Z GAMMA GLOBULIN ASSAY (IGG),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOZYME SCREEN,86403,CPT,300,RC,,OUTPATIENT,,,159,63.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.2,OTHER,119.25,155.82,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOZYME SCREEN,86403,CPT,300,RC,,OUTPATIENT,,,159,63.6,MONUMENT,COMMERCIAL,,,,127.2,,119.25,155.82,
Z GAMMA GLOBULIN ASSAY (IGM),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOZYME TITER,86406,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.8,OTHER,92.63,121.03,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOZYME TITER,86406,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.2,102.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HELICOBACTER PYLORI CULT SENS,87081,CPT,306,RC,,OUTPATIENT,,,114,45.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,91.2,OTHER,85.5,111.72,PERCENT OF CHARGES BASED ON HCPCS CODE
HELICOBACTER PYLORI CULT SENS,87081,CPT,306,RC,,OUTPATIENT,,,114,45.6,MONUMENT,COMMERCIAL,,,,91.2,,85.5,111.72,
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.2,102.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TETANUS ANTIBODY,86317,CPT,300,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
TETANUS ANTIBODY,86317,CPT,300,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.2,102.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSMOLALITY  SERUM,83930,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
OSMOLALITY  SERUM,83930,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,18.6,7.44,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,14,18.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSMOLALITY  URINE,83935,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
OSMOLALITY  URINE,83935,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ZASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,149.71,59.884,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.3,146.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE OSMOLALITY,83935,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE OSMOLALITY,83935,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
IGE,82785,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLASMINOGEN,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
PLASMINOGEN,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,175,70,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.25,171.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FFP THAWING EA UNIT,86927,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
FFP THAWING EA UNIT,86927,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVEROLIMUS,80169,CPT,300,RC,,OUTPATIENT,,,433.25,173.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,346.6,OTHER,324.94,424.59,PERCENT OF CHARGES BASED ON HCPCS CODE
EVEROLIMUS,80169,CPT,300,RC,,OUTPATIENT,,,433.25,173.3,MONUMENT,COMMERCIAL,,,,346.6,,324.94,424.59,
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VORICONAZOLE,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
VORICONAZOLE,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VORICONAZOLE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,147.5,59,BLUE CROSS ANTHEM,COMMERCIAL,,,,118,OTHER,110.63,144.55,PERCENT OF CHARGES BASED ON HCPCS CODE
VORICONAZOLE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,147.5,59,MONUMENT,COMMERCIAL,,,,118,,110.63,144.55,
VENOUS PH ONLY,82800,CPT,300,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PT MIX 1:1,85611,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
PT MIX 1:1,85611,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.31,331,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PTT (PARTIAL THROMBO TIME),85730,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
PTT (PARTIAL THROMBO TIME),85730,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
CORD BLOOD ARTERIAL,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.31,331,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BODY FLUID TRIGLYCERIDE,84478,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,261,OTHER,244.69,319.73,PERCENT OF CHARGES BASED ON HCPCS CODE
BODY FLUID TRIGLYCERIDE,84478,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,MONUMENT,COMMERCIAL,,,,261,,244.69,319.73,
CORD BLOOD VENOUS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.31,331,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.31,331,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ELECTROPHORETIC TECHNIQUE,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.6,OTHER,115.88,151.41,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ELECTROPHORETIC TECHNIQUE,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,MONUMENT,COMMERCIAL,,,,123.6,,115.88,151.41,
GASTRIN,82941,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SPECTROPHOTOMETRY ANALYTE,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SPECTROPHOTOMETRY ANALYTE,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
GLUCAGON,82943,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,135.94,177.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SPECTROPHOTOMETRY ANALYTE,8431191,CPT,300,RC,91,OUTPATIENT,,,86.25,34.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,69,OTHER,64.69,84.53,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SPECTROPHOTOMETRY ANALYTE,8431191,CPT,300,RC,91,OUTPATIENT,,,86.25,34.5,MONUMENT,COMMERCIAL,,,,69,,64.69,84.53,
BFL GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
CSF GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICROSOMAL ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROSOMAL ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
SYNOVIAL FLUID GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROID PEROXIDASE ANTIBODY,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROID PEROXIDASE ANTIBODY,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
GLUCOSE BODY FLUID  NOT BLOOD,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ANTITHYROID MICROSOMAL ANTBD,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANTITHYROID MICROSOMAL ANTBD,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
GLUCOSE RANDOM,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIVER-KIDNEY MICROSOMAL ANTBDS,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.2,OTHER,92.06,120.3,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER-KIDNEY MICROSOMAL ANTBDS,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,MONUMENT,COMMERCIAL,,,,98.2,,92.06,120.3,
GLUCOSE FASTING,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z THYROGLOBULIN AB,86376,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z THYROGLOBULIN AB,86376,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
GLUCOSE - INSULIN RATIO,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BODY FLUID ALBUMIN,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.2,OTHER,50.81,66.4,PERCENT OF CHARGES BASED ON HCPCS CODE
BODY FLUID ALBUMIN,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,MONUMENT,COMMERCIAL,,,,54.2,,50.81,66.4,
GLUCOSE 2HR POST/MEAL,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BODY FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
BODY FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
DEXTROSTIX,82948,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLEURAL FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
PLEURAL FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
GLUCOSE SCREENING 1 HOUR,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLEURAL FLUID LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
PLEURAL FLUID LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
GLUCOSE 2HR POST/GLUCOSE,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLEURAL FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,38.5,15.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.8,OTHER,28.88,37.73,PERCENT OF CHARGES BASED ON HCPCS CODE
PLEURAL FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,38.5,15.4,MONUMENT,COMMERCIAL,,,,30.8,,28.88,37.73,
GLUCOSE TEST,82950,CPT,301,RC,,OUTPATIENT,,,16,6.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12,15.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BODY FLUID BILIRUBIN,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
BODY FLUID BILIRUBIN,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
Z TOLERANCE TEST (GTT) 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.38,133.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PH  URINE,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
PH  URINE,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
GLUCOSE TOLERANCE 2 HOUR,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.38,133.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHENOBARBITOL,80184,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
PHENOBARBITOL,80184,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
Z TOLERANCE TEST 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.38,133.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEWBORN SCREENING 1,S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,128.08,OTHER,105.56,137.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEWBORN SCREENING 1,S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,MONUMENT,COMMERCIAL,,,,112.6,,105.56,137.94,
NEWBORN SCREENING 1,S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,UNITED HEALTH,UNITED COMMERCIAL,,,,105.56,,105.56,137.94,
NEWBORN SCREENING 2 (PKU),S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,128.08,OTHER,105.56,137.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NEWBORN SCREENING 2 (PKU),S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,MONUMENT,COMMERCIAL,,,,112.6,,105.56,137.94,
NEWBORN SCREENING 2 (PKU),S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,UNITED HEALTH,UNITED COMMERCIAL,,,,105.56,,105.56,137.94,
P PHENYLALANINE (PKU),84030,CPT,300,RC,,OUTPATIENT,,,15,6,BLUE CROSS ANTHEM,COMMERCIAL,,,,12,OTHER,11.25,14.7,PERCENT OF CHARGES BASED ON HCPCS CODE
P PHENYLALANINE (PKU),84030,CPT,300,RC,,OUTPATIENT,,,15,6,MONUMENT,COMMERCIAL,,,,12,,11.25,14.7,
GTT EACH ADD BEYOND 3 SPECIMEN,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DILUTE RUSSELL VIPER VENOM,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.2,OTHER,97.69,127.65,PERCENT OF CHARGES BASED ON HCPCS CODE
DILUTE RUSSELL VIPER VENOM,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,MONUMENT,COMMERCIAL,,,,104.2,,97.69,127.65,
GTT EACH ADDITIONAL (2),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DILANTIN (PHENYTOIN),80185,CPT,301,RC,,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,120.94,158.03,PERCENT OF CHARGES BASED ON HCPCS CODE
DILANTIN (PHENYTOIN),80185,CPT,301,RC,,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
GTT EACH ADDITIONAL (3),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DILANTIN FREE (PHENYTOIN),80186,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
DILANTIN FREE (PHENYTOIN),80186,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
GTT EACH ADDITIONAL (4),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARBAMAZEPINE (TEGRETOL),80156,CPT,301,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
CARBAMAZEPINE (TEGRETOL),80156,CPT,301,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
GTT EACH ADDITIONAL (5),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PIN WORM EXAM,87172,CPT,306,RC,,OUTPATIENT,,,67.25,26.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.8,OTHER,50.44,65.91,PERCENT OF CHARGES BASED ON HCPCS CODE
PIN WORM EXAM,87172,CPT,306,RC,,OUTPATIENT,,,67.25,26.9,MONUMENT,COMMERCIAL,,,,53.8,,50.44,65.91,
GLUCOSE TEST ADD SAMPLE,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.6,OTHER,18.38,24.01,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
Z TOLERANCE TEST EA ADD'L SPEC,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CBC WITH AUTO DIFF,85025,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.6,OTHER,51.19,66.89,PERCENT OF CHARGES BASED ON HCPCS CODE
CBC WITH AUTO DIFF,85025,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,MONUMENT,COMMERCIAL,,,,54.6,,51.19,66.89,
G-6 PD,82955,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AFB SPECIAL STAINS,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
AFB SPECIAL STAINS,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
Z ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOPIRIMATE,80201,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.8,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
TOPIRIMATE,80201,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,85,34,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63.8,83.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POTASSIUM (K) SERUM,84132,CPT,301,RC,,OUTPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,64,OTHER,60,78.4,PERCENT OF CHARGES BASED ON HCPCS CODE
POTASSIUM (K) SERUM,84132,CPT,301,RC,,OUTPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
GLUCOSE PCX REAGENT STRIP,82962,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POTASSIUM,84999,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,55,OTHER,51.56,67.38,PERCENT OF CHARGES BASED ON HCPCS CODE
POTASSIUM,84999,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,MONUMENT,COMMERCIAL,,,,55,,51.56,67.38,
GLUCOSE BLOOD TEST,82962,CPT,300,RC,,OUTPATIENT,,,6.56,2.624,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,4.5,5.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
GGT GLUTAMYLTRANSFERASE ASSAY,82977,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TOXOPLASMA  IGM,86778,CPT,300,RC,,OUTPATIENT,,,49.5,19.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.6,OTHER,37.13,48.51,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TOXOPLASMA  IGM,86778,CPT,300,RC,,OUTPATIENT,,,49.5,19.8,MONUMENT,COMMERCIAL,,,,39.6,,37.13,48.51,
GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,397,158.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,297.75,389.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOXOCARA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
TOXOCARA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
Z ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FASCIOLA HEPATICA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
FASCIOLA HEPATICA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,140,56,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105,137.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHINOCOCCUS GRANULOSUS AB IGG,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHINOCOCCUS GRANULOSUS AB IGG,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
FRUCTOSAMINE,82985,CPT,300,RC,,OUTPATIENT,,,82,32.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,61.5,80.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOXOPLASMA IGM,86778,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.8,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
TOXOPLASMA IGM,86778,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
FSH FOLLICLE STIMULATING HARMO,83001,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PREGNENOLONE,84140,CPT,300,RC,,OUTPATIENT,,,264.75,105.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,211.8,OTHER,198.56,259.46,PERCENT OF CHARGES BASED ON HCPCS CODE
PREGNENOLONE,84140,CPT,300,RC,,OUTPATIENT,,,264.75,105.9,MONUMENT,COMMERCIAL,,,,211.8,,198.56,259.46,
LH LUTEINIZING HORMONE,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.63,171.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PRIMIDONE (MYSOLINE),80188,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PRIMIDONE (MYSOLINE),80188,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
LUTEINIZING HORMONE BY ICMA,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.63,171.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PHENOBARB,80184,CPT,300,RC,,OUTPATIENT,,,54.75,21.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.8,OTHER,41.06,53.66,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PHENOBARB,80184,CPT,300,RC,,OUTPATIENT,,,54.75,21.9,MONUMENT,COMMERCIAL,,,,43.8,,41.06,53.66,
HUMAN GROWTH HORMONE,83003,CPT,301,RC,,OUTPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.13,64.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROCAINAMIDE ASSAY,80190,CPT,300,RC,,OUTPATIENT,,,130,52,BLUE CROSS ANTHEM,COMMERCIAL,,,,104,OTHER,97.5,127.4,PERCENT OF CHARGES BASED ON HCPCS CODE
PROCAINAMIDE ASSAY,80190,CPT,300,RC,,OUTPATIENT,,,130,52,MONUMENT,COMMERCIAL,,,,104,,97.5,127.4,
HAPTOGLOBIN,83010,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROGESTERONE,84144,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
PROGESTERONE,84144,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
H PYLORI BREATH TEST,83013,CPT,300,RC,,OUTPATIENT,,,279.75,111.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,209.81,274.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROLACTIN,84146,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
PROLACTIN,84146,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
HEAVY METAL-QUANTITATIVE,83018,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRICHOMONAS,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
TRICHOMONAS,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
TITANIUM SERUM,83018,CPT,300,RC,,OUTPATIENT,,,258.75,103.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.06,253.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PSA  TOTAL DIAGNOSTIC,84153,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
PSA  TOTAL DIAGNOSTIC,84153,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
"THALLIUM, BLOOD",83018,CPT,300,RC,,OUTPATIENT,,,327,130.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,245.3,320.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROSTATIC ACID PHOSPHATASE,84066,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.6,OTHER,60.56,79.14,PERCENT OF CHARGES BASED ON HCPCS CODE
PROSTATIC ACID PHOSPHATASE,84066,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
Z HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,111.56,145.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,258.25,103.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,206.6,OTHER,193.69,253.09,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,258.25,103.3,MONUMENT,COMMERCIAL,,,,206.6,,193.69,253.09,
P HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTEIN C ANTIGEN,85302,CPT,300,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN C ANTIGEN,85302,CPT,300,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.4,110.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTEIN S TOTAT  REFLEX,85305,CPT,300,RC,,OUTPATIENT,,,203.5,81.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,162.8,OTHER,152.63,199.43,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN S TOTAT  REFLEX,85305,CPT,300,RC,,OUTPATIENT,,,203.5,81.4,MONUMENT,COMMERCIAL,,,,162.8,,152.63,199.43,
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.4,110.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"MACROPROLACTIN, S",84146,CPT,300,RC,,OUTPATIENT,,,133,53.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.4,OTHER,99.75,130.34,PERCENT OF CHARGES BASED ON HCPCS CODE
"MACROPROLACTIN, S",84146,CPT,300,RC,,OUTPATIENT,,,133,53.2,MONUMENT,COMMERCIAL,,,,106.4,,99.75,130.34,
QUANTITATE BY ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,111.56,145.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"URINE PROTEIN, TOTAL",84156,CPT,301,RC,,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.75,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
"URINE PROTEIN, TOTAL",84156,CPT,301,RC,,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
Z HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.44,156.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE ELECTROPHORESIS PROTEIN,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,123,OTHER,115.31,150.68,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE ELECTROPHORESIS PROTEIN,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,MONUMENT,COMMERCIAL,,,,123,,115.31,150.68,
HEMOGLOBIN A2 AND F,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.44,156.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRICYCLIC ANTIDEPRESSANT,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
TRICYCLIC ANTIDEPRESSANT,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
HEMOGLOBLIN ELECTRO(EVALUATION,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.44,156.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PROTEIN S TOTAL,85305,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROTEIN S TOTAL,85305,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,160,64,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120,156.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PROTEIN S FREE,85306,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROTEIN S FREE,85306,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
QUANTITATE BY HPLC,83021,CPT,301,RC,,OUTPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.44,156.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.8,OTHER,35.44,46.31,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
FETAL HEMOGLOBIN APT,83033,CPT,300,RC,,OUTPATIENT,,,23.25,9.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.44,22.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
I-STAT PT (INR),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.8,OTHER,35.44,46.31,PERCENT OF CHARGES BASED ON HCPCS CODE
I-STAT PT (INR),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,MONUMENT,COMMERCIAL,,,,37.8,,35.44,46.31,
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTROMBIN G20210A MUTATION B,81240,CPT,300,RC,,OUTPATIENT,,,246,98.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.8,OTHER,184.5,241.08,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTROMBIN G20210A MUTATION B,81240,CPT,300,RC,,OUTPATIENT,,,246,98.4,MONUMENT,COMMERCIAL,,,,196.8,,184.5,241.08,
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,33,13.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24.8,32.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
METHEMOGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
METHEMAGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TROPONIN QUANTATIVE,84484,CPT,301,RC,,OUTPATIENT,,,170.25,68.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.2,OTHER,127.69,166.85,PERCENT OF CHARGES BASED ON HCPCS CODE
TROPONIN QUANTATIVE,84484,CPT,301,RC,,OUTPATIENT,,,170.25,68.1,MONUMENT,COMMERCIAL,,,,136.2,,127.69,166.85,
HEMAGLOBIN PLASMA,83051,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HPGDE DNA EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HPGDE DNA EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
Z HGB UNSTABLE SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,25.75,10.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.31,25.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOLECULAR DIAG ISO EA EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,354,141.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,283.2,OTHER,265.5,346.92,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR DIAG ISO EA EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,354,141.6,MONUMENT,COMMERCIAL,,,,283.2,,265.5,346.92,
HEMOGLOBIN STABILITY SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,85,34,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63.8,83.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULAR ISOLATION/EXTRACTN,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULAR ISOLATION/EXTRACTN,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
HEMOSIDERIN,83070,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PTH INTACT MOLECULE CALCIUM,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,243.2,OTHER,228,297.92,PERCENT OF CHARGES BASED ON HCPCS CODE
PTH INTACT MOLECULE CALCIUM,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,MONUMENT,COMMERCIAL,,,,243.2,,228,297.92,
HISTAMINE PLASMA,83088,CPT,301,RC,,OUTPATIENT,,,176.25,70.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132.19,172.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PARATHORMONE,83970,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.4,OTHER,81.94,107.07,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PARATHORMONE,83970,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,MONUMENT,COMMERCIAL,,,,87.4,,81.94,107.07,
HOMOCYSTINE TOTAL,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.63,183.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARATHYROID HORMONE,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,243.2,OTHER,228,297.92,PERCENT OF CHARGES BASED ON HCPCS CODE
PARATHYROID HORMONE,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,MONUMENT,COMMERCIAL,,,,243.2,,228,297.92,
THCY,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.63,183.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARATHYROID HORMONE RELATED PE,82397,CPT,301,RC,,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PARATHYROID HORMONE RELATED PE,82397,CPT,301,RC,,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
HOMOCYSTEINE TOTAL URINE,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.63,183.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CREATININE,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CREATININE,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
HOMOVANILLIC ACID URINE,83150,CPT,300,RC,,OUTPATIENT,,,167.25,66.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.44,163.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROID IMMUNOGLOBULINS TSI,84445,CPT,301,RC,,OUTPATIENT,,,526.25,210.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,421,OTHER,394.69,515.73,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROID IMMUNOGLOBULINS TSI,84445,CPT,301,RC,,OUTPATIENT,,,526.25,210.5,MONUMENT,COMMERCIAL,,,,421,,394.69,515.73,
17-HYDROXYCORTICOSTEROIDS,83491,CPT,301,RC,,OUTPATIENT,,,166,66.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,124.5,162.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEISHMANIASIS AB,86717,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.2,OTHER,105.19,137.45,PERCENT OF CHARGES BASED ON HCPCS CODE
LEISHMANIASIS AB,86717,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,MONUMENT,COMMERCIAL,,,,112.2,,105.19,137.45,
5-HIAA ASSAY,83497,CPT,300,RC,,OUTPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,167.06,218.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TULAREMIA ANTIBODY,86000,CPT,302,RC,,OUTPATIENT,,,159,63.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.2,OTHER,119.25,155.82,PERCENT OF CHARGES BASED ON HCPCS CODE
TULAREMIA ANTIBODY,86000,CPT,302,RC,,OUTPATIENT,,,159,63.6,MONUMENT,COMMERCIAL,,,,127.2,,119.25,155.82,
5 HYDROXYINDOLEACETIC ACID P,83497,CPT,300,RC,,OUTPATIENT,,,25.8,10.32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.4,25.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
QUINIDINE,80194,CPT,300,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
QUINIDINE,80194,CPT,300,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
HYDROXYPROGESTERONE - 17,83498,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,135.94,177.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TYROSINE ASSAY,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.8,OTHER,112.31,146.76,PERCENT OF CHARGES BASED ON HCPCS CODE
TYROSINE ASSAY,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,MONUMENT,COMMERCIAL,,,,119.8,,112.31,146.76,
P HYDROXYPROGESTERONE 17-ALPHA,83498,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.69,64.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMEAR CYTOPATHOLOGY,88161,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
SMEAR CYTOPATHOLOGY,88161,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
HYDROXYPROLINE  TOTAL URINE,83505,CPT,301,RC,,OUTPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,90.56,118.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSMOTIC FRAGILITY,85555,CPT,305,RC,,OUTPATIENT,,,292,116.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,233.6,OTHER,219,286.16,PERCENT OF CHARGES BASED ON HCPCS CODE
OSMOTIC FRAGILITY,85555,CPT,305,RC,,OUTPATIENT,,,292,116.8,MONUMENT,COMMERCIAL,,,,233.6,,219,286.16,
DESMOGLEIN 1&3 SERUM,83516,CPT,300,RC,,OUTPATIENT,,,174.6,69.84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.95,171.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSMOTIC FRAGILITY RBC,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,147,OTHER,137.81,180.08,PERCENT OF CHARGES BASED ON HCPCS CODE
OSMOTIC FRAGILITY RBC,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,MONUMENT,COMMERCIAL,,,,147,,137.81,180.08,
IMMUNOASSAY FOR ANALYTE MULT,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RENIN ACTIVITY,84244,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
RENIN ACTIVITY,84244,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
PARIETAL CELL ANTIBODIES  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RESP SYNCYTIAL VIRUS ANTIBODY,86756,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
RESP SYNCYTIAL VIRUS ANTIBODY,86756,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
ANTI KU,83516,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.56,55.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RETICULOCYTE COUNT,85045,CPT,305,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
RETICULOCYTE COUNT,85045,CPT,305,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
Z IMMUNOASSAY NON ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RSV ANTIGEN,87807,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.4,OTHER,150.38,196.49,PERCENT OF CHARGES BASED ON HCPCS CODE
RSV ANTIGEN,87807,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,MONUMENT,COMMERCIAL,,,,160.4,,150.38,196.49,
TISSUE TRANSGLUTAMINASE AB IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RETICULIN ANTIBODY  IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
RETICULIN ANTIBODY  IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
GLOMERULAR (GBM) ELISHA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RHEUMATOID FACTOR,86431,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
RHEUMATOID FACTOR,86431,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
MYELOPEROXIDASE,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RABIES ANTIBODY,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
RABIES ANTIBODY,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
Z TISS TRANSGLUTAMINASE IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BARTONELLA HENSELAE IGG,86611,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BARTONELLA HENSELAE IGG,86611,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
F ACTIN,83516,CPT,300,RC,,OUTPATIENT,,,220,88,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,165,215.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BARTONELLA HENSELAE IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BARTONELLA HENSELAE IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
ANTIMITOCHONDRIAL M2 AB  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BARTONELLA QUINTANA IGG,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BARTONELLA QUINTANA IGG,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
IMMUNOASSAY QUANT NOS NONAB,83516,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BARTONELLA QUINTANA IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.2,OTHER,28.31,37,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BARTONELLA QUINTANA IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,MONUMENT,COMMERCIAL,,,,30.2,,28.31,37,
SIGNAL RECOGNITION PROTEIN,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
E. HISTOLYTICA ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.8,OTHER,92.63,121.03,PERCENT OF CHARGES BASED ON HCPCS CODE
E. HISTOLYTICA ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
GLIAD ANTIBODY - IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRYPANOSOMA CRUZI AB IGG,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.8,OTHER,92.63,121.03,PERCENT OF CHARGES BASED ON HCPCS CODE
TRYPANOSOMA CRUZI AB IGG,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,MONUMENT,COMMERCIAL,,,,98.8,,92.63,121.03,
Z GLIADIN IGG ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RUBELLA IGG ANTIBODY,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.4,OTHER,75.38,98.49,PERCENT OF CHARGES BASED ON HCPCS CODE
RUBELLA IGG ANTIBODY,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,MONUMENT,COMMERCIAL,,,,80.4,,75.38,98.49,
HISTONE ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RUBEOLA IGG ANTIBODY,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
RUBEOLA IGG ANTIBODY,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
TYSABRI IMMUNOGENICITY,83516,CPT,300,RC,,OUTPATIENT,,,547,218.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,410.25,536.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MEASLES  IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.8,OTHER,100.13,130.83,PERCENT OF CHARGES BASED ON HCPCS CODE
MEASLES  IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,MONUMENT,COMMERCIAL,,,,106.8,,100.13,130.83,
IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SALICYLATE,80307,CPT,301,RC,,OUTPATIENT,,,290.75,116.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,232.6,OTHER,218.06,284.94,PERCENT OF CHARGES BASED ON HCPCS CODE
SALICYLATE,80307,CPT,301,RC,,OUTPATIENT,,,290.75,116.3,MONUMENT,COMMERCIAL,,,,232.6,,218.06,284.94,
ANTI MI 2 AB,83516,CPT,300,RC,,OUTPATIENT,,,164,65.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,123,160.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLINICAL CHEMISTRY TEST,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,85,OTHER,79.69,104.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CLINICAL CHEMISTRY TEST,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,MONUMENT,COMMERCIAL,,,,85,,79.69,104.13,
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,363.8,145.52,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,272.9,356.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CANCER TYPE INDEX,84999,CPT,301,RC,,OUTPATIENT,,,6049,2419.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,4839.2,OTHER,4536.75,5928.02,PERCENT OF CHARGES BASED ON HCPCS CODE
CANCER TYPE INDEX,84999,CPT,301,RC,,OUTPATIENT,,,6049,2419.6,MONUMENT,COMMERCIAL,,,,4839.2,,4536.75,5928.02,
Z IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.1,35.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESR (AUTO),85652,CPT,305,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
ESR (AUTO),85652,CPT,305,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.3,97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEMEN ANALYSIS COMPLETE,89320,CPT,309,RC,,OUTPATIENT,,,202.5,81,BLUE CROSS ANTHEM,COMMERCIAL,,,,162,OTHER,151.88,198.45,PERCENT OF CHARGES BASED ON HCPCS CODE
SEMEN ANALYSIS COMPLETE,89320,CPT,309,RC,,OUTPATIENT,,,202.5,81,MONUMENT,COMMERCIAL,,,,162,,151.88,198.45,
RIBOSOME P ANTIBODIES IGG,83516,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SERUM KILLING LEVEL  PEAK,87197,CPT,300,RC,,OUTPATIENT,,,362,144.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,289.6,OTHER,271.5,354.76,PERCENT OF CHARGES BASED ON HCPCS CODE
SERUM KILLING LEVEL  PEAK,87197,CPT,300,RC,,OUTPATIENT,,,362,144.8,MONUMENT,COMMERCIAL,,,,289.6,,271.5,354.76,
CENTROMERE ANTIBODIES,83516,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SERUM KILLING LEVEL  TROUGH,87197,CPT,300,RC,,OUTPATIENT,,,240.5,96.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,192.4,OTHER,180.38,235.69,PERCENT OF CHARGES BASED ON HCPCS CODE
SERUM KILLING LEVEL  TROUGH,87197,CPT,300,RC,,OUTPATIENT,,,240.5,96.2,MONUMENT,COMMERCIAL,,,,192.4,,180.38,235.69,
TRYPSIN LIKE IMMUNOREACTIVITY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEROTONIN,84260,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.2,OTHER,107.06,139.9,PERCENT OF CHARGES BASED ON HCPCS CODE
SEROTONIN,84260,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,MONUMENT,COMMERCIAL,,,,114.2,,107.06,139.9,
ACH R GANGLIONIC NEURONAL ANTI,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SELENIUM,84255,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
SELENIUM,84255,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
C-NEURONAL (V-G) K+ CHANNEL AB,83519,CPT,300,RC,,OUTPATIENT,,,219.5,87.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,164.63,215.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIPOPROTEIN A,83695,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
LIPOPROTEIN A,83695,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
ACETYLCHOLINE RECEPTOR AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEMEN ANALYSIS  POST VAS,89321,CPT,300,RC,,OUTPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.4,OTHER,49.13,64.19,PERCENT OF CHARGES BASED ON HCPCS CODE
SEMEN ANALYSIS  POST VAS,89321,CPT,300,RC,,OUTPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
TSH RECEPTOR ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
MELATONIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
MELANTONIN 24 HR URINE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SGPT EMPLOYEE,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,41,OTHER,38.44,50.23,PERCENT OF CHARGES BASED ON HCPCS CODE
SGPT EMPLOYEE,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,MONUMENT,COMMERCIAL,,,,41,,38.44,50.23,
Z ACH RECEPTOR BINDING AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SICKLE CELL,85660,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
SICKLE CELL,85660,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
HYDROXYLASE 21 ANTIBODIES,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SS-A,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
SS-A,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
ACH RECEPTOR MUSCLE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SS-B,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.4,OTHER,45.38,59.29,PERCENT OF CHARGES BASED ON HCPCS CODE
SS-B,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,MONUMENT,COMMERCIAL,,,,48.4,,45.38,59.29,
IMMUNOASSAY FOR ANALYTE RIA,83519,CPT,300,RC,,OUTPATIENT,,,1491.5,596.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1118.63,1461.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ORGANIC ACID SCREEN URINE,83919,CPT,301,RC,,OUTPATIENT,,,217.25,86.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.8,OTHER,162.94,212.91,PERCENT OF CHARGES BASED ON HCPCS CODE
ORGANIC ACID SCREEN URINE,83919,CPT,301,RC,,OUTPATIENT,,,217.25,86.9,MONUMENT,COMMERCIAL,,,,173.8,,162.94,212.91,
THYROTROPIN RELEASING HORMONE,83519,CPT,300,RC,,OUTPATIENT,,,373.75,149.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,280.31,366.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SODIUM (NA) SERUM,84295,CPT,301,RC,,OUTPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,64,OTHER,60,78.4,PERCENT OF CHARGES BASED ON HCPCS CODE
SODIUM (NA) SERUM,84295,CPT,301,RC,,OUTPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
INSULIN-LIKE GROWTH FACTOR-2,83519,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.13,205.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
PANCREATIC POLYPEPTIDE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.4,OTHER,54.75,71.54,PERCENT OF CHARGES BASED ON HCPCS CODE
SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,MONUMENT,COMMERCIAL,,,,58.4,,54.75,71.54,
SECRETIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE PHOSPHORUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,114.25,45.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,91.4,OTHER,85.69,111.97,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE PHOSPHORUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,114.25,45.7,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
PANCREATIC ELASTASE SERUM,83519,CPT,300,RC,,OUTPATIENT,,,390,156,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,292.5,382.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
MYASTHENIA GRAVIS MUSK REFLEX,83519,CPT,300,RC,,OUTPATIENT,,,195,78,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.3,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
MELANOCYTE STM HOR ALPHA,83519,CPT,300,RC,,OUTPATIENT,,,305.67,122.268,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,229.3,299.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
Z RIA NONANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,188.05,75.22,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,141,184.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE SODIUM 24 HR,84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.4,OTHER,54.75,71.54,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE SODIUM 24 HR,84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,MONUMENT,COMMERCIAL,,,,58.4,,54.75,71.54,
RIA ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,71.75,28.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,53.81,70.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.88,45.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,167.75,67.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,134.2,OTHER,125.81,164.4,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,167.75,67.1,MONUMENT,COMMERCIAL,,,,134.2,,125.81,164.4,
P GALACTOSE 1 PHOSPHATE,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.56,16.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,25.2,10.08,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.16,OTHER,15.56,20.34,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,25.2,10.08,MONUMENT,COMMERCIAL,,,,16.6,,15.56,20.34,
P CF IMMUNOASSAY,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.5,33.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE TOXIC SCREEN,80306,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE TOXIC SCREEN,80306,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
ANTI-HMGCR AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,256,102.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,192,250.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSAY EA DRUG CLASS,8030159,CPT,300,RC,59,OUTPATIENT,,,190.5,76.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.4,OTHER,142.88,186.69,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY EA DRUG CLASS,8030159,CPT,300,RC,59,OUTPATIENT,,,190.5,76.2,MONUMENT,COMMERCIAL,,,,152.4,,142.88,186.69,
INHIBIN B,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOMATOSTATIN,84307,CPT,301,RC,,OUTPATIENT,,,442.75,177.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,354.2,OTHER,332.06,433.9,PERCENT OF CHARGES BASED ON HCPCS CODE
SOMATOSTATIN,84307,CPT,301,RC,,OUTPATIENT,,,442.75,177.1,MONUMENT,COMMERCIAL,,,,354.2,,332.06,433.9,
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.3,93.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOMATOMEDIN-C,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,157.2,OTHER,147.38,192.57,PERCENT OF CHARGES BASED ON HCPCS CODE
SOMATOMEDIN-C,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,MONUMENT,COMMERCIAL,,,,157.2,,147.38,192.57,
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.3,93.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BFL-SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,70.75,28.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.6,OTHER,53.06,69.34,PERCENT OF CHARGES BASED ON HCPCS CODE
BFL-SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,70.75,28.3,MONUMENT,COMMERCIAL,,,,56.6,,53.06,69.34,
Z GALOP AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE CHEM STRIP AUTO,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.2,OTHER,42.38,55.37,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CHEM STRIP AUTO,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
C1 ESTERASE INHIBITOR FUNCT,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE NEISSERIA GONORRHEA DNA,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.2,OTHER,68.63,89.67,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE NEISSERIA GONORRHEA DNA,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,MONUMENT,COMMERCIAL,,,,73.2,,68.63,89.67,
ALPHA SUBUNIT PITUITARY TM,83520,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
GLOMERULAR BASEMENT MEM AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE PHOSPHOROUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE PHOSPHOROUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
ANTI MULLERIAN HORMONE,83520,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPERM ANTIBODY,89325,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.2,OTHER,137.06,179.1,PERCENT OF CHARGES BASED ON HCPCS CODE
SPERM ANTIBODY,89325,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,MONUMENT,COMMERCIAL,,,,146.2,,137.06,179.1,
HUMAN ANTI - MOUSE AB ELISA,83520,CPT,300,RC,,OUTPATIENT,,,304.25,121.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,228.19,298.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE VOLUME MEASUREMENT,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,27,OTHER,25.31,33.08,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE VOLUME MEASUREMENT,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
SACCHAROMYCES CEREVISIAE IGA,83520,CPT,300,RC,,OUTPATIENT,,,90,36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINOLEVULENIC ACID 24 HR URIN,82135,CPT,301,RC,,OUTPATIENT,,,101.25,40.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,81,OTHER,75.94,99.23,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINOLEVULENIC ACID 24 HR URIN,82135,CPT,301,RC,,OUTPATIENT,,,101.25,40.5,MONUMENT,COMMERCIAL,,,,81,,75.94,99.23,
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINO ACID SCREEN  PLASMA QUAL,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINO ACID SCREEN  PLASMA QUAL,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
SACCHAROMYCES CEREVISIAE IGG,83520,CPT,300,RC,,OUTPATIENT,,,90,36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINO ACID SCRN  PLASMA QUANT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,BLUE CROSS ANTHEM,COMMERCIAL,,,,372,OTHER,348.75,455.7,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINO ACID SCRN  PLASMA QUANT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,MONUMENT,COMMERCIAL,,,,372,,348.75,455.7,
TRANSFORMING GRWTH FACTOR BETA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINOLEVULENIC ACID (ALA),82135,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINOLEVULENIC ACID (ALA),82135,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
PROMETHEUS INFLIXAMAB HACA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMNIODARONE LEVEL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
AMNIODARONE LEVEL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
RNA POLYMERASE III AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMITRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMITRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
AMITRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
AMITRIPTYLINE NORTRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,55.25,22.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.28,OTHER,41.44,54.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMITRIPTYLINE NORTRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,55.25,22.1,MONUMENT,COMMERCIAL,,,,44.2,,41.44,54.15,
AMITRIPTYLINE NORTRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,55.25,22.1,UNITED HEALTH,UNITED COMMERCIAL,,,,41.44,,41.44,54.15,
AMPHETAMINE SCREEN SERUM,G0480,HCPCS,300,RC,,BOTH,,,298.25,119.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,271.41,OTHER,223.69,292.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMPHETAMINE SCREEN SERUM,G0480,HCPCS,300,RC,,BOTH,,,298.25,119.3,MONUMENT,COMMERCIAL,,,,238.6,,223.69,292.29,
AMPHETAMINE SCREEN SERUM,G0480,HCPCS,300,RC,,BOTH,,,298.25,119.3,UNITED HEALTH,UNITED COMMERCIAL,,,,223.69,,223.69,292.29,
ARSENIC LEVEL,82175,CPT,301,RC,,OUTPATIENT,,,129,51.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.2,OTHER,96.75,126.42,PERCENT OF CHARGES BASED ON HCPCS CODE
ARSENIC LEVEL,82175,CPT,301,RC,,OUTPATIENT,,,129,51.6,MONUMENT,COMMERCIAL,,,,103.2,,96.75,126.42,
IMMUNOASSAY QUANT NOS,83520,CPT,300,RC,,OUTPATIENT,,,289.75,115.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,217.31,283.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPHETAMINE ASSAY,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.66,OTHER,59.06,77.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z AMPHETAMINE ASSAY,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,MONUMENT,COMMERCIAL,,,,63,,59.06,77.18,
Z AMPHETAMINE ASSAY,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,,59.06,,59.06,77.18,
Z AMPHETAMINE ASSAY,8214559,CPT,300,RC,59,OUTPATIENT,,,56.25,22.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,45,OTHER,42.19,55.13,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPHETAMINE ASSAY,8214559,CPT,300,RC,59,OUTPATIENT,,,56.25,22.5,MONUMENT,COMMERCIAL,,,,45,,42.19,55.13,
LEPTIN LEVEL,83520,CPT,300,RC,,OUTPATIENT,,,263.75,105.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,197.81,258.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPHENTAMINES ANALYSIS SERUM,G0480,HCPCS,300,RC,,BOTH,,,177.5,71,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.53,OTHER,133.13,173.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMPHENTAMINES ANALYSIS SERUM,G0480,HCPCS,300,RC,,BOTH,,,177.5,71,MONUMENT,COMMERCIAL,,,,142,,133.13,173.95,
AMPHENTAMINES ANALYSIS SERUM,G0480,HCPCS,300,RC,,BOTH,,,177.5,71,UNITED HEALTH,UNITED COMMERCIAL,,,,133.13,,133.13,173.95,
FECES EXAM (MEAT FIBERS),89160,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.4,OTHER,57.56,75.22,PERCENT OF CHARGES BASED ON HCPCS CODE
FECES EXAM (MEAT FIBERS),89160,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
C1 ESTERASE INHIBITOR,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMNISURE FOR ROM,84112,CPT,300,RC,,OUTPATIENT,,,196.25,78.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,157,OTHER,147.19,192.33,PERCENT OF CHARGES BASED ON HCPCS CODE
AMNISURE FOR ROM,84112,CPT,300,RC,,OUTPATIENT,,,196.25,78.5,MONUMENT,COMMERCIAL,,,,157,,147.19,192.33,
Z GANGLIOSIDE ANTIBODY PANEL 1,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OCCULT BLOOD SCREENING,82270,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.2,OTHER,33.94,44.35,PERCENT OF CHARGES BASED ON HCPCS CODE
OCCULT BLOOD SCREENING,82270,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
Z GANGLIOSIDE ANTIBODY PANEL 2,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OCCULT BLOOD DIAGNOSTIC,82272,CPT,301,RC,,OUTPATIENT,,,47,18.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.6,OTHER,35.25,46.06,PERCENT OF CHARGES BASED ON HCPCS CODE
OCCULT BLOOD DIAGNOSTIC,82272,CPT,301,RC,,OUTPATIENT,,,47,18.8,MONUMENT,COMMERCIAL,,,,37.6,,35.25,46.06,
Z GANGLIOSIDE ANTIBODY PANEL 3,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OCCULT BLD IMM,G0328,HCPCS,300,RC,,BOTH,,,206.25,82.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187.69,OTHER,154.69,202.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OCCULT BLD IMM,G0328,HCPCS,300,RC,,BOTH,,,206.25,82.5,MONUMENT,COMMERCIAL,,,,165,,154.69,202.13,
OCCULT BLD IMM,G0328,HCPCS,300,RC,,BOTH,,,206.25,82.5,UNITED HEALTH,UNITED COMMERCIAL,,,,154.69,,154.69,202.13,
BLOOD VISCOSITY EXAM,85810,CPT,305,RC,,OUTPATIENT,,,170.25,68.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.2,OTHER,127.69,166.85,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD VISCOSITY EXAM,85810,CPT,305,RC,,OUTPATIENT,,,170.25,68.1,MONUMENT,COMMERCIAL,,,,136.2,,127.69,166.85,
Z GANGLIOSIDE ANTIBODY PANEL 4,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FACTOR XIII QUALITATIVE,85291,CPT,305,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FACTOR XIII QUALITATIVE,85291,CPT,305,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
Z GANGLIOSIDE ANTIBODY PANEL 5,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FIBRINOGEN TEST,85366,CPT,300,RC,,OUTPATIENT,,,165.5,66.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,132.4,OTHER,124.13,162.19,PERCENT OF CHARGES BASED ON HCPCS CODE
FIBRINOGEN TEST,85366,CPT,300,RC,,OUTPATIENT,,,165.5,66.2,MONUMENT,COMMERCIAL,,,,132.4,,124.13,162.19,
Z GANGLIOSIDE ANTIBODY PANEL 6,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOCOCCUS PHEUM IGG 7 SER,86317,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOCOCCUS PHEUM IGG 7 SER,86317,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
Z STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOCOCCUS PNEUM IGG 23 SER,8631759,CPT,300,RC,59,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOCOCCUS PNEUM IGG 23 SER,8631759,CPT,300,RC,59,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
INTERLEUKIN 8,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z STREPTOCOCCUS PHEUM IGG 7SER,8631759,CPT,300,RC,59,OUTPATIENT,,,426.75,170.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,341.4,OTHER,320.06,418.22,PERCENT OF CHARGES BASED ON HCPCS CODE
Z STREPTOCOCCUS PHEUM IGG 7SER,8631759,CPT,300,RC,59,OUTPATIENT,,,426.75,170.7,MONUMENT,COMMERCIAL,,,,341.4,,320.06,418.22,
INTERLEUKIN 6,83520,CPT,300,RC,,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREP PHEUMONIAE AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.6,OTHER,99,129.36,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP PHEUMONIAE AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,MONUMENT,COMMERCIAL,,,,105.6,,99,129.36,
INSULIN GROWTH BINDING,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STREPTOCOCCUS PNEUMO AG CSF,87899,CPT,300,RC,,OUTPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.6,OTHER,159,207.76,PERCENT OF CHARGES BASED ON HCPCS CODE
STREPTOCOCCUS PNEUMO AG CSF,87899,CPT,300,RC,,OUTPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
NEUROMYELITIS OPTICA EVAL,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z VITAMIN A,84590,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
Z VITAMIN A,84590,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
NEURONAL CELL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VITAMIN B1 (THIAMINE),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.8,OTHER,128.25,167.58,PERCENT OF CHARGES BASED ON HCPCS CODE
VITAMIN B1 (THIAMINE),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,MONUMENT,COMMERCIAL,,,,136.8,,128.25,167.58,
NEURON SPECIFIC ENOLASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
T3 UPTAKE,84479,CPT,300,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
T3 UPTAKE,84479,CPT,300,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
TUMOR NECROSIS FACTOR - ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,157.2,OTHER,147.38,192.57,PERCENT OF CHARGES BASED ON HCPCS CODE
TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,MONUMENT,COMMERCIAL,,,,157.2,,147.38,192.57,
PLASMINOGEN ACTIVATOR INH ANTI,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.8,OTHER,57,74.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
VASCULAR ENDOTHELIAL GROWTH,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,77,30.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.6,OTHER,57.75,75.46,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,77,30.8,MONUMENT,COMMERCIAL,,,,61.6,,57.75,75.46,
TRYPTASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TESTOSTERONE BIOAVAILABLE,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.048,OTHER,57,74.48,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TESTOSTERONE BIOAVAILABLE,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
Z SULFATIDE AUTOANTIBODY,83520,CPT,300,RC,,OUTPATIENT,,,443,177.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,332.25,434.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TESTOSTERONE,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,157.2,OTHER,147.38,192.57,PERCENT OF CHARGES BASED ON HCPCS CODE
TESTOSTERONE,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,MONUMENT,COMMERCIAL,,,,157.2,,147.38,192.57,
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,130.75,52.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.06,128.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,131,OTHER,122.81,160.48,PERCENT OF CHARGES BASED ON HCPCS CODE
TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,MONUMENT,COMMERCIAL,,,,131,,122.81,160.48,
SOLUBLE LIVER ANTIGEN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VITAMIN B6,84207,CPT,301,RC,,OUTPATIENT,,,179.25,71.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,143.4,OTHER,134.44,175.67,PERCENT OF CHARGES BASED ON HCPCS CODE
VITAMIN B6,84207,CPT,301,RC,,OUTPATIENT,,,179.25,71.7,MONUMENT,COMMERCIAL,,,,143.4,,134.44,175.67,
MYELIN ASSOC GLYCOPROTEIN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THEOPHYLLINE,80198,CPT,301,RC,,OUTPATIENT,,,212,84.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.6,OTHER,159,207.76,PERCENT OF CHARGES BASED ON HCPCS CODE
THEOPHYLLINE,80198,CPT,301,RC,,OUTPATIENT,,,212,84.8,MONUMENT,COMMERCIAL,,,,169.6,,159,207.76,
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24.19,31.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIOCYANATE ASSAY,84430,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.2,OTHER,139.88,182.77,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOCYANATE ASSAY,84430,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,MONUMENT,COMMERCIAL,,,,149.2,,139.88,182.77,
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.7,65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIORIDAZINE (MELLARIL),84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,55,OTHER,51.56,67.38,PERCENT OF CHARGES BASED ON HCPCS CODE
THIORIDAZINE (MELLARIL),84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,MONUMENT,COMMERCIAL,,,,55,,51.56,67.38,
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.7,65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIOTHIXENE (NAVANE),82491,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
THIOTHIXENE (NAVANE),82491,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.7,65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,89,OTHER,83.44,109.03,PERCENT OF CHARGES BASED ON HCPCS CODE
THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
ANTITHROMBIN COMPLEX,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,182.3,238.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROGLOBULIN ASSAY (SO),84432,CPT,301,RC,,OUTPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,94,OTHER,88.13,115.15,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROGLOBULIN ASSAY (SO),84432,CPT,301,RC,,OUTPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
ANTI MDA 5 AB,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,182.3,238.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROGLOBULIN ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROGLOBULIN ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
PHOSPHOLIPASE A2 RECEPTOR,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,295.5,386.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROGLOBULIN AB,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.2,OTHER,93,121.52,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROGLOBULIN AB,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,MONUMENT,COMMERCIAL,,,,99.2,,93,121.52,
TISSUE NECROSIS FACTOR ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,486,194.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,364.5,476.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TYPHUS FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.6,OTHER,41.81,54.64,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TYPHUS FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,MONUMENT,COMMERCIAL,,,,44.6,,41.81,54.64,
PRI MEMBRANOUS NEPHROPATH DIAG,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,295.5,386.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TYPHUS FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,44.6,OTHER,41.81,54.64,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TYPHUS FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,MONUMENT,COMMERCIAL,,,,44.6,,41.81,54.64,
IL 2 RECEPTOR SOLUBLE,83520,CPT,300,RC,,OUTPATIENT,,,144.31,57.724,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,108.2,141.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE DOT SLOT BLOT,83893,CPT,300,RC,,OUTPATIENT,,,29.75,11.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.8,OTHER,22.31,29.16,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE DOT SLOT BLOT,83893,CPT,300,RC,,OUTPATIENT,,,29.75,11.9,MONUMENT,COMMERCIAL,,,,23.8,,22.31,29.16,
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,295.5,386.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.8,OTHER,22.31,29.16,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,MONUMENT,COMMERCIAL,,,,23.8,,22.31,29.16,
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,295.5,386.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.8,OTHER,22.31,29.16,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,MONUMENT,COMMERCIAL,,,,23.8,,22.31,29.16,
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,295.5,386.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,47,OTHER,44.06,57.58,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,MONUMENT,COMMERCIAL,,,,47,,44.06,57.58,
INSULIN  TOTAL,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FACTOR VIII COAGULATION,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,BLUE CROSS ANTHEM,COMMERCIAL,,,,222,OTHER,208.13,271.95,PERCENT OF CHARGES BASED ON HCPCS CODE
FACTOR VIII COAGULATION,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,MONUMENT,COMMERCIAL,,,,222,,208.13,271.95,
INSULIN,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THCY,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,BLUE CROSS ANTHEM,COMMERCIAL,,,,150,OTHER,140.63,183.75,PERCENT OF CHARGES BASED ON HCPCS CODE
THCY,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,MONUMENT,COMMERCIAL,,,,150,,140.63,183.75,
INSULIN  FREE,83527,CPT,301,RC,,OUTPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.56,59.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ISOLATION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
ISOLATION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
IRON,83540,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.69,53.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPLIFICATION X2,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFICATION X2,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
IRON BINDING CAPACITY  TOTAL,83550,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.06,57.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
"17 KETOSTEROID, 24 HR",83582,CPT,301,RC,,OUTPATIENT,,,291,116.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,218.25,285.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
LACTIC ACID,83605,CPT,301,RC,,OUTPATIENT,,,130,52,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.5,127.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APC,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.4,OTHER,150.38,196.49,PERCENT OF CHARGES BASED ON HCPCS CODE
APC,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,MONUMENT,COMMERCIAL,,,,160.4,,150.38,196.49,
LACTIC ACID CSF,83605,CPT,301,RC,,OUTPATIENT,,,130,52,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.5,127.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TSH - THYROID STIMU HORMONE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
TSH - THYROID STIMU HORMONE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
LDH TOTAL DIRECT,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC 2 SEQ,83900,CPT,300,RC,,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC 2 SEQ,83900,CPT,300,RC,,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
BFL LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
CSF LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
PERITONEAL FLUID  LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
P TSH,84443,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
P TSH,84443,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
LACTATE ENZYME LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TSH SENSITIVE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.4,OTHER,92.25,120.54,PERCENT OF CHARGES BASED ON HCPCS CODE
TSH SENSITIVE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,MONUMENT,COMMERCIAL,,,,98.4,,92.25,120.54,
PLEURAL FLUID LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FREE T4 THYROXINE,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
FREE T4 THYROXINE,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
LDH ISOENZYMES,83625,CPT,301,RC,,OUTPATIENT,,,100.75,40.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.56,98.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
P THYROXINE (T4),84437,CPT,300,RC,,OUTPATIENT,,,18.5,7.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,14.8,OTHER,13.88,18.13,PERCENT OF CHARGES BASED ON HCPCS CODE
P THYROXINE (T4),84437,CPT,300,RC,,OUTPATIENT,,,18.5,7.4,MONUMENT,COMMERCIAL,,,,14.8,,13.88,18.13,
LEUKOCYTES STOOL,83630,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOTAL T4,84436,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.4,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
TOTAL T4,84436,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
Z LEAD,83655,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
T4 FREE BY DIALYSIS,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.48,PERCENT OF CHARGES BASED ON HCPCS CODE
T4 FREE BY DIALYSIS,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.48,
LEAD LEVEL BLOOD,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69,90.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROXINE BINDING GLOBULIN,84442,CPT,300,RC,,OUTPATIENT,,,169,67.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.2,OTHER,126.75,165.62,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROXINE BINDING GLOBULIN,84442,CPT,300,RC,,OUTPATIENT,,,169,67.6,MONUMENT,COMMERCIAL,,,,135.2,,126.75,165.62,
HF LEAD WITH DEMOGRAPHICS,83655,CPT,301,RC,,OUTPATIENT,,,38.75,15.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.06,37.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOBRAMYCIN PEAK,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.8,OTHER,57,74.48,PERCENT OF CHARGES BASED ON HCPCS CODE
TOBRAMYCIN PEAK,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
LEAD URINE,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69,90.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOBRAMYCIN TROUGH,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.8,OTHER,57,74.48,PERCENT OF CHARGES BASED ON HCPCS CODE
TOBRAMYCIN TROUGH,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,MONUMENT,COMMERCIAL,,,,60.8,,57,74.48,
L/S FETAL LUNG,83661,CPT,301,RC,,OUTPATIENT,,,101,40.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.75,98.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOCAINIDE QUANT SERUM,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
TOCAINIDE QUANT SERUM,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
FETAL LUNG MATURITY,83663,CPT,300,RC,,OUTPATIENT,,,293.5,117.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,220.13,287.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LAMELLAR BODY COUNT,83664,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.88,104.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LEUCINE AMINOPEPTIDASE,83670,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.38,196.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LIPASE,83690,CPT,300,RC,,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.5,103.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LIPOPROTEIN A,83695,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LIPOPROTEN ASSOC PHOSPLIPSE A2,83698,CPT,300,RC,,OUTPATIENT,,,280.5,112.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,210.38,274.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
LIPOPROTEIN ELECTROPHORESIS,83700,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,274.88,359.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
ZLIPOPRO BLD ELECTROPHORETIC,83700,CPT,300,RC,,OUTPATIENT,,,22.52,9.008,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,16.9,22.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
ZLIPOPROTEIN BLD HR FRACTION,83701,CPT,301,RC,,OUTPATIENT,,,67.72,27.088,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.8,66.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.2,OTHER,21.75,28.42,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,MONUMENT,COMMERCIAL,,,,23.2,,21.75,28.42,
NMR LIPOPROTEIN PROFILE,83704,CPT,301,RC,,OUTPATIENT,,,100,40,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75,98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NUCLEAR ANTIGEN ANITBODY,86235,CPT,300,RC,,OUTPATIENT,,,45.5,18.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.4,OTHER,34.13,44.59,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEAR ANTIGEN ANITBODY,86235,CPT,300,RC,,OUTPATIENT,,,45.5,18.2,MONUMENT,COMMERCIAL,,,,36.4,,34.13,44.59,
LIPOPROTEIN WITH LDL HDL PART,83704,CPT,301,RC,,OUTPATIENT,,,212.75,85.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159.56,208.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NUCLEAR ANTIGEN ANITBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.4,OTHER,34.13,44.59,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEAR ANTIGEN ANITBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,MONUMENT,COMMERCIAL,,,,36.4,,34.13,44.59,
HDL CHOLESTEROL,83718,CPT,301,RC,,OUTPATIENT,,,130.5,52.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.88,127.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.4,OTHER,34.13,44.59,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,MONUMENT,COMMERCIAL,,,,36.4,,34.13,44.59,
LOW DENSITY LIPOPROTEIN,83721,CPT,301,RC,,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.4,OTHER,34.13,44.59,PERCENT OF CHARGES BASED ON HCPCS CODE
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,MONUMENT,COMMERCIAL,,,,36.4,,34.13,44.59,
GONADOTROPIN RELEASING HORMONE,83727,CPT,300,RC,,OUTPATIENT,,,529.75,211.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,397.31,519.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.632,OTHER,24.19,31.61,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.94,87.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.632,OTHER,24.19,31.61,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
MAGNESIUM URINE,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.94,87.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOTAL PROTEIN,84155,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
TOTAL PROTEIN,84155,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
Z URINE MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,27.632,OTHER,24.19,31.61,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,MONUMENT,COMMERCIAL,,,,25.8,,24.19,31.61,
MAGNESIUM RBC'S,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.94,87.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CSF TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
MAGNESIUM QUANTITATIVE FECES,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.94,87.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMINO ACID SCRN URINE QUALIT,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
AMINO ACID SCRN URINE QUALIT,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
MANGANESE SERUM,83785,CPT,300,RC,,OUTPATIENT,,,184.75,73.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.56,181.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEUCINE AMINOPEPTIDASE,83670,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.4,OTHER,150.38,196.49,PERCENT OF CHARGES BASED ON HCPCS CODE
LEUCINE AMINOPEPTIDASE,83670,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,MONUMENT,COMMERCIAL,,,,160.4,,150.38,196.49,
P MS-MS EXPANDED SCREEN,83788,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z VITAMIN E,84446,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
Z VITAMIN E,84446,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
Z MASS SPECTOMETRY,83788,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CORTISON BINDING GLOBULIN,84449,CPT,300,RC,,OUTPATIENT,,,203.75,81.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,163,OTHER,152.81,199.68,PERCENT OF CHARGES BASED ON HCPCS CODE
CORTISON BINDING GLOBULIN,84449,CPT,300,RC,,OUTPATIENT,,,203.75,81.5,MONUMENT,COMMERCIAL,,,,163,,152.81,199.68,
Z IODINE,83789,CPT,300,RC,,OUTPATIENT,,,300,120,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,225,294,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHELOMETRY ASSAY NOT SPEC,83916,CPT,301,RC,,OUTPATIENT,,,131,52.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,104.8,OTHER,98.25,128.38,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHELOMETRY ASSAY NOT SPEC,83916,CPT,301,RC,,OUTPATIENT,,,131,52.4,MONUMENT,COMMERCIAL,,,,104.8,,98.25,128.38,
BILE ACIDS FRACTIONATE TOTAL,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WILLEBRAND MULTIMERIC,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.8,OTHER,200.44,261.91,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WILLEBRAND MULTIMERIC,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,MONUMENT,COMMERCIAL,,,,213.8,,200.44,261.91,
IODINE URINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RISTOCETIN,85245,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,155,OTHER,145.31,189.88,PERCENT OF CHARGES BASED ON HCPCS CODE
RISTOCETIN,85245,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,MONUMENT,COMMERCIAL,,,,155,,145.31,189.88,
IODINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WILLEBRAND FACTOR MULTI,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.8,OTHER,200.44,261.91,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WILLEBRAND FACTOR MULTI,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,MONUMENT,COMMERCIAL,,,,213.8,,200.44,261.91,
THIOPURINE METHYLTRANSFERESE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WILLEBRAND FACTOR ANTIGEN,85246,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WILLEBRAND FACTOR ANTIGEN,85246,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
"HB VARIANT BY MASS SPEC, B",83789,CPT,300,RC,,OUTPATIENT,,,261.5,104.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,196.13,256.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WILLEBRAND FACTOR ACTIVITY,85397,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.8,OTHER,238.88,312.13,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WILLEBRAND FACTOR ACTIVITY,85397,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,MONUMENT,COMMERCIAL,,,,254.8,,238.88,312.13,
MERCURY  URINE,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.63,109.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOTAL PROTEIN URINE TIMED 24HR,84156,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
TOTAL PROTEIN URINE TIMED 24HR,84156,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
Z MERCURY  QUANTITATIVE,83825,CPT,301,RC,,OUTPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.44,46.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRIIODOTHYRONINE T3; (TT-3),84480,CPT,301,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.25,61.74,PERCENT OF CHARGES BASED ON HCPCS CODE
TRIIODOTHYRONINE T3; (TT-3),84480,CPT,301,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
MERCURY QUANTITATIVE BLOOD,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.63,109.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
METANEPHRINES (TOTAL),83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.13,205.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRANSFERRIN,84466,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,48.6,OTHER,45.56,59.54,PERCENT OF CHARGES BASED ON HCPCS CODE
TRANSFERRIN,84466,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,MONUMENT,COMMERCIAL,,,,48.6,,45.56,59.54,
METANEPHRINES PLASMA,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.13,205.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRAZODONE (DESYREL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
TRAZODONE (DESYREL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
METANEPHRINES FRACT URINE RNDM,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.13,205.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OXYCARBAZAPINE (TRILIPTAL),80183,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.8,OTHER,102.94,134.51,PERCENT OF CHARGES BASED ON HCPCS CODE
OXYCARBAZAPINE (TRILIPTAL),80183,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,MONUMENT,COMMERCIAL,,,,109.8,,102.94,134.51,
CELONTIN (METHSUXIMIDE),83858,CPT,301,RC,,OUTPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
MUCOPOLYSACCHARIDES  QUAL,83866,CPT,301,RC,,OUTPATIENT,,,236,94.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,177,231.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COXSACKIE A9 VIRUS ANTIBODY,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.4,OTHER,51.94,67.87,PERCENT OF CHARGES BASED ON HCPCS CODE
COXSACKIE A9 VIRUS ANTIBODY,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,MONUMENT,COMMERCIAL,,,,55.4,,51.94,67.87,
MYOGLOBIN SERUM,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UREA NITROGEN URINE,84540,CPT,301,RC,,OUTPATIENT,,,150.5,60.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.4,OTHER,112.88,147.49,PERCENT OF CHARGES BASED ON HCPCS CODE
UREA NITROGEN URINE,84540,CPT,301,RC,,OUTPATIENT,,,150.5,60.2,MONUMENT,COMMERCIAL,,,,120.4,,112.88,147.49,
MYOGLOBIN URINE,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z URINE UREA NITROGEN,84540,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.92,OTHER,12.1,15.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z URINE UREA NITROGEN,84540,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,MONUMENT,COMMERCIAL,,,,12.9,,12.1,15.8,
B TYPE NATRIURECTIC PEPTIDE,83880,CPT,301,RC,,OUTPATIENT,,,475.5,190.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,356.63,465.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UREA NITROGEN CLEARANCE,84545,CPT,300,RC,,OUTPATIENT,,,145,58,BLUE CROSS ANTHEM,COMMERCIAL,,,,116,OTHER,108.75,142.1,PERCENT OF CHARGES BASED ON HCPCS CODE
UREA NITROGEN CLEARANCE,84545,CPT,300,RC,,OUTPATIENT,,,145,58,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
NEPHELOMETRY EA ANALYTE,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.25,128.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URIC ACID,84550,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
URIC ACID,84550,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
Z IMMUNOGLOB LIGHT CHAINS,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.25,128.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APO E GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,313.25,125.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,250.6,OTHER,234.94,306.99,PERCENT OF CHARGES BASED ON HCPCS CODE
APO E GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,313.25,125.3,MONUMENT,COMMERCIAL,,,,250.6,,234.94,306.99,
ALPHA-2-MCAROGLOBULIN,83883,CPT,301,RC,,OUTPATIENT,,,27.2,10.88,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.4,26.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APOLIPOPROTEIN A1,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
APOLIPOPROTEIN A1,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
NICKEL SERUM,83885,CPT,300,RC,,OUTPATIENT,,,221.5,88.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,166.13,217.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URIC ACID  PLEURAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URIC ACID  PLEURAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
Z MOLECULAR DIAG ISO/EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URIC ACID  SYNOVIAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URIC ACID  SYNOVIAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
MOLECU DIAG ISOLATION/EXTRACTI,83890,CPT,301,RC,,OUTPATIENT,,,1153,461.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,864.75,1129.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URIC ACID  URINE RANDOM,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URIC ACID  URINE RANDOM,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
MOLECULAR DIAG ISO EA EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,354,141.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,265.5,346.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URIC ACID  URINE TIMED,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.8,OTHER,67.31,87.96,PERCENT OF CHARGES BASED ON HCPCS CODE
URIC ACID  URINE TIMED,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,MONUMENT,COMMERCIAL,,,,71.8,,67.31,87.96,
Z MOLECULAR ISOLATION/EXTRACTN,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINALYSIS/COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,71.25,28.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,57,OTHER,53.44,69.83,PERCENT OF CHARGES BASED ON HCPCS CODE
URINALYSIS/COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,71.25,28.5,MONUMENT,COMMERCIAL,,,,57,,53.44,69.83,
ISOLATION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VALPROIC ACID (DEPAKENE),80164,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,55.8,OTHER,52.31,68.36,PERCENT OF CHARGES BASED ON HCPCS CODE
VALPROIC ACID (DEPAKENE),80164,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,MONUMENT,COMMERCIAL,,,,55.8,,52.31,68.36,
MOLECULAR ISOLATION/EXTRACTION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VANCOMYCIN PEAK/TROUGH,80202,CPT,301,RC,,OUTPATIENT,,,314.75,125.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,251.8,OTHER,236.06,308.46,PERCENT OF CHARGES BASED ON HCPCS CODE
VANCOMYCIN PEAK/TROUGH,80202,CPT,301,RC,,OUTPATIENT,,,314.75,125.9,MONUMENT,COMMERCIAL,,,,251.8,,236.06,308.46,
Z MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WB DZ INTERP,85390,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,241.8,OTHER,226.69,296.21,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WB DZ INTERP,85390,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,MONUMENT,COMMERCIAL,,,,241.8,,226.69,296.21,
ISO PURIFIED NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,337.13,440.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VON WB FACTOR MULT,85247,CPT,300,RC,,OUTPATIENT,,,390,156,BLUE CROSS ANTHEM,COMMERCIAL,,,,312,OTHER,292.5,382.2,PERCENT OF CHARGES BASED ON HCPCS CODE
VON WB FACTOR MULT,85247,CPT,300,RC,,OUTPATIENT,,,390,156,MONUMENT,COMMERCIAL,,,,312,,292.5,382.2,
Z ISO/EXTRACTION NUCLIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,65.25,26.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.94,63.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VANILLYLMANDELIC ACID,84585,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.6,OTHER,60.56,79.14,PERCENT OF CHARGES BASED ON HCPCS CODE
VANILLYLMANDELIC ACID,84585,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,MONUMENT,COMMERCIAL,,,,64.6,,60.56,79.14,
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VARICELLA-ZOSTER IGG&IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.2,OTHER,100.5,131.32,PERCENT OF CHARGES BASED ON HCPCS CODE
VARICELLA-ZOSTER IGG&IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,MONUMENT,COMMERCIAL,,,,107.2,,100.5,131.32,
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VARICELLA-ZOSTER VIRUS AB IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.2,OTHER,100.5,131.32,PERCENT OF CHARGES BASED ON HCPCS CODE
VARICELLA-ZOSTER VIRUS AB IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,MONUMENT,COMMERCIAL,,,,107.2,,100.5,131.32,
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VARICELLA-ZOSTER VIRUS,87290,CPT,306,RC,,OUTPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.6,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
VARICELLA-ZOSTER VIRUS,87290,CPT,306,RC,,OUTPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,337.13,440.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VARICELLA-ZOSTER VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
VARICELLA-ZOSTER VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VARICELLA-ZOSTER AB-IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,107.2,OTHER,100.5,131.32,PERCENT OF CHARGES BASED ON HCPCS CODE
VARICELLA-ZOSTER AB-IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,MONUMENT,COMMERCIAL,,,,107.2,,100.5,131.32,
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIQUID BASED PREPARATION,88174,CPT,300,RC,,OUTPATIENT,,,240,96,BLUE CROSS ANTHEM,COMMERCIAL,,,,192,OTHER,180,235.2,PERCENT OF CHARGES BASED ON HCPCS CODE
LIQUID BASED PREPARATION,88174,CPT,300,RC,,OUTPATIENT,,,240,96,MONUMENT,COMMERCIAL,,,,192,,180,235.2,
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z OVA PARASITES DIRECT SMEARS,87177,CPT,306,RC,,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z OVA PARASITES DIRECT SMEARS,87177,CPT,306,RC,,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
ISOLATION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SMEAR COMPLEX STAIN,87209,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SMEAR COMPLEX STAIN,87209,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MACROSCOPIC ARTHROPOD EXAM,87168,CPT,300,RC,,OUTPATIENT,,,57,22.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.6,OTHER,42.75,55.86,PERCENT OF CHARGES BASED ON HCPCS CODE
MACROSCOPIC ARTHROPOD EXAM,87168,CPT,300,RC,,OUTPATIENT,,,57,22.8,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MACROSCOPIC PARASITE EXAM,87169,CPT,300,RC,,OUTPATIENT,,,57,22.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.6,OTHER,42.75,55.86,PERCENT OF CHARGES BASED ON HCPCS CODE
MACROSCOPIC PARASITE EXAM,87169,CPT,300,RC,,OUTPATIENT,,,57,22.8,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
HPGDE DNA EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARAKEET DROPPINGS BY GEL DIFF,86331,CPT,300,RC,,OUTPATIENT,,,106.25,42.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,85,OTHER,79.69,104.13,PERCENT OF CHARGES BASED ON HCPCS CODE
PARAKEET DROPPINGS BY GEL DIFF,86331,CPT,300,RC,,OUTPATIENT,,,106.25,42.5,MONUMENT,COMMERCIAL,,,,85,,79.69,104.13,
Z MOLECULAR DIAGNOS ENZ DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KRAS GENE 7 MUTATION PANEL TMR,81275,CPT,300,RC,,OUTPATIENT,,,1314.75,525.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1051.8,OTHER,986.06,1288.46,PERCENT OF CHARGES BASED ON HCPCS CODE
KRAS GENE 7 MUTATION PANEL TMR,81275,CPT,300,RC,,OUTPATIENT,,,1314.75,525.9,MONUMENT,COMMERCIAL,,,,1051.8,,986.06,1288.46,
MOLECULAR DIAGNOSTICS,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KPC PCR,87150,CPT,300,RC,,OUTPATIENT,,,185.5,74.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.4,OTHER,139.13,181.79,PERCENT OF CHARGES BASED ON HCPCS CODE
KPC PCR,87150,CPT,300,RC,,OUTPATIENT,,,185.5,74.2,MONUMENT,COMMERCIAL,,,,148.4,,139.13,181.79,
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VIT D 1  25 DIHDROXY,82652,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.6,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
VIT D 1  25 DIHDROXY,82652,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
Z DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VIT D  HYDROXY,82306,CPT,300,RC,,OUTPATIENT,,,103.25,41.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.6,OTHER,77.44,101.19,PERCENT OF CHARGES BASED ON HCPCS CODE
VIT D  HYDROXY,82306,CPT,300,RC,,OUTPATIENT,,,103.25,41.3,MONUMENT,COMMERCIAL,,,,82.6,,77.44,101.19,
Z ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VITAMIN K1,84597,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.8,OTHER,153.56,200.66,PERCENT OF CHARGES BASED ON HCPCS CODE
VITAMIN K1,84597,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,MONUMENT,COMMERCIAL,,,,163.8,,153.56,200.66,
ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VITAMIN B12,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
VITAMIN B12,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VIT B2 RIBOFLAVIN,84252,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
VIT B2 RIBOFLAVIN,84252,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
Z MOLECULE DOT SLOT BLOT,83893,CPT,300,RC,,OUTPATIENT,,,29.75,11.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.31,29.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERNICIOUS ANEMIA CASCADE,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.6,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
PERNICIOUS ANEMIA CASCADE,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOSTRIDIUM DIFFICLE TOXIN,87324,CPT,306,RC,,OUTPATIENT,,,30.82,12.328,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.656,OTHER,90.56,118.34,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSTRIDIUM DIFFICLE TOXIN,87324,CPT,306,RC,,OUTPATIENT,,,30.82,12.328,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CRYPTOSPORIDIUM,87328,CPT,306,RC,,OUTPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,35,OTHER,32.81,42.88,PERCENT OF CHARGES BASED ON HCPCS CODE
CRYPTOSPORIDIUM,87328,CPT,306,RC,,OUTPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
Z MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GIARDIA,87329,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.4,OTHER,33.19,43.37,PERCENT OF CHARGES BASED ON HCPCS CODE
GIARDIA,87329,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,MONUMENT,COMMERCIAL,,,,35.4,,33.19,43.37,
SEPARTN BY GEL ELECTROPHORESIS,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"CRYPTOSPORIDIUM ANTIGEN, FECES",87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.19,102.17,PERCENT OF CHARGES BASED ON HCPCS CODE
"CRYPTOSPORIDIUM ANTIGEN, FECES",87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.19,102.17,
PCR PRODUCTS # FOR DETECTION,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WET PREP,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.8,OTHER,54.19,70.81,PERCENT OF CHARGES BASED ON HCPCS CODE
WET PREP,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,MONUMENT,COMMERCIAL,,,,57.8,,54.19,70.81,
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WBC (WHITE BLOOD COUNT),85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.38,35.77,PERCENT OF CHARGES BASED ON HCPCS CODE
WBC (WHITE BLOOD COUNT),85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.38,35.77,
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MANUAL SMEAR EXAM  NO DIFF,85008,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,27,OTHER,25.31,33.08,PERCENT OF CHARGES BASED ON HCPCS CODE
MANUAL SMEAR EXAM  NO DIFF,85008,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
Z NUCLEIC ACID PROBE 1ST,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMATOCRIT,85014,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.6,OTHER,18.38,24.01,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMATOCRIT,85014,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,MONUMENT,COMMERCIAL,,,,19.6,,18.38,24.01,
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZINC,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
ZINC,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZINC  URINE,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
ZINC  URINE,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
D-XYLOSE,84620,CPT,301,RC,,OUTPATIENT,,,184.75,73.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.8,OTHER,138.56,181.06,PERCENT OF CHARGES BASED ON HCPCS CODE
D-XYLOSE,84620,CPT,301,RC,,OUTPATIENT,,,184.75,73.9,MONUMENT,COMMERCIAL,,,,147.8,,138.56,181.06,
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RENAL FUNCTION PANEL,80069,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,149.2,OTHER,139.88,182.77,PERCENT OF CHARGES BASED ON HCPCS CODE
RENAL FUNCTION PANEL,80069,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,MONUMENT,COMMERCIAL,,,,149.2,,139.88,182.77,
PROBES (96),83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA A,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA A,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA B,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.6,OTHER,39,50.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA B,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,MONUMENT,COMMERCIAL,,,,41.6,,39,50.96,
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EMPLOYEE INFLUENZAE A,3008987,CDM,,,,INPATIENT,,,25.75,10.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.43,OTHER,19.31,25.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EMPLOYEE INFLUENZAE A,3008987,CDM,,,,INPATIENT,,,25.75,10.3,MONUMENT,COMMERCIAL,,,,20.6,,19.31,25.24,
EMPLOYEE INFLUENZAE A,3008987,CDM,,,,INPATIENT,,,25.75,10.3,UNITED HEALTH,UNITED COMMERCIAL,,,,19.31,,19.31,25.24,
EMPLOYEE INFLUENZAE B,3008988,CDM,,,,INPATIENT,,,25.75,10.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.43,OTHER,19.31,25.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EMPLOYEE INFLUENZAE B,3008988,CDM,,,,INPATIENT,,,25.75,10.3,MONUMENT,COMMERCIAL,,,,20.6,,19.31,25.24,
EMPLOYEE INFLUENZAE B,3008988,CDM,,,,INPATIENT,,,25.75,10.3,UNITED HEALTH,UNITED COMMERCIAL,,,,19.31,,19.31,25.24,
GIEMSA STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
GIEMSA STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
MOLECULE NUCLEIC TRANSFER,83897,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,111.56,145.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA VIRUS ANTIBODY IGG,86710,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA VIRUS ANTIBODY IGG,86710,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
Z MOLECULAR EA NUCLEIC SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA VIRUS ANTIBODY IGM,8671059,CPT,300,RC,59,OUTPATIENT,,,47.75,19.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.2,OTHER,35.81,46.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA VIRUS ANTIBODY IGM,8671059,CPT,300,RC,59,OUTPATIENT,,,47.75,19.1,MONUMENT,COMMERCIAL,,,,38.2,,35.81,46.8,
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTI-NEURONAL NUCLEAR ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI-NEURONAL NUCLEAR ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
MOLECULE NUCLEIC AMPLI EACH,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INFLUENZA A H1N1 BY PCR,87502,CPT,306,RC,,OUTPATIENT,,,592,236.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,473.6,OTHER,444,580.16,PERCENT OF CHARGES BASED ON HCPCS CODE
INFLUENZA A H1N1 BY PCR,87502,CPT,306,RC,,OUTPATIENT,,,592,236.8,MONUMENT,COMMERCIAL,,,,473.6,,444,580.16,
AMPLIFICATION (2),83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA A H1N1 BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA A H1N1 BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
Z AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INFLUENZA A H1N1 BY PCR,8779891,CPT,300,RC,91,OUTPATIENT,,,225.75,90.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,180.6,OTHER,169.31,221.24,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INFLUENZA A H1N1 BY PCR,8779891,CPT,300,RC,91,OUTPATIENT,,,225.75,90.3,MONUMENT,COMMERCIAL,,,,180.6,,169.31,221.24,
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,112.5,147,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.06,57.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,112.5,147,PERCENT OF CHARGES BASED ON HCPCS CODE
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KIT MUTATION EX 811&17,81272,CPT,300,RC,,OUTPATIENT,,,659.02,263.608,BLUE CROSS ANTHEM,COMMERCIAL,,,,527.216,OTHER,494.3,645.8,PERCENT OF CHARGES BASED ON HCPCS CODE
KIT MUTATION EX 811&17,81272,CPT,300,RC,,OUTPATIENT,,,659.02,263.608,MONUMENT,COMMERCIAL,,,,527.2,,494.3,645.8,
MODECULE NUCLEIC AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
Z AMPLIFICATION NUCLEIC ACID,83898,CPT,300,RC,,OUTPATIENT,,,171.75,68.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.81,168.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
Z AMPLIFICATION NUCLEIC 2 SEQ,83900,CPT,300,RC,,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
Z MOLECULE NUCLEIC AMPLI,83901,CPT,300,RC,,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SEPARATE & ID BY HIGH RESLTN,8390959,CPT,300,RC,59,OUTPATIENT,,,1601.75,640.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1281.4,OTHER,1201.31,1569.72,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATE & ID BY HIGH RESLTN,8390959,CPT,300,RC,59,OUTPATIENT,,,1601.75,640.7,MONUMENT,COMMERCIAL,,,,1281.4,,1201.31,1569.72,
Z REVERSE TRANSCRIPTION,83902,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.06,139.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
Z MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.76,
Z MUTATION SCREEN,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,BLUE CROSS ANTHEM,COMMERCIAL,,,,22,OTHER,20.63,26.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,MONUMENT,COMMERCIAL,,,,22,,20.63,26.95,
MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,BLUE CROSS ANTHEM,COMMERCIAL,,,,22,OTHER,20.63,26.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,MONUMENT,COMMERCIAL,,,,22,,20.63,26.95,
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,BLUE CROSS ANTHEM,COMMERCIAL,,,,22,OTHER,20.63,26.95,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,MONUMENT,COMMERCIAL,,,,22,,20.63,26.95,
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE MUTATION IDENTIFY,83905,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE MUTATION IDENTIFY,83905,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
Z MOLECULE MUTATION IDENTIFY,83905,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE MUTATION IDENTIFY,8390559,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE MUTATION IDENTIFY,8390559,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
Z MOLECULE MUTATION IDENTIFY,83906,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE MUTATION IDENTIFY,83906,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE MUTATION IDENTIFY,83906,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
LYSE CELLS FOR NUCLEIC EXTRACT,83907,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,104.06,135.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE MUTATION IDENTIFY,8390659,CPT,300,RC,59,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE MUTATION IDENTIFY,8390659,CPT,300,RC,59,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
Z SIGNAL AMPLIFICATION,83908,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.56,59.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
Z SEPARATE&ID BY HIGH RESOLTN,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE NUCLEIC AMPLI,83901,CPT,300,RC,,OUTPATIENT,,,78,31.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,62.4,OTHER,58.5,76.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE NUCLEIC AMPLI,83901,CPT,300,RC,,OUTPATIENT,,,78,31.2,MONUMENT,COMMERCIAL,,,,62.4,,58.5,76.44,
Z SEP ID BY HIGH RESOLUTION,83909,CPT,300,RC,,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.8,OTHER,29.81,38.96,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,MONUMENT,COMMERCIAL,,,,31.8,,29.81,38.96,
MOLECULAR DIAG ISO EA NUCLEIC,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRCA1 2 GENE ANALYSIS,81162,CPT,300,RC,,OUTPATIENT,,,3017.9,1207.16,BLUE CROSS ANTHEM,COMMERCIAL,,,,2414.32,OTHER,2263.4,2957.5,PERCENT OF CHARGES BASED ON HCPCS CODE
BRCA1 2 GENE ANALYSIS,81162,CPT,300,RC,,OUTPATIENT,,,3017.9,1207.16,MONUMENT,COMMERCIAL,,,,2414.3,,2263.4,2957.5,
Z MOLECULAR DIAG SEP AND IDENT,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FECAL WBC STAIN,89055,CPT,300,RC,,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.75,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
FECAL WBC STAIN,89055,CPT,300,RC,,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.75,63.7,
NUCLEIC ACID HIGH RESOLUTE,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,207.8,OTHER,194.81,254.56,PERCENT OF CHARGES BASED ON HCPCS CODE
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,MONUMENT,COMMERCIAL,,,,207.8,,194.81,254.56,
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NATURAL KILLER CELLS,86357,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,207.8,OTHER,194.81,254.56,PERCENT OF CHARGES BASED ON HCPCS CODE
NATURAL KILLER CELLS,86357,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,MONUMENT,COMMERCIAL,,,,207.8,,194.81,254.56,
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,207.8,OTHER,194.81,254.56,PERCENT OF CHARGES BASED ON HCPCS CODE
T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,MONUMENT,COMMERCIAL,,,,207.8,,194.81,254.56,
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABSOLUTE CD4/CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,276.5,110.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.2,OTHER,207.38,270.97,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSOLUTE CD4/CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,276.5,110.6,MONUMENT,COMMERCIAL,,,,221.2,,207.38,270.97,
Z INTERPRETAION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NATURAL KILLER CYTOTOXICITY,86805,CPT,300,RC,,OUTPATIENT,,,379.02,151.608,BLUE CROSS ANTHEM,COMMERCIAL,,,,303.216,OTHER,270.56,353.54,PERCENT OF CHARGES BASED ON HCPCS CODE
NATURAL KILLER CYTOTOXICITY,86805,CPT,300,RC,,OUTPATIENT,,,379.02,151.608,MONUMENT,COMMERCIAL,,,,288.6,,270.56,353.54,
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HTLV I/II AB S,86790,CPT,300,RC,,OUTPATIENT,,,95.25,38.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.2,OTHER,71.44,93.35,PERCENT OF CHARGES BASED ON HCPCS CODE
HTLV I/II AB S,86790,CPT,300,RC,,OUTPATIENT,,,95.25,38.1,MONUMENT,COMMERCIAL,,,,76.2,,71.44,93.35,
Z ENZYMATIC DIGESTION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HTLV I/II AB CONFIRMATION S,86689,CPT,300,RC,,OUTPATIENT,,,494.75,197.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,395.8,OTHER,371.06,484.86,PERCENT OF CHARGES BASED ON HCPCS CODE
HTLV I/II AB CONFIRMATION S,86689,CPT,300,RC,,OUTPATIENT,,,494.75,197.9,MONUMENT,COMMERCIAL,,,,395.8,,371.06,484.86,
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URINE TRAMADOL AND METABOLITE,80373,CPT,300,RC,,OUTPATIENT,,,100.6,40.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.48,OTHER,75.45,98.59,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE TRAMADOL AND METABOLITE,80373,CPT,300,RC,,OUTPATIENT,,,100.6,40.24,MONUMENT,COMMERCIAL,,,,80.48,,75.45,98.59,
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CAROTENE BETA,82380,CPT,301,RC,,OUTPATIENT,,,184.13,73.652,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.304,OTHER,138.1,180.45,PERCENT OF CHARGES BASED ON HCPCS CODE
CAROTENE BETA,82380,CPT,301,RC,,OUTPATIENT,,,184.13,73.652,MONUMENT,COMMERCIAL,,,,147.3,,138.1,180.45,
GENETIC EXAMINATION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOMEGALOVIRUS IGG AVIDITY,86644,CPT,302,RC,,OUTPATIENT,,,217.82,87.128,BLUE CROSS ANTHEM,COMMERCIAL,,,,174.256,OTHER,163.37,213.46,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOMEGALOVIRUS IGG AVIDITY,86644,CPT,302,RC,,OUTPATIENT,,,217.82,87.128,MONUMENT,COMMERCIAL,,,,174.26,,163.37,213.46,
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NRAS GENE VARIANTS EXON 2&3,81311,CPT,300,RC,,OUTPATIENT,,,622.5,249,BLUE CROSS ANTHEM,COMMERCIAL,,,,498,OTHER,466.88,610.05,PERCENT OF CHARGES BASED ON HCPCS CODE
NRAS GENE VARIANTS EXON 2&3,81311,CPT,300,RC,,OUTPATIENT,,,622.5,249,MONUMENT,COMMERCIAL,,,,498,,466.88,610.05,
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
M-PROT ISO MALD TOF CHARGE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.59,OTHER,111.8,146,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
M-PROT ISO MALD TOF CHARGE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,MONUMENT,COMMERCIAL,,,,119.2,,111.8,146,
M-PROT ISO MALD TOF CHARGE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,UNITED HEALTH,UNITED COMMERCIAL,,,,111.8,,111.8,146,
ALL BLACK/WHITE PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL BLACK/WHITE PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL GREEN PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL GREEN PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL CARROT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL CARROT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.63,26.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL AVOCADO IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL AVOCADO IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.63,26.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL ONION IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL ONION IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
NUCLEOTIDASE-5,83915,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL GARLIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL GARLIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
RBC ENZYMES,83915,CPT,301,RC,,OUTPATIENT,,,797.25,318.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,597.94,781.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL LENTIL IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL LENTIL IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
Z ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,215,86,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,161.3,210.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL GREEN STRING BEAN IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL GREEN STRING BEAN IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,95,38,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.3,93.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL CHILI PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL CHILI PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
OLIGOCLONAL BAND SERUM,83916,CPT,301,RC,,OUTPATIENT,,,83.5,33.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,62.63,81.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL OLIVE FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL OLIVE FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
NEPHELOMETRY ASSAY NOT SPEC,83916,CPT,301,RC,,OUTPATIENT,,,131,52.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.25,128.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL CURRY IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL CURRY IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
ORGANIC ACIDS  PLASMA,83918,CPT,301,RC,,OUTPATIENT,,,527.75,211.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,395.81,517.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL GINGER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL GINGER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
ORGANIC ACID SCREEN URINE,83919,CPT,301,RC,,OUTPATIENT,,,217.25,86.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,162.94,212.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL LETTUCE IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,29.2,OTHER,27.4,35.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL LETTUCE IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,MONUMENT,COMMERCIAL,,,,29.2,,27.4,35.8,
METHYLMALONIC ACID URINE,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.13,181.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THIOPURINE METHYLTRANS NUDIX15,0034U,HCPCS,300,RC,,INPATIENT,,,494,197.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,449.54,OTHER,370.5,484.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
THIOPURINE METHYLTRANS NUDIX15,0034U,HCPCS,300,RC,,INPATIENT,,,494,197.6,MONUMENT,COMMERCIAL,,,,395.2,,370.5,484.1,
THIOPURINE METHYLTRANS NUDIX15,0034U,HCPCS,300,RC,,INPATIENT,,,494,197.6,UNITED HEALTH,UNITED COMMERCIAL,,,,370.5,,370.5,484.1,
CHROMO MICRO AUTO STILL,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2747.2,OTHER,2575.5,3365.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMO MICRO AUTO STILL,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,MONUMENT,COMMERCIAL,,,,2747.2,,2575.5,3365.3,
METHYLMALONIC ACID  SERUM,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.13,181.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HLA I LOW RESOLUTION ONE ANTI,81374,CPT,300,RC,,OUTPATIENT,,,255,102,BLUE CROSS ANTHEM,COMMERCIAL,,,,204,OTHER,191.3,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
HLA I LOW RESOLUTION ONE ANTI,81374,CPT,300,RC,,OUTPATIENT,,,255,102,MONUMENT,COMMERCIAL,,,,204,,191.3,249.9,
OSMOLALITY  SERUM,83930,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GALACTOSEMIA GALT GENE PANEL,81401,CPT,300,RC,,OUTPATIENT,,,1259,503.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1007.2,OTHER,944.3,1233.8,PERCENT OF CHARGES BASED ON HCPCS CODE
GALACTOSEMIA GALT GENE PANEL,81401,CPT,300,RC,,OUTPATIENT,,,1259,503.6,MONUMENT,COMMERCIAL,,,,1007.2,,944.3,1233.8,
OSMOLALITY  URINE,83935,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PT MIX 1:1,81448,CPT,300,RC,,OUTPATIENT,,,1169.8,467.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,935.84,OTHER,877.4,1146.4,PERCENT OF CHARGES BASED ON HCPCS CODE
PT MIX 1:1,81448,CPT,300,RC,,OUTPATIENT,,,1169.8,467.92,MONUMENT,COMMERCIAL,,,,935.8,,877.4,1146.4,
Z URINE OSMOLALITY,83935,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
M PROTEIN ISOTYPE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.59,OTHER,111.8,146,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
M PROTEIN ISOTYPE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,MONUMENT,COMMERCIAL,,,,119.2,,111.8,146,
M PROTEIN ISOTYPE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,UNITED HEALTH,UNITED COMMERCIAL,,,,111.8,,111.8,146,
BIRT HOGG DUB SYNDROME,81479,CPT,300,RC,,OUTPATIENT,,,1896.79,758.716,BLUE CROSS ANTHEM,COMMERCIAL,,,,1517.432,OTHER,1422.6,1858.9,PERCENT OF CHARGES BASED ON HCPCS CODE
BIRT HOGG DUB SYNDROME,81479,CPT,300,RC,,OUTPATIENT,,,1896.79,758.716,MONUMENT,COMMERCIAL,,,,1517.4,,1422.6,1858.9,
OSTEOCALCIN SERUM,83937,CPT,301,RC,,OUTPATIENT,,,211.3,84.52,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,158.5,207.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHARMACOGENOMICS PANEL V,0029U,HCPCS,300,RC,,INPATIENT,,,1484.54,593.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,1350.93,OTHER,1113.4,1454.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PHARMACOGENOMICS PANEL V,0029U,HCPCS,300,RC,,INPATIENT,,,1484.54,593.816,MONUMENT,COMMERCIAL,,,,1187.6,,1113.4,1454.8,
PHARMACOGENOMICS PANEL V,0029U,HCPCS,300,RC,,INPATIENT,,,1484.54,593.816,UNITED HEALTH,UNITED COMMERCIAL,,,,1113.4,,1113.4,1454.8,
ZMOPATH PROCEDURE LEVEL 7,81406,CPT,300,RC,,OUTPATIENT,,,1650,660,BLUE CROSS ANTHEM,COMMERCIAL,,,,1320,OTHER,1237.5,1617,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMOPATH PROCEDURE LEVEL 7,81406,CPT,300,RC,,OUTPATIENT,,,1650,660,MONUMENT,COMMERCIAL,,,,1320,,1237.5,1617,
OXALATE PLASMA,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.81,105.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZUNLISTED MOLECULAR PATHOLOGY,81479,CPT,300,RC,,OUTPATIENT,,,550,220,BLUE CROSS ANTHEM,COMMERCIAL,,,,440,OTHER,412.5,539,PERCENT OF CHARGES BASED ON HCPCS CODE
ZUNLISTED MOLECULAR PATHOLOGY,81479,CPT,300,RC,,OUTPATIENT,,,550,220,MONUMENT,COMMERCIAL,,,,440,,412.5,539,
URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.81,105.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROMO MICRO AUTO STILL FFPE,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2747.2,OTHER,2575.5,3365.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMO MICRO AUTO STILL FFPE,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,MONUMENT,COMMERCIAL,,,,2747.2,,2575.5,3365.3,
Z URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OUT-PT/OBS RESPIRATORY PANEL,87631,CPT,300,RC,,OUTPATIENT,,,285.26,114.104,BLUE CROSS ANTHEM,COMMERCIAL,,,,228.208,OTHER,213.9,279.6,PERCENT OF CHARGES BASED ON HCPCS CODE
OUT-PT/OBS RESPIRATORY PANEL,87631,CPT,300,RC,,OUTPATIENT,,,285.26,114.104,MONUMENT,COMMERCIAL,,,,228.2,,213.9,279.6,
HER-2/NEU QUANTITATIVE,83950,CPT,300,RC,,OUTPATIENT,,,482.75,193.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,362.06,473.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZINC TRANSPORT 8 AB,86341,CPT,302,RC,,OUTPATIENT,,,665.19,266.076,BLUE CROSS ANTHEM,COMMERCIAL,,,,532.152,OTHER,498.9,651.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZINC TRANSPORT 8 AB,86341,CPT,302,RC,,OUTPATIENT,,,665.19,266.076,MONUMENT,COMMERCIAL,,,,532.2,,498.9,651.9,
DES-GAMMA CARBOXY PROTHROMBIN,83951,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,226.69,296.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALPHA-2-MCAROGLOBULIN,83883,CPT,301,RC,,OUTPATIENT,,,27.2,10.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,21.76,OTHER,20.4,26.7,PERCENT OF CHARGES BASED ON HCPCS CODE
ALPHA-2-MCAROGLOBULIN,83883,CPT,301,RC,,OUTPATIENT,,,27.2,10.88,MONUMENT,COMMERCIAL,,,,21.8,,20.4,26.7,
PTH INTACT MOLECULE CALCIUM,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,228,297.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HHTGG GENEIC PANEL 1,81406,CPT,300,RC,,OUTPATIENT,,,3779.96,1511.984,BLUE CROSS ANTHEM,COMMERCIAL,,,,3023.968,OTHER,2835,3704.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HHTGG GENEIC PANEL 1,81406,CPT,300,RC,,OUTPATIENT,,,3779.96,1511.984,MONUMENT,COMMERCIAL,,,,3024,,2835,3704.4,
Z PARATHORMONE,83970,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.94,107.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HHTGG GENEIC PANEL 2,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,BLUE CROSS ANTHEM,COMMERCIAL,,,,3537.288,OTHER,3316.2,4333.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HHTGG GENEIC PANEL 2,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,MONUMENT,COMMERCIAL,,,,3537.3,,3316.2,4333.2,
PARATHYROID HORMONE,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,228,297.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NCDA GENE PANEL,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,BLUE CROSS ANTHEM,COMMERCIAL,,,,3537.288,OTHER,3316.2,4333.2,PERCENT OF CHARGES BASED ON HCPCS CODE
NCDA GENE PANEL,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,MONUMENT,COMMERCIAL,,,,3537.3,,3316.2,4333.2,
STOOL PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MUMPS PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,BLUE CROSS ANTHEM,COMMERCIAL,,,,540,OTHER,506.3,661.5,PERCENT OF CHARGES BASED ON HCPCS CODE
MUMPS PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,MONUMENT,COMMERCIAL,,,,540,,506.3,661.5,
BODY FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MEASLES PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,BLUE CROSS ANTHEM,COMMERCIAL,,,,540,OTHER,506.3,661.5,PERCENT OF CHARGES BASED ON HCPCS CODE
MEASLES PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,MONUMENT,COMMERCIAL,,,,540,,506.3,661.5,
PLEURAL FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.2,102.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.2,102.2,
URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.2,102.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.2,102.2,
Z URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,83.4,OTHER,78.2,102.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,MONUMENT,COMMERCIAL,,,,83.4,,78.2,102.2,
PHENCYCLIDINE LEVEL,83992,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.06,77.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"THALLIUM, BLOOD",83018,CPT,300,RC,,OUTPATIENT,,,327,130.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,261.6,OTHER,245.3,320.5,PERCENT OF CHARGES BASED ON HCPCS CODE
"THALLIUM, BLOOD",83018,CPT,300,RC,,OUTPATIENT,,,327,130.8,MONUMENT,COMMERCIAL,,,,261.6,,245.3,320.5,
UR PHENCYCLIDINE CONFIMATION,83992,CPT,301,RC,,OUTPATIENT,,,120,48,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,90,117.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HISTAMINE PLASMA,83088,CPT,301,RC,,OUTPATIENT,,,176.25,70.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,141,OTHER,132.19,172.73,PERCENT OF CHARGES BASED ON HCPCS CODE
HISTAMINE PLASMA,83088,CPT,301,RC,,OUTPATIENT,,,176.25,70.5,MONUMENT,COMMERCIAL,,,,141,,132.19,172.73,
CALPROTECTIN FECAL,83993,CPT,300,RC,,OUTPATIENT,,,435,174,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,326.25,426.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HOMOCYSTEINE TOTAL URINE,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,BLUE CROSS ANTHEM,COMMERCIAL,,,,150,OTHER,140.63,183.75,PERCENT OF CHARGES BASED ON HCPCS CODE
HOMOCYSTEINE TOTAL URINE,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,MONUMENT,COMMERCIAL,,,,150,,140.63,183.75,
FLUPHENAZINE,84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.56,67.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FAMILIIAL AMYLOIDOSIS REFLEX,82542,CPT,301,RC,,OUTPATIENT,,,332,132.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,265.6,OTHER,249,325.4,PERCENT OF CHARGES BASED ON HCPCS CODE
FAMILIIAL AMYLOIDOSIS REFLEX,82542,CPT,301,RC,,OUTPATIENT,,,332,132.8,MONUMENT,COMMERCIAL,,,,265.6,,249,325.4,
THIORIDAZINE (MELLARIL),84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.56,67.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,18.6,7.44,BLUE CROSS ANTHEM,COMMERCIAL,,,,14.88,OTHER,14,18.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,18.6,7.44,MONUMENT,COMMERCIAL,,,,14.9,,14,18.2,
P PHENYLALANINE (PKU),84030,CPT,300,RC,,OUTPATIENT,,,15,6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.25,14.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
ACID PHOS TOTAL,84060,CPT,300,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESTRADIOL SERUM,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.2,OTHER,154.88,202.37,PERCENT OF CHARGES BASED ON HCPCS CODE
ESTRADIOL SERUM,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,MONUMENT,COMMERCIAL,,,,165.2,,154.88,202.37,
PROSTATIC ACID PHOSPHATASE,84066,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.56,79.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROGLOBULIN MASS SPECT MAYO,84432,CPT,301,RC,,OUTPATIENT,,,362.8,145.12,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.24,OTHER,272.1,355.5,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROGLOBULIN MASS SPECT MAYO,84432,CPT,301,RC,,OUTPATIENT,,,362.8,145.12,MONUMENT,COMMERCIAL,,,,290.2,,272.1,355.5,
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.38,47.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.38,47.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BENZODIAZEPINE CONFIRM URINE,G0480,HCPCS,300,RC,,INPATIENT,,,228.86,91.544,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.26,OTHER,171.6,224.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BENZODIAZEPINE CONFIRM URINE,G0480,HCPCS,300,RC,,INPATIENT,,,228.86,91.544,MONUMENT,COMMERCIAL,,,,183.1,,171.6,224.3,
BENZODIAZEPINE CONFIRM URINE,G0480,HCPCS,300,RC,,INPATIENT,,,228.86,91.544,UNITED HEALTH,UNITED COMMERCIAL,,,,171.6,,171.6,224.3,
INTERPRETATION & WRITTEN REPRT,86078,CPT,300,RC,,OUTPATIENT,,,136.5,54.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.2,OTHER,102.38,133.77,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERPRETATION & WRITTEN REPRT,86078,CPT,300,RC,,OUTPATIENT,,,136.5,54.6,MONUMENT,COMMERCIAL,,,,109.2,,102.38,133.77,
Z AKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,10.36,4.144,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PANCREATIC ELASTASE SERUM,83519,CPT,300,RC,,OUTPATIENT,,,390,156,BLUE CROSS ANTHEM,COMMERCIAL,,,,312,OTHER,292.5,382.2,PERCENT OF CHARGES BASED ON HCPCS CODE
PANCREATIC ELASTASE SERUM,83519,CPT,300,RC,,OUTPATIENT,,,390,156,MONUMENT,COMMERCIAL,,,,312,,292.5,382.2,
ALKALINE PHOSPHATASE ISO,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,124.88,163.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MODECULE NUCLEIC AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
MODECULE NUCLEIC AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
BONE ALKALINE PHOSPHATASE,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,124.88,163.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOLECULE NUCLEIC AMPLIFICATION,8389859,CPT,301,RC,59,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULE NUCLEIC AMPLIFICATION,8389859,CPT,301,RC,59,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
Z PHOSPHATIDYLGLYCEROL,84081,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,171.75,68.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.4,OTHER,128.81,168.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,171.75,68.7,MONUMENT,COMMERCIAL,,,,137.4,,128.81,168.32,
Z ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,210,84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.5,205.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC ACID,83898,CPT,300,RC,,OUTPATIENT,,,171.75,68.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.4,OTHER,128.81,168.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC ACID,83898,CPT,300,RC,,OUTPATIENT,,,171.75,68.7,MONUMENT,COMMERCIAL,,,,137.4,,128.81,168.32,
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,95,38,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.3,93.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,57,22.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.75,55.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
Z PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,14.25,5.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,10.69,13.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
URINE PHOSPHORUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,114.25,45.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.69,111.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z REVERSE TRANSCRIPTION,83902,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.2,OTHER,107.06,139.9,PERCENT OF CHARGES BASED ON HCPCS CODE
Z REVERSE TRANSCRIPTION,83902,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,MONUMENT,COMMERCIAL,,,,114.2,,107.06,139.9,
Z URINE PHOSPHOROUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
PORPHOBILINGEN QUANT,84110,CPT,301,RC,,OUTPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
AMNISURE FOR ROM,84112,CPT,300,RC,,OUTPATIENT,,,196.25,78.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.19,192.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOLECULAR ISOLATION/EXTRACTION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.2,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
MOLECULAR ISOLATION/EXTRACTION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
PORPHYRINS QUANT 24 HR,84120,CPT,301,RC,,OUTPATIENT,,,188,75.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,141,184.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,35.8,OTHER,33.56,43.86,PERCENT OF CHARGES BASED ON HCPCS CODE
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,MONUMENT,COMMERCIAL,,,,35.8,,33.56,43.86,
FECES PORPHYRINS ASSAY,84126,CPT,301,RC,,OUTPATIENT,,,333,133.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,249.75,326.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
POTASSIUM (K) SERUM,84132,CPT,301,RC,,OUTPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60,78.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HMG-COA REDUCTASE AB,82397,CPT,301,RC,,OUTPATIENT,,,274,109.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,219.2,OTHER,205.5,268.5,PERCENT OF CHARGES BASED ON HCPCS CODE
HMG-COA REDUCTASE AB,82397,CPT,301,RC,,OUTPATIENT,,,274,109.6,MONUMENT,COMMERCIAL,,,,219.2,,205.5,268.5,
URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z MUTATION SCANNING,8390359,CPT,300,RC,59,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
Z MUTATION SCANNING,8390359,CPT,300,RC,59,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
Z URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSMOLALITY FECES,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,85,OTHER,79.69,104.13,PERCENT OF CHARGES BASED ON HCPCS CODE
OSMOLALITY FECES,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,MONUMENT,COMMERCIAL,,,,85,,79.69,104.13,
PREALBUMIN,84134,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.69,64.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALDOSTERONE URINE,82088,CPT,300,RC,,OUTPATIENT,,,255,102,BLUE CROSS ANTHEM,COMMERCIAL,,,,204,OTHER,191.25,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ALDOSTERONE URINE,82088,CPT,300,RC,,OUTPATIENT,,,255,102,MONUMENT,COMMERCIAL,,,,204,,191.25,249.9,
PREGNENOLONE,84140,CPT,300,RC,,OUTPATIENT,,,264.75,105.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,198.56,259.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NIACIN (NICOTINIC ACID),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.8,OTHER,128.25,167.58,PERCENT OF CHARGES BASED ON HCPCS CODE
NIACIN (NICOTINIC ACID),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,MONUMENT,COMMERCIAL,,,,136.8,,128.25,167.58,
17 HYROXYPREGNEN,84143,CPT,300,RC,,OUTPATIENT,,,211,84.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,158.25,206.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGEST,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGEST,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
PROGESTERONE,84144,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
PROCALCITONIN SERUM,84145,CPT,300,RC,,OUTPATIENT,,,212.5,85,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159.38,208.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
PROLACTIN,84146,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
"MACROPROLACTIN, S",84146,CPT,300,RC,,OUTPATIENT,,,133,53.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.75,130.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.25,57.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.25,57.82,
PROSTAGLANDIN,84150,CPT,300,RC,,OUTPATIENT,,,142,56.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,106.5,139.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SODIUM QUANTITATIVE FECES,84302,CPT,301,RC,,OUTPATIENT,,,144.75,57.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.8,OTHER,108.56,141.86,PERCENT OF CHARGES BASED ON HCPCS CODE
SODIUM QUANTITATIVE FECES,84302,CPT,301,RC,,OUTPATIENT,,,144.75,57.9,MONUMENT,COMMERCIAL,,,,115.8,,108.56,141.86,
UR PROSTAGLANDIN D2 (PG D2),84150,CPT,300,RC,,OUTPATIENT,,,603,241.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,452.3,590.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTIC FIBROSIS MUTATION ANALY,81220,CPT,300,RC,,OUTPATIENT,,,1113.2,445.28,BLUE CROSS ANTHEM,COMMERCIAL,,,,890.56,OTHER,301.88,394.45,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTIC FIBROSIS MUTATION ANALY,81220,CPT,300,RC,,OUTPATIENT,,,1113.2,445.28,MONUMENT,COMMERCIAL,,,,322,,301.88,394.45,
PSA COMPLEXED (DIRECT METHOD),84152,CPT,301,RC,,OUTPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,151.88,198.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTATIN C,82610,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.8,OTHER,153.56,200.66,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTATIN C,82610,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,MONUMENT,COMMERCIAL,,,,163.8,,153.56,200.66,
Z TOTAL PSA,84153,CPT,301,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MTHFR MUTATION DETECTION,81291,CPT,300,RC,,OUTPATIENT,,,447.5,179,BLUE CROSS ANTHEM,COMMERCIAL,,,,358,OTHER,335.63,438.55,PERCENT OF CHARGES BASED ON HCPCS CODE
MTHFR MUTATION DETECTION,81291,CPT,300,RC,,OUTPATIENT,,,447.5,179,MONUMENT,COMMERCIAL,,,,358,,335.63,438.55,
PSA  TOTAL DIAGNOSTIC,84153,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,125.81,164.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UR PROSTAGLANDIN D2 (PG D2),84150,CPT,300,RC,,OUTPATIENT,,,603,241.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,482.4,OTHER,452.3,590.9,PERCENT OF CHARGES BASED ON HCPCS CODE
UR PROSTAGLANDIN D2 (PG D2),84150,CPT,300,RC,,OUTPATIENT,,,603,241.2,MONUMENT,COMMERCIAL,,,,482.4,,452.3,590.9,
MAYO PSAD SENDOUT,84153,CPT,301,RC,,OUTPATIENT,,,151,60.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,113.3,148,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.064,OTHER,49.7,65,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,MONUMENT,COMMERCIAL,,,,53.1,,49.7,65,
PSA-FREE   DIAGNOSTIC,84154,CPT,301,RC,,OUTPATIENT,,,158.25,63.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,118.69,155.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.064,OTHER,49.7,65,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,MONUMENT,COMMERCIAL,,,,53.1,,49.7,65,
TOTAL PROTEIN,84155,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.064,OTHER,49.7,65,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,MONUMENT,COMMERCIAL,,,,53.1,,49.7,65,
ZASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,OUTPATIENT,,,25,10,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18.8,24.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SEROTONIN RELEASE ASSAY,82542,CPT,301,RC,,OUTPATIENT,,,447,178.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,357.6,OTHER,335.3,438.1,PERCENT OF CHARGES BASED ON HCPCS CODE
SEROTONIN RELEASE ASSAY,82542,CPT,301,RC,,OUTPATIENT,,,447,178.8,MONUMENT,COMMERCIAL,,,,357.6,,335.3,438.1,
URINE PROTEIN,84156,CPT,301,RC,,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.75,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
QUAD SCREEN (SECOND TRIMESTER),81511,CPT,300,RC,,OUTPATIENT,,,307,122.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,245.6,OTHER,147.75,193.06,PERCENT OF CHARGES BASED ON HCPCS CODE
QUAD SCREEN (SECOND TRIMESTER),81511,CPT,300,RC,,OUTPATIENT,,,307,122.8,MONUMENT,COMMERCIAL,,,,157.6,,147.75,193.06,
"URINE PROTEIN, TOTAL",84156,CPT,301,RC,,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.75,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AFP,82105,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AFP,82105,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
TOTAL PROTEIN URINE TIMED 24HR,84156,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ESTRIOL,82677,CPT,301,RC,,OUTPATIENT,,,66,26.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.8,OTHER,49.5,64.68,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ESTRIOL,82677,CPT,301,RC,,OUTPATIENT,,,66,26.4,MONUMENT,COMMERCIAL,,,,52.8,,49.5,64.68,
BFL TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HCG,84702,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.4,OTHER,31.31,40.92,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HCG,84702,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,MONUMENT,COMMERCIAL,,,,33.4,,31.31,40.92,
PERITONEAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z INHIBIN,86336,CPT,300,RC,,OUTPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,34.4,OTHER,32.25,42.14,PERCENT OF CHARGES BASED ON HCPCS CODE
Z INHIBIN,86336,CPT,300,RC,,OUTPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
PLEURAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,215,86,BLUE CROSS ANTHEM,COMMERCIAL,,,,172,OTHER,161.3,210.7,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,215,86,MONUMENT,COMMERCIAL,,,,172,,161.3,210.7,
SYNOVIAL FLUID T.P.,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
CSF TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
Z PROTEIN ELECTROPHORESIS,84165,CPT,300,RC,,OUTPATIENT,,,20,8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.38,39.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,210,84,BLUE CROSS ANTHEM,COMMERCIAL,,,,168,OTHER,157.5,205.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,210,84,MONUMENT,COMMERCIAL,,,,168,,157.5,205.8,
ZPROTEIN E-PHORESIS SERUM,84165,CPT,300,RC,,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.3,57.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY OF PRIMIDONE,80188,CPT,300,RC,,OUTPATIENT,,,52.5,21,BLUE CROSS ANTHEM,COMMERCIAL,,,,42,OTHER,39.4,51.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF PRIMIDONE,80188,CPT,300,RC,,OUTPATIENT,,,52.5,21,MONUMENT,COMMERCIAL,,,,42,,39.4,51.5,
PROTEIN ELECTROPHORESIS BDY FL,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.31,150.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,122,48.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.6,OTHER,91.5,119.6,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,122,48.8,MONUMENT,COMMERCIAL,,,,97.6,,91.5,119.6,
URINE ELECTROPHORESIS PROTEIN,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.31,150.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OSTEOCALCIN SERUM,83937,CPT,301,RC,,OUTPATIENT,,,211.3,84.52,BLUE CROSS ANTHEM,COMMERCIAL,,,,169.04,OTHER,158.5,207.1,PERCENT OF CHARGES BASED ON HCPCS CODE
OSTEOCALCIN SERUM,83937,CPT,301,RC,,OUTPATIENT,,,211.3,84.52,MONUMENT,COMMERCIAL,,,,169,,158.5,207.1,
"MYELIN ASSOC GLYCOPROTEIN, IGM",84181,CPT,300,RC,,OUTPATIENT,,,255,102,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.25,249.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.3,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.3,563.5,
AUTOIMMUNE INNER EAR 68KD,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,214.13,279.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
COLLAPSIN RESPONSE MP 5 IGG,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,214.13,279.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CAROTENE BETA (LS),82380,CPT,301,RC,,OUTPATIENT,,,184,73.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,147.2,OTHER,138,180.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CAROTENE BETA (LS),82380,CPT,301,RC,,OUTPATIENT,,,184,73.6,MONUMENT,COMMERCIAL,,,,147.2,,138,180.3,
CRMP S IGG WESTERN BLOT,84182,CPT,300,RC,,OUTPATIENT,,,192,76.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144,188.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTITHROMBIN COMPLEX,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.4,OTHER,182.3,238.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTITHROMBIN COMPLEX,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,MONUMENT,COMMERCIAL,,,,194.4,,182.3,238.1,
PROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,165,66,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,123.8,161.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTI MDA 5 AB,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.4,OTHER,182.3,238.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI MDA 5 AB,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,MONUMENT,COMMERCIAL,,,,194.4,,182.3,238.1,
ZPROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,553,221.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,414.8,541.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTI MI 2 AB,83516,CPT,300,RC,,OUTPATIENT,,,164,65.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.2,OTHER,123,160.7,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI MI 2 AB,83516,CPT,300,RC,,OUTPATIENT,,,164,65.6,MONUMENT,COMMERCIAL,,,,131.2,,123,160.7,
PROTOPORPHYRINS FRAC ERYTHRO,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHOLIPASE A2 RECEPTOR,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,295.5,386.1,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHOLIPASE A2 RECEPTOR,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,315.2,,295.5,386.1,
ZINC PROTOPORPHYRINS,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APOLIPOPROTEIN B SINGLE,82172,CPT,301,RC,,OUTPATIENT,,,42.18,16.872,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.744,OTHER,31.6,41.3,PERCENT OF CHARGES BASED ON HCPCS CODE
APOLIPOPROTEIN B SINGLE,82172,CPT,301,RC,,OUTPATIENT,,,42.18,16.872,MONUMENT,COMMERCIAL,,,,33.7,,31.6,41.3,
PROINSULIN ASSAY,84206,CPT,301,RC,,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MECONIUM DRUG PANEL,80307,CPT,301,RC,,OUTPATIENT,,,224.25,89.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,179.4,OTHER,168.19,219.77,PERCENT OF CHARGES BASED ON HCPCS CODE
MECONIUM DRUG PANEL,80307,CPT,301,RC,,OUTPATIENT,,,224.25,89.7,MONUMENT,COMMERCIAL,,,,179.4,,168.19,219.77,
VITAMIN B6,84207,CPT,301,RC,,OUTPATIENT,,,179.25,71.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,134.44,175.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AMPHETAMINE,G0480,HCPCS,300,RC,,BOTH,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.64,OTHER,42.56,55.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z AMPHETAMINE,G0480,HCPCS,300,RC,,BOTH,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
Z AMPHETAMINE,G0480,HCPCS,300,RC,,BOTH,,,56.75,22.7,UNITED HEALTH,UNITED COMMERCIAL,,,,42.56,,42.56,55.62,
Z COCAINE & METABOLITES,80353,CPT,301,RC,,OUTPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.4,OTHER,42.56,55.62,PERCENT OF CHARGES BASED ON HCPCS CODE
Z COCAINE & METABOLITES,80353,CPT,301,RC,,OUTPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
PYRUVIC ACID B,84210,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.81,180.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CANNABINOIDS,80349,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.4,OTHER,42.56,55.62,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CANNABINOIDS,80349,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
PYRUVATE KINASE ERYTHROCYTES,84220,CPT,300,RC,,OUTPATIENT,,,145.75,58.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.31,142.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z OPIATES,80361,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.4,OTHER,42.56,55.62,PERCENT OF CHARGES BASED ON HCPCS CODE
Z OPIATES,80361,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,MONUMENT,COMMERCIAL,,,,45.4,,42.56,55.62,
Z ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,187.5,245,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PHENCYCLIDINE,8010191,CPT,300,RC,91,OUTPATIENT,,,70.5,28.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.4,OTHER,52.88,69.09,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PHENCYCLIDINE,8010191,CPT,300,RC,91,OUTPATIENT,,,70.5,28.2,MONUMENT,COMMERCIAL,,,,56.4,,52.88,69.09,
ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,85,34,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63.8,83.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYASTHENIA GRAVIS MUSK REFLEX,83519,CPT,300,RC,,OUTPATIENT,,,195,78,BLUE CROSS ANTHEM,COMMERCIAL,,,,156,OTHER,146.3,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
MYASTHENIA GRAVIS MUSK REFLEX,83519,CPT,300,RC,,OUTPATIENT,,,195,78,MONUMENT,COMMERCIAL,,,,156,,146.3,191.1,
SOLUBLE TRANSFERRIN RECEPTOR,84238,CPT,300,RC,,OUTPATIENT,,,200.25,80.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.19,196.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INFLIXIMAB AB S CHARGE,82397,CPT,301,RC,,OUTPATIENT,,,236,94.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,188.8,OTHER,177,231.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INFLIXIMAB AB S CHARGE,82397,CPT,301,RC,,OUTPATIENT,,,236,94.4,MONUMENT,COMMERCIAL,,,,188.8,,177,231.3,
RENIN ACTIVITY,84244,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PORPHYRINS EVALUATION WB,84311,CPT,300,RC,,OUTPATIENT,,,164,65.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.2,OTHER,123,160.7,PERCENT OF CHARGES BASED ON HCPCS CODE
PORPHYRINS EVALUATION WB,84311,CPT,300,RC,,OUTPATIENT,,,164,65.6,MONUMENT,COMMERCIAL,,,,131.2,,123,160.7,
VIT B2 RIBOFLAVIN,84252,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE NECROSIS FACTOR ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,486,194.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,388.8,OTHER,364.5,476.3,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE NECROSIS FACTOR ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,486,194.4,MONUMENT,COMMERCIAL,,,,388.8,,364.5,476.3,
SELENIUM,84255,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MELANOCYTE STM HOR ALPHA,83519,CPT,300,RC,,OUTPATIENT,,,305.67,122.268,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.536,OTHER,229.3,299.6,PERCENT OF CHARGES BASED ON HCPCS CODE
MELANOCYTE STM HOR ALPHA,83519,CPT,300,RC,,OUTPATIENT,,,305.67,122.268,MONUMENT,COMMERCIAL,,,,244.5,,229.3,299.6,
SEROTONIN,84260,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.06,139.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PRI MEMBRANOUS NEPHROPATH DIAG,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,295.5,386.1,PERCENT OF CHARGES BASED ON HCPCS CODE
PRI MEMBRANOUS NEPHROPATH DIAG,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,315.2,,295.5,386.1,
SEX HORMONE BINDING GLOBULIN,84270,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OBSTETRIC PROFILE,80081,CPT,301,RC,,OUTPATIENT,,,149.72,59.888,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.776,OTHER,112.3,146.7,PERCENT OF CHARGES BASED ON HCPCS CODE
OBSTETRIC PROFILE,80081,CPT,301,RC,,OUTPATIENT,,,149.72,59.888,MONUMENT,COMMERCIAL,,,,119.8,,112.3,146.7,
SODIUM (NA) SERUM,84295,CPT,301,RC,,OUTPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60,78.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN STABILITY SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,85,34,BLUE CROSS ANTHEM,COMMERCIAL,,,,68,OTHER,63.8,83.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN STABILITY SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,85,34,MONUMENT,COMMERCIAL,,,,68,,63.8,83.3,
Z SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,165,66,BLUE CROSS ANTHEM,COMMERCIAL,,,,132,OTHER,123.8,161.7,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,165,66,MONUMENT,COMMERCIAL,,,,132,,123.8,161.7,
SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.75,71.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,95,38,BLUE CROSS ANTHEM,COMMERCIAL,,,,76,OTHER,71.3,93.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,95,38,MONUMENT,COMMERCIAL,,,,76,,71.3,93.1,
URINE SODIUM 24 HR,84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.75,71.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.4,110.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.4,110.3,
SODIUM QUANTITATIVE FECES,84302,CPT,301,RC,,OUTPATIENT,,,144.75,57.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,108.56,141.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.4,110.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.4,110.3,
INSULIN GROWTH FACTOR I,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.38,192.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,160,64,BLUE CROSS ANTHEM,COMMERCIAL,,,,128,OTHER,120,156.8,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,160,64,MONUMENT,COMMERCIAL,,,,128,,120,156.8,
SOMATOMEDIN-C,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.38,192.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,85,34,BLUE CROSS ANTHEM,COMMERCIAL,,,,68,OTHER,63.8,83.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,85,34,MONUMENT,COMMERCIAL,,,,68,,63.8,83.3,
SOMATOSTATIN,84307,CPT,301,RC,,OUTPATIENT,,,442.75,177.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,332.06,433.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,85,34,BLUE CROSS ANTHEM,COMMERCIAL,,,,68,OTHER,63.8,83.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,85,34,MONUMENT,COMMERCIAL,,,,68,,63.8,83.3,
PORPHYRINS  TOTAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,95,38,BLUE CROSS ANTHEM,COMMERCIAL,,,,76,OTHER,71.3,93.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,95,38,MONUMENT,COMMERCIAL,,,,76,,71.3,93.1,
ADENOSINE DEAMINASE FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,185,74,BLUE CROSS ANTHEM,COMMERCIAL,,,,148,OTHER,138.8,181.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,185,74,MONUMENT,COMMERCIAL,,,,148,,138.8,181.3,
CHYMOTRYSIN FECAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,140,56,BLUE CROSS ANTHEM,COMMERCIAL,,,,112,OTHER,105,137.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,140,56,MONUMENT,COMMERCIAL,,,,112,,105,137.2,
CHOLESTEROL BODY FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PHOSPHATIDYLETHANOL CONFIRM B,80321,CPT,300,RC,,OUTPATIENT,,,126,50.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,100.8,OTHER,94.5,123.5,PERCENT OF CHARGES BASED ON HCPCS CODE
PHOSPHATIDYLETHANOL CONFIRM B,80321,CPT,300,RC,,OUTPATIENT,,,126,50.4,MONUMENT,COMMERCIAL,,,,100.8,,94.5,123.5,
BROMIDE  BLOOD,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,OUTPATIENT,,,258.4,103.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,206.72,OTHER,193.8,253.2,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,OUTPATIENT,,,258.4,103.36,MONUMENT,COMMERCIAL,,,,206.7,,193.8,253.2,
Z SPECTROPHOTOMETRY ANALYTE,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IL 2 RECEPTOR SOLUBLE,83520,CPT,300,RC,,OUTPATIENT,,,144.31,57.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.448,OTHER,108.2,141.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IL 2 RECEPTOR SOLUBLE,83520,CPT,300,RC,,OUTPATIENT,,,144.31,57.724,MONUMENT,COMMERCIAL,,,,115.4,,108.2,141.4,
PORPHYRINS EVALUATION WB,84311,CPT,300,RC,,OUTPATIENT,,,164,65.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,123,160.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORIDE PLASMA,82735,CPT,301,RC,,OUTPATIENT,,,135,54,BLUE CROSS ANTHEM,COMMERCIAL,,,,108,OTHER,101.3,132.3,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORIDE PLASMA,82735,CPT,301,RC,,OUTPATIENT,,,135,54,MONUMENT,COMMERCIAL,,,,108,,101.3,132.3,
PLEURAL FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,38.5,15.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.88,37.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOBAZAM AND METABOLITE,80339,CPT,301,RC,,OUTPATIENT,,,228.86,91.544,BLUE CROSS ANTHEM,COMMERCIAL,,,,183.088,OTHER,171.6,224.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOBAZAM AND METABOLITE,80339,CPT,301,RC,,OUTPATIENT,,,228.86,91.544,MONUMENT,COMMERCIAL,,,,183.1,,171.6,224.3,
BFL-SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,70.75,28.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,53.06,69.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NIACIN (NICOTINIC ACID),84591,CPT,300,RC,,OUTPATIENT,,,210,84,BLUE CROSS ANTHEM,COMMERCIAL,,,,168,OTHER,157.5,205.8,PERCENT OF CHARGES BASED ON HCPCS CODE
NIACIN (NICOTINIC ACID),84591,CPT,300,RC,,OUTPATIENT,,,210,84,MONUMENT,COMMERCIAL,,,,168,,157.5,205.8,
FECAL REDUCING SUBSTANCE,84376,CPT,301,RC,,OUTPATIENT,,,191.75,76.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,143.81,187.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZPROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,553,221.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,442.4,OTHER,414.8,541.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZPROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,553,221.2,MONUMENT,COMMERCIAL,,,,442.4,,414.8,541.9,
GLYCOMARK,84378,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,151.31,197.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
QUANTITATE BY HPLC,83021,CPT,301,RC,,OUTPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,36,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
QUANTITATE BY HPLC,83021,CPT,301,RC,,OUTPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
Z URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
QUANTITATE BY ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,36,OTHER,111.56,145.78,PERCENT OF CHARGES BASED ON HCPCS CODE
QUANTITATE BY ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,119,,111.56,145.78,
URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UR PHENCYCLIDINE CONFIMATION,83992,CPT,301,RC,,OUTPATIENT,,,120,48,BLUE CROSS ANTHEM,COMMERCIAL,,,,96,OTHER,90,117.6,PERCENT OF CHARGES BASED ON HCPCS CODE
UR PHENCYCLIDINE CONFIMATION,83992,CPT,301,RC,,OUTPATIENT,,,120,48,MONUMENT,COMMERCIAL,,,,96,,90,117.6,
Z TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,76,30.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57,74.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UR AMMONIUM RANDOM,82140,CPT,301,RC,,OUTPATIENT,,,538.66,215.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.928,OTHER,404,527.9,PERCENT OF CHARGES BASED ON HCPCS CODE
UR AMMONIUM RANDOM,82140,CPT,301,RC,,OUTPATIENT,,,538.66,215.464,MONUMENT,COMMERCIAL,,,,430.9,,404,527.9,
TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,16.92,6.768,BLUE CROSS ANTHEM,COMMERCIAL,,,,13.536,OTHER,12.7,16.6,PERCENT OF CHARGES BASED ON HCPCS CODE
Z BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,16.92,6.768,MONUMENT,COMMERCIAL,,,,13.5,,12.7,16.6,
TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.38,192.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"Z BILIRUBIN,TOTAL",82247,CPT,301,RC,,OUTPATIENT,,,10.04,4.016,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.032,OTHER,7.5,9.8,PERCENT OF CHARGES BASED ON HCPCS CODE
"Z BILIRUBIN,TOTAL",82247,CPT,301,RC,,OUTPATIENT,,,10.04,4.016,MONUMENT,COMMERCIAL,,,,8,,7.5,9.8,
Z TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,77,30.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.75,75.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,10.36,4.144,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.288,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,10.36,4.144,MONUMENT,COMMERCIAL,,,,8.3,,7.8,10.2,
TESTOSTERONE,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.38,192.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,10.6,4.24,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.48,OTHER,8,10.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,10.6,4.24,MONUMENT,COMMERCIAL,,,,8.5,,8,10.4,
Z TESTOSTERONE BIOAVAILABLE,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57,74.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z AKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,10.36,4.144,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.288,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
Z AKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,10.36,4.144,MONUMENT,COMMERCIAL,,,,8.3,,7.8,10.2,
TEST FW BOUND TOT TEST,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.9,100.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z RIA NONANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,188.05,75.22,BLUE CROSS ANTHEM,COMMERCIAL,,,,150.44,OTHER,141,184.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z RIA NONANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,188.05,75.22,MONUMENT,COMMERCIAL,,,,150.4,,141,184.3,
VITAMIN B1 (THIAMINE),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.25,167.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,OUTPATIENT,,,188.05,75.22,BLUE CROSS ANTHEM,COMMERCIAL,,,,150.44,OTHER,141,184.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,OUTPATIENT,,,188.05,75.22,MONUMENT,COMMERCIAL,,,,150.4,,141,184.3,
NIACIN (NICOTINIC ACID),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.25,167.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZLIPOPRO BLD ELECTROPHORETIC,83700,CPT,300,RC,,OUTPATIENT,,,22.52,9.008,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.016,OTHER,16.9,22.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZLIPOPRO BLD ELECTROPHORETIC,83700,CPT,300,RC,,OUTPATIENT,,,22.52,9.008,MONUMENT,COMMERCIAL,,,,18,,16.9,22.1,
THIOCYANATE ASSAY,84430,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.88,182.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZLIPOPROTEIN BLD HR FRACTION,83701,CPT,301,RC,,OUTPATIENT,,,67.72,27.088,BLUE CROSS ANTHEM,COMMERCIAL,,,,54.176,OTHER,50.8,66.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZLIPOPROTEIN BLD HR FRACTION,83701,CPT,301,RC,,OUTPATIENT,,,67.72,27.088,MONUMENT,COMMERCIAL,,,,54.2,,50.8,66.4,
THYROGLOBULIN ASSAY (SO),84432,CPT,301,RC,,OUTPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.13,115.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.4,OTHER,21.9,28.7,PERCENT OF CHARGES BASED ON HCPCS CODE
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,MONUMENT,COMMERCIAL,,,,23.4,,21.9,28.7,
THYROGLOBULIN MASS SPECT MAYO,84432,CPT,301,RC,,OUTPATIENT,,,362.8,145.12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,272.1,355.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,23.4,OTHER,21.9,28.7,PERCENT OF CHARGES BASED ON HCPCS CODE
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,MONUMENT,COMMERCIAL,,,,23.4,,21.9,28.7,
TOTAL T4,84436,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.19,121.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TEST FW BOUND TOT TEST,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.048,OTHER,76.9,100.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TEST FW BOUND TOT TEST,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,MONUMENT,COMMERCIAL,,,,82,,76.9,100.5,
P THYROXINE (T4),84437,CPT,300,RC,,OUTPATIENT,,,18.5,7.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,13.88,18.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXAMETHASONE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,160.24,64.096,BLUE CROSS ANTHEM,COMMERCIAL,,,,128.192,OTHER,120.2,157,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXAMETHASONE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,160.24,64.096,MONUMENT,COMMERCIAL,,,,128.2,,120.2,157,
FREE T4 THYROXINE,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UR SYNTHETIC THC METABOLITE SC,80307,CPT,301,RC,,OUTPATIENT,,,206.56,82.624,BLUE CROSS ANTHEM,COMMERCIAL,,,,165.248,OTHER,154.9,202.4,PERCENT OF CHARGES BASED ON HCPCS CODE
UR SYNTHETIC THC METABOLITE SC,80307,CPT,301,RC,,OUTPATIENT,,,206.56,82.624,MONUMENT,COMMERCIAL,,,,165.2,,154.9,202.4,
T4 FREE BY DIALYSIS,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GENERAL HEALTH PANEL,80050,CPT,301,RC,,OUTPATIENT,,,324.75,129.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,259.8,OTHER,243.6,318.3,PERCENT OF CHARGES BASED ON HCPCS CODE
GENERAL HEALTH PANEL,80050,CPT,301,RC,,OUTPATIENT,,,324.75,129.9,MONUMENT,COMMERCIAL,,,,259.8,,243.6,318.3,
THYROXINE BINDING GLOBULIN,84442,CPT,300,RC,,OUTPATIENT,,,169,67.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,126.75,165.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BIOTIN VITAMIN,84591,CPT,300,RC,,OUTPATIENT,,,210,84,BLUE CROSS ANTHEM,COMMERCIAL,,,,168,OTHER,157.5,205.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BIOTIN VITAMIN,84591,CPT,300,RC,,OUTPATIENT,,,210,84,MONUMENT,COMMERCIAL,,,,168,,157.5,205.8,
TSH - THYROID STIMU HORMONE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAYO PSAD SENDOUT,84153,CPT,301,RC,,OUTPATIENT,,,151,60.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.8,OTHER,113.3,148,PERCENT OF CHARGES BASED ON HCPCS CODE
MAYO PSAD SENDOUT,84153,CPT,301,RC,,OUTPATIENT,,,151,60.4,MONUMENT,COMMERCIAL,,,,120.8,,113.3,148,
P TSH,84443,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAYO PSAS SENDOUT,G0103,HCPCS,301,RC,,INPATIENT,,,151,60.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.41,OTHER,113.3,148,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAYO PSAS SENDOUT,G0103,HCPCS,301,RC,,INPATIENT,,,151,60.4,MONUMENT,COMMERCIAL,,,,120.8,,113.3,148,
MAYO PSAS SENDOUT,G0103,HCPCS,301,RC,,INPATIENT,,,151,60.4,UNITED HEALTH,UNITED COMMERCIAL,,,,113.3,,113.3,148,
MAGNESIUM QUANTITATIVE FECES,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.4,OTHER,66.94,87.47,PERCENT OF CHARGES BASED ON HCPCS CODE
MAGNESIUM QUANTITATIVE FECES,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,MONUMENT,COMMERCIAL,,,,71.4,,66.94,87.47,
TSH SENSITIVE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
5 HYDROXYINDOLEACETIC ACID P,83497,CPT,300,RC,,OUTPATIENT,,,25.8,10.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.64,OTHER,19.4,25.3,PERCENT OF CHARGES BASED ON HCPCS CODE
5 HYDROXYINDOLEACETIC ACID P,83497,CPT,300,RC,,OUTPATIENT,,,25.8,10.32,MONUMENT,COMMERCIAL,,,,20.6,,19.4,25.3,
THYROID IMMUNOGLOBULINS TSI,84445,CPT,301,RC,,OUTPATIENT,,,526.25,210.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,394.69,515.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,363.8,145.52,BLUE CROSS ANTHEM,COMMERCIAL,,,,291.04,OTHER,272.9,356.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,363.8,145.52,MONUMENT,COMMERCIAL,,,,291,,272.9,356.5,
Z VITAMIN E,84446,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,149.71,59.884,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.768,OTHER,112.3,146.7,PERCENT OF CHARGES BASED ON HCPCS CODE
ZASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,149.71,59.884,MONUMENT,COMMERCIAL,,,,119.8,,112.3,146.7,
CORTISON BINDING GLOBULIN,84449,CPT,300,RC,,OUTPATIENT,,,203.75,81.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,152.81,199.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,OUTPATIENT,,,25,10,BLUE CROSS ANTHEM,COMMERCIAL,,,,20,OTHER,18.8,24.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,OUTPATIENT,,,25,10,MONUMENT,COMMERCIAL,,,,20,,18.8,24.5,
SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZPROTEIN E-PHORESIS SERUM,84165,CPT,300,RC,,OUTPATIENT,,,59,23.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.2,OTHER,44.3,57.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZPROTEIN E-PHORESIS SERUM,84165,CPT,300,RC,,OUTPATIENT,,,59,23.6,MONUMENT,COMMERCIAL,,,,47.2,,44.3,57.8,
Z SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,10.36,4.144,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APOLIPOPROTEIN B PLASMA,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.6,OTHER,71.81,93.84,PERCENT OF CHARGES BASED ON HCPCS CODE
APOLIPOPROTEIN B PLASMA,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,MONUMENT,COMMERCIAL,,,,76.6,,71.81,93.84,
EMPLOYEE SGPT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,295.5,386.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,315.2,,295.5,386.1,
SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,295.5,386.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,315.2,,295.5,386.1,
SGPT EMPLOYEE,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,295.5,386.1,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,315.2,,295.5,386.1,
Z SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,10.6,4.24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,8,10.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GIARDIA LAMBLIA AB IGG,86674,CPT,302,RC,,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GIARDIA LAMBLIA AB IGG,86674,CPT,302,RC,,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
TRANSFERRIN,84466,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.56,59.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GIARDIA LAMBLIA AB IGA,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GIARDIA LAMBLIA AB IGA,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
BODY FLUID TRIGLYCERIDE,84478,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,244.69,319.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z GIARDIA LAMBLIA AB IGM,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,39,OTHER,36.56,47.78,PERCENT OF CHARGES BASED ON HCPCS CODE
Z GIARDIA LAMBLIA AB IGM,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,MONUMENT,COMMERCIAL,,,,39,,36.56,47.78,
Z TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BETA 2 GLYCOPROTEIN 1 ANTIBODY,86146,CPT,300,RC,,OUTPATIENT,,,65,26,BLUE CROSS ANTHEM,COMMERCIAL,,,,52,OTHER,48.8,63.7,PERCENT OF CHARGES BASED ON HCPCS CODE
BETA 2 GLYCOPROTEIN 1 ANTIBODY,86146,CPT,300,RC,,OUTPATIENT,,,65,26,MONUMENT,COMMERCIAL,,,,52,,48.8,63.7,
TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LOCUST BLACK IGE,86003,CPT,300,RC,,OUTPATIENT,,,88.72,35.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.976,OTHER,66.5,86.9,PERCENT OF CHARGES BASED ON HCPCS CODE
LOCUST BLACK IGE,86003,CPT,300,RC,,OUTPATIENT,,,88.72,35.488,MONUMENT,COMMERCIAL,,,,71,,66.5,86.9,
T3 UPTAKE,84479,CPT,300,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEATHER PANEL 2 ALLERGENS,86003,CPT,300,RC,,OUTPATIENT,,,52.82,21.128,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.256,OTHER,39.6,51.8,PERCENT OF CHARGES BASED ON HCPCS CODE
FEATHER PANEL 2 ALLERGENS,86003,CPT,300,RC,,OUTPATIENT,,,52.82,21.128,MONUMENT,COMMERCIAL,,,,42.3,,39.6,51.8,
TRIIODOTHYRONINE T3; (TT-3),84480,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EASTERN SYCAMORE IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,9.6,OTHER,9,11.8,PERCENT OF CHARGES BASED ON HCPCS CODE
EASTERN SYCAMORE IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,MONUMENT,COMMERCIAL,,,,9.6,,9,11.8,
FREE T3,84481,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRONGYLOIDES IGG AB,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.6,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
STRONGYLOIDES IGG AB,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
T3 REVERSE,84482,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JOHNSONS GRASS IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,9.6,OTHER,9,11.8,PERCENT OF CHARGES BASED ON HCPCS CODE
JOHNSONS GRASS IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,MONUMENT,COMMERCIAL,,,,9.6,,9,11.8,
TROPONIN QUANTATIVE,84484,CPT,301,RC,,OUTPATIENT,,,170.25,68.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.69,166.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LAMBS QUARTER IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,9.6,OTHER,9,11.8,PERCENT OF CHARGES BASED ON HCPCS CODE
LAMBS QUARTER IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,MONUMENT,COMMERCIAL,,,,9.6,,9,11.8,
TRYPSIN FECAL,84488,CPT,300,RC,,OUTPATIENT,,,157.25,62.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.94,154.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CASHEW IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CASHEW IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
UREA NITROGEN (BUN),84520,CPT,301,RC,,OUTPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60,78.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MACADAMIA NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MACADAMIA NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
UREA NITROGEN URINE,84540,CPT,301,RC,,OUTPATIENT,,,150.5,60.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.88,147.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PINE NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
PINE NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
Z URINE UREA NITROGEN,84540,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PEANUT IGE COMPONENTS REFLEX,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
PEANUT IGE COMPONENTS REFLEX,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
UREA NITROGEN CLEARANCE,84545,CPT,300,RC,,OUTPATIENT,,,145,58,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,108.75,142.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BELL PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.68,OTHER,50.3,65.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BELL PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,MONUMENT,COMMERCIAL,,,,53.7,,50.3,65.8,
URIC ACID,84550,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLACK PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.68,OTHER,50.3,65.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLACK PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,MONUMENT,COMMERCIAL,,,,53.7,,50.3,65.8,
URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PEA GREEN IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.68,OTHER,50.3,65.8,PERCENT OF CHARGES BASED ON HCPCS CODE
PEA GREEN IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,MONUMENT,COMMERCIAL,,,,53.7,,50.3,65.8,
Z URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,12.1,15.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C DSDNA AB CRITHIDIA IFA IGG,86255,CPT,300,RC,,OUTPATIENT,,,223,89.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.4,OTHER,167.3,218.5,PERCENT OF CHARGES BASED ON HCPCS CODE
C DSDNA AB CRITHIDIA IFA IGG,86255,CPT,300,RC,,OUTPATIENT,,,223,89.2,MONUMENT,COMMERCIAL,,,,178.4,,167.3,218.5,
URIC ACID  PLEURAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CANDIDA ALBICANS IGG,86001,CPT,300,RC,,OUTPATIENT,,,65.44,26.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.352,OTHER,49.1,64.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CANDIDA ALBICANS IGG,86001,CPT,300,RC,,OUTPATIENT,,,65.44,26.176,MONUMENT,COMMERCIAL,,,,52.4,,49.1,64.1,
URIC ACID  SYNOVIAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THSD7A AB S CHARGE,86255,CPT,300,RC,,OUTPATIENT,,,380,152,BLUE CROSS ANTHEM,COMMERCIAL,,,,304,OTHER,285,372.4,PERCENT OF CHARGES BASED ON HCPCS CODE
THSD7A AB S CHARGE,86255,CPT,300,RC,,OUTPATIENT,,,380,152,MONUMENT,COMMERCIAL,,,,304,,285,372.4,
URIC ACID  URINE RANDOM,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAPIOCA IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,57.41,22.964,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.928,OTHER,43.1,56.3,PERCENT OF CHARGES BASED ON HCPCS CODE
TAPIOCA IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,57.41,22.964,MONUMENT,COMMERCIAL,,,,45.9,,43.1,56.3,
URIC ACID  URINE TIMED,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.31,87.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
VANILLYLMANDELIC ACID,84585,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.56,79.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
VASO INTESTINAL POLYPETIDE,84586,CPT,300,RC,,OUTPATIENT,,,245,98,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,183.75,240.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
ADH (VASOPRESSIN),84588,CPT,300,RC,,OUTPATIENT,,,372,148.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,279,364.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
Z VITAMIN A,84590,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
PANTOTHENIC ACID (VIT B5),84591,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.06,179.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
NIACIN (NICOTINIC ACID),84591,CPT,300,RC,,OUTPATIENT,,,210,84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.5,205.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
BIOTIN VITAMIN,84591,CPT,300,RC,,OUTPATIENT,,,210,84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.5,205.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.84,OTHER,25.2,32.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,MONUMENT,COMMERCIAL,,,,26.8,,25.2,32.9,
VITAMIN K1,84597,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,153.56,200.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIRECT ANTIGLOBULIN IGG,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.4,110.3,PERCENT OF CHARGES BASED ON HCPCS CODE
DIRECT ANTIGLOBULIN IGG,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.4,110.3,
BENZENE BLOOD,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIRECT ANTIGLOBULIN C3,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.4,110.3,PERCENT OF CHARGES BASED ON HCPCS CODE
DIRECT ANTIGLOBULIN C3,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.4,110.3,
METHANOL LEVEL,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JALAPENO CHIPOTLE IGE,86003,CPT,300,RC,,OUTPATIENT,,,96,38.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,76.8,OTHER,72,94.1,PERCENT OF CHARGES BASED ON HCPCS CODE
JALAPENO CHIPOTLE IGE,86003,CPT,300,RC,,OUTPATIENT,,,96,38.4,MONUMENT,COMMERCIAL,,,,76.8,,72,94.1,
D-XYLOSE,84620,CPT,301,RC,,OUTPATIENT,,,184.75,73.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.56,181.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.3,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.3,34.3,
ZINC,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.3,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.3,34.3,
ZINC  URINE,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.3,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.3,34.3,
C-PEPTIDE,84681,CPT,301,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.25,97.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.3,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.3,34.3,
HCG QUANTATATIVE,84702,CPT,301,RC,,OUTPATIENT,,,194.25,77.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,145.69,190.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.3,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.3,34.3,
Z HCG,84702,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRAZIL NUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BRAZIL NUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
HCG SERUM-QUAL,84703,CPT,301,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
CHORIONIC GONAD BETA SUBUNIT,84704,CPT,300,RC,,OUTPATIENT,,,70.75,28.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,53.06,69.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
POTASSIUM,84999,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.56,67.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
CLINICAL CHEMISTRY TEST,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.69,104.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
CANCER TYPE INDEX,84999,CPT,301,RC,,OUTPATIENT,,,6049,2419.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,4536.75,5928.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
OSMOLALITY FECES,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.69,104.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
BLEEDING TIME,85002,CPT,305,RC,,OUTPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
SMEAR EXAM W/MANUAL DIFF,85007,CPT,305,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
BLOOD SMEAR INTERPRETATION,85007,CPT,305,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
MANUAL SMEAR EXAM  NO DIFF,85008,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.31,33.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
HEMATOCRIT,85014,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18.38,24.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,36.16,14.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.928,OTHER,27.1,35.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,36.16,14.464,MONUMENT,COMMERCIAL,,,,28.9,,27.1,35.4,
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18.38,24.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.936,OTHER,27.1,35.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,MONUMENT,COMMERCIAL,,,,28.9,,27.1,35.4,
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18.38,24.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.936,OTHER,27.1,35.4,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,MONUMENT,COMMERCIAL,,,,28.9,,27.1,35.4,
CBC WITH AUTO DIFF,85025,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.19,66.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PINEAPPLE IGG,86001,CPT,300,RC,,OUTPATIENT,,,62,24.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.6,OTHER,46.5,60.8,PERCENT OF CHARGES BASED ON HCPCS CODE
PINEAPPLE IGG,86001,CPT,300,RC,,OUTPATIENT,,,62,24.8,MONUMENT,COMMERCIAL,,,,49.6,,46.5,60.8,
HEMOGRAM,85027,CPT,305,RC,,OUTPATIENT,,,58.75,23.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.06,57.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C1Q BINDING ASSAY,86332,CPT,302,RC,,OUTPATIENT,,,48.74,19.496,BLUE CROSS ANTHEM,COMMERCIAL,,,,38.992,OTHER,36.6,47.8,PERCENT OF CHARGES BASED ON HCPCS CODE
C1Q BINDING ASSAY,86332,CPT,302,RC,,OUTPATIENT,,,48.74,19.496,MONUMENT,COMMERCIAL,,,,39,,36.6,47.8,
RETICULOCYTE COUNT,85045,CPT,305,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLIADIN DEAMIDATED AB,86258,CPT,300,RC,,OUTPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.4,OTHER,47.3,61.7,PERCENT OF CHARGES BASED ON HCPCS CODE
GLIADIN DEAMIDATED AB,86258,CPT,300,RC,,OUTPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.3,61.7,
EOSINOPHIL COUNT,85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTI TIF 1GAMMA AB,86235,CPT,300,RC,,OUTPATIENT,,,185.73,74.292,BLUE CROSS ANTHEM,COMMERCIAL,,,,148.584,OTHER,139.3,182,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTI TIF 1GAMMA AB,86235,CPT,300,RC,,OUTPATIENT,,,185.73,74.292,MONUMENT,COMMERCIAL,,,,148.6,,139.3,182,
WBC (WHITE BLOOD COUNT),85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.168,OTHER,18,23.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
PLATELET  AUTO,85049,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18.38,24.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.168,OTHER,18,23.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
PATH REVIEW,85060,CPT,305,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.168,OTHER,18,23.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
SMEAR INTER ONLY  W/WO CELL CT,85097,CPT,310,RC,,OUTPATIENT,,,1307.81,523.124,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.168,OTHER,18,23.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
HEPARIN CO FACTOR II,85130,CPT,300,RC,,OUTPATIENT,,,338.5,135.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.88,331.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,BLUE CROSS ANTHEM,COMMERCIAL,,,,19.168,OTHER,18,23.5,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,MONUMENT,COMMERCIAL,,,,19.2,,18,23.5,
COAGULATION FACTOR II ACTIVITY,85210,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAGULATION FACTOR V,85220,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAGULATION FACTOR VII,85230,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAGULATION FACTOR VIII,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,208.13,271.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
FACTOR VIII COAGULATION,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,208.13,271.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
RISTOCETIN,85245,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,145.31,189.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
VON WILLEBRAND FACTOR ANTIGEN,85246,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
VON WILLEBRAND MULTIMERIC,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,200.44,261.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
VON WILLEBRAND FACTOR MULTI,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,200.44,261.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
VON WB FACTOR MULT,85247,CPT,300,RC,,OUTPATIENT,,,390,156,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,292.5,382.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAGULATION FACTOR IX,85250,CPT,305,RC,,OUTPATIENT,,,371.75,148.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,278.81,364.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAGULATION FACTOR X,85260,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
COAG FACTOR X1 ACTIVITY,85270,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
HAGEMAN COAGULATION FACTOR XII,85280,CPT,305,RC,,OUTPATIENT,,,200.25,80.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.19,196.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
FACTOR XIII QUALITATIVE,85291,CPT,305,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
Z ANTITHROMBIN III ACTIVITY,85300,CPT,300,RC,,OUTPATIENT,,,88.75,35.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.56,86.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
ANTITHROMBIN III ACTVTY PLASMA,85300,CPT,300,RC,,OUTPATIENT,,,210.5,84.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,157.88,206.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
ANTITHROMBIN ANTIGEN,85301,CPT,305,RC,,OUTPATIENT,,,186.5,74.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.88,182.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,BLUE CROSS ANTHEM,COMMERCIAL,,,,56,OTHER,52.5,68.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,MONUMENT,COMMERCIAL,,,,56,,52.5,68.6,
PROTEIN C ANTIGEN,85302,CPT,300,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.25,97.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ISLET CELL ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,135,54,BLUE CROSS ANTHEM,COMMERCIAL,,,,108,OTHER,101.3,132.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ISLET CELL ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,135,54,MONUMENT,COMMERCIAL,,,,108,,101.3,132.3,
Z PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,159.75,63.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.81,156.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COW EPITHELIUM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
COW EPITHELIUM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,258.25,103.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,193.69,253.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL POTATO,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL POTATO,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
PROTEIN S TOTAT  REFLEX,85305,CPT,300,RC,,OUTPATIENT,,,203.5,81.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,152.63,199.43,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL FRUIT PANEL,86001,CPT,300,RC,,OUTPATIENT,,,305.35,122.14,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.28,OTHER,229,299.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL FRUIT PANEL,86001,CPT,300,RC,,OUTPATIENT,,,305.35,122.14,MONUMENT,COMMERCIAL,,,,244.3,,229,299.2,
Z PROTEIN S TOTAL,85305,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZFLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,380,152,BLUE CROSS ANTHEM,COMMERCIAL,,,,304,OTHER,285,372.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZFLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,380,152,MONUMENT,COMMERCIAL,,,,304,,285,372.4,
PROTEIN S ACTIVITY,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,176.81,231.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
Z PROTEIN S ANTIGEN  FREE,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,176.81,231.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.512,OTHER,11.7,15.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,MONUMENT,COMMERCIAL,,,,12.5,,11.7,15.3,
Z PROTEIN S FREE,85306,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRICHINELLA ANTIBODY,86784,CPT,302,RC,,OUTPATIENT,,,66,26.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.8,OTHER,49.5,64.7,PERCENT OF CHARGES BASED ON HCPCS CODE
TRICHINELLA ANTIBODY,86784,CPT,302,RC,,OUTPATIENT,,,66,26.4,MONUMENT,COMMERCIAL,,,,52.8,,49.5,64.7,
PROTEIN C RESISTANCE V  PLASMA,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.38,196.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.424,OTHER,50.1,65.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,MONUMENT,COMMERCIAL,,,,53.4,,50.1,65.4,
APC,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.38,196.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.424,OTHER,50.1,65.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,MONUMENT,COMMERCIAL,,,,53.4,,50.1,65.4,
FACTOR VIII INHIBITOR,85335,CPT,300,RC,,OUTPATIENT,,,287.25,114.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,215.44,281.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.424,OTHER,50.1,65.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,MONUMENT,COMMERCIAL,,,,53.4,,50.1,65.4,
EUGLOBULIN LYSIS TIME,85360,CPT,300,RC,,OUTPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.13,115.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.424,OTHER,50.1,65.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,MONUMENT,COMMERCIAL,,,,53.4,,50.1,65.4,
FIBRIN SPLIT PRODUCTS,85362,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,110,44,BLUE CROSS ANTHEM,COMMERCIAL,,,,88,OTHER,82.5,107.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,110,44,MONUMENT,COMMERCIAL,,,,88,,82.5,107.8,
FIBRINOGEN TEST,85366,CPT,300,RC,,OUTPATIENT,,,165.5,66.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,124.13,162.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZFLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,109,43.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,87.2,OTHER,81.8,106.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZFLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,109,43.6,MONUMENT,COMMERCIAL,,,,87.2,,81.8,106.8,
SOLUBLE FIBRIN MONOMER CHARGE,85366,CPT,300,RC,,OUTPATIENT,,,160.92,64.368,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120.7,157.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.2,OTHER,74.3,97,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.3,97,
D-DIMER,85378,CPT,305,RC,,OUTPATIENT,,,209.25,83.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,156.94,205.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.4,OTHER,17.3,22.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.3,22.5,
Z D DIMER,85379,CPT,300,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.4,OTHER,17.3,22.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.3,22.5,
D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.4,OTHER,17.3,22.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.3,22.5,
R D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.4,OTHER,17.3,22.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.3,22.5,
FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,18.4,OTHER,17.3,22.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,MONUMENT,COMMERCIAL,,,,18.4,,17.3,22.5,
R FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.25,120.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZIMMUNOFIX E-PHORESIS SERUM,86334,CPT,300,RC,,OUTPATIENT,,,100,40,BLUE CROSS ANTHEM,COMMERCIAL,,,,80,OTHER,75,98,PERCENT OF CHARGES BASED ON HCPCS CODE
ZIMMUNOFIX E-PHORESIS SERUM,86334,CPT,300,RC,,OUTPATIENT,,,100,40,MONUMENT,COMMERCIAL,,,,80,,75,98,
FIBRINOGEN ANTIGEN,85385,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,162.38,212.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COOMBS TEST DIRECT IGG,86880,CPT,300,RC,,OUTPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,36,OTHER,33.8,44.1,PERCENT OF CHARGES BASED ON HCPCS CODE
COOMBS TEST DIRECT IGG,86880,CPT,300,RC,,OUTPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.8,44.1,
FIBRINOLYSINS/COAG SCR REPORT,85390,CPT,300,RC,,OUTPATIENT,,,57,22.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.75,55.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COOMBS TEST DIRECT C3,86880,CPT,300,RC,,OUTPATIENT,,,45,18,BLUE CROSS ANTHEM,COMMERCIAL,,,,36,OTHER,33.8,44.1,PERCENT OF CHARGES BASED ON HCPCS CODE
COOMBS TEST DIRECT C3,86880,CPT,300,RC,,OUTPATIENT,,,45,18,MONUMENT,COMMERCIAL,,,,36,,33.8,44.1,
VON WB DZ INTERP,85390,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,226.69,296.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COOMBS TEST DIRECT POLY,86880,CPT,300,RC,,OUTPATIENT,,,58,23.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.4,OTHER,43.5,56.8,PERCENT OF CHARGES BASED ON HCPCS CODE
COOMBS TEST DIRECT POLY,86880,CPT,300,RC,,OUTPATIENT,,,58,23.2,MONUMENT,COMMERCIAL,,,,46.4,,43.5,56.8,
VON WILLEBRAND FACTOR ACTIVITY,85397,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,238.88,312.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL SQUASH,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL SQUASH,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
ADMATS13 ACTIVITY INHIBITOR PF,85397,CPT,300,RC,,OUTPATIENT,,,337.5,135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,253.1,330.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL WASP VENOM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL WASP VENOM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
Z PLASMINOGEN ACTIVITY,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL DOG DANDER IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL DOG DANDER IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
PLASMINOGEN,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALL ROUGH PIGWEED IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.352,OTHER,7.8,10.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ALL ROUGH PIGWEED IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,MONUMENT,COMMERCIAL,,,,8.4,,7.8,10.2,
FETAL SCREEN,85461,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.94,44.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIA ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,71.75,28.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.4,OTHER,53.81,70.32,PERCENT OF CHARGES BASED ON HCPCS CODE
RIA ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,71.75,28.7,MONUMENT,COMMERCIAL,,,,57.4,,53.81,70.32,
HEPARIN ANTI-XA,85520,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,182.63,238.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUROESCENT ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUROESCENT ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
LEUKOCYTE ALK PHOS,85540,CPT,305,RC,,OUTPATIENT,,,175.75,70.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ISLET ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.6,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
ISLET ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
LYSOZYME SERUM,85549,CPT,300,RC,,OUTPATIENT,,,160,64,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120,156.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEPARIN - PF4 ANTIBODY,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,266.8,OTHER,250.13,326.83,PERCENT OF CHARGES BASED ON HCPCS CODE
HEPARIN - PF4 ANTIBODY,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,MONUMENT,COMMERCIAL,,,,266.8,,250.13,326.83,
OSMOTIC FRAGILITY,85555,CPT,305,RC,,OUTPATIENT,,,292,116.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,219,286.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
HEREDITARY SPHEROCYTOSIS EVAL,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.81,180.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
R D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,135.6,OTHER,127.13,166.11,PERCENT OF CHARGES BASED ON HCPCS CODE
R D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,MONUMENT,COMMERCIAL,,,,135.6,,127.13,166.11,
OSMOTIC FRAGILITY RBC,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.81,180.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HERPES VIRUS 6 IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HERPES VIRUS 6 IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
RBC OSMOTIC FRAGILITY,85557,CPT,300,RC,,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.8,122.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HERPES VIRUS 6 IGM,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,87,OTHER,81.56,106.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HERPES VIRUS 6 IGM,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,MONUMENT,COMMERCIAL,,,,87,,81.56,106.58,
PLATELET NEUTRALIZATION,85597,CPT,300,RC,,OUTPATIENT,,,178,71.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,133.5,174.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DENGUE FEVER IGG,86790,CPT,300,RC,,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DENGUE FEVER IGG,86790,CPT,300,RC,,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
HEXAGONAL PHASE CONFIRM,85597,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,155.06,202.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DENGUE FEVER IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,162,64.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.6,OTHER,121.5,158.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DENGUE FEVER IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,162,64.8,MONUMENT,COMMERCIAL,,,,129.6,,121.5,158.76,
Z STACLOT LUPUS ANTICOAGULANT,85598,CPT,300,RC,,OUTPATIENT,,,241.25,96.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,180.94,236.43,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTITHROMBIN III ACTVTY PLASMA,85300,CPT,300,RC,,OUTPATIENT,,,210.5,84.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.4,OTHER,157.88,206.29,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTITHROMBIN III ACTVTY PLASMA,85300,CPT,300,RC,,OUTPATIENT,,,210.5,84.2,MONUMENT,COMMERCIAL,,,,168.4,,157.88,206.29,
Z PT (PROTIME),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.44,46.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADMATS13 ACTIVITY INHIBITOR PF,85397,CPT,300,RC,,OUTPATIENT,,,337.5,135,BLUE CROSS ANTHEM,COMMERCIAL,,,,270,OTHER,253.1,330.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ADMATS13 ACTIVITY INHIBITOR PF,85397,CPT,300,RC,,OUTPATIENT,,,337.5,135,MONUMENT,COMMERCIAL,,,,270,,253.1,330.8,
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.44,46.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD SMEAR INTERPRETATION,85007,CPT,305,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD SMEAR INTERPRETATION,85007,CPT,305,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
I-STAT PT (INR),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.44,46.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RBC OSMOTIC FRAGILITY,85557,CPT,300,RC,,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.8,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
RBC OSMOTIC FRAGILITY,85557,CPT,300,RC,,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.8,122.5,
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,13,5.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,9.8,12.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SOLUBLE FIBRIN MONOMER CHARGE,85366,CPT,300,RC,,OUTPATIENT,,,160.92,64.368,BLUE CROSS ANTHEM,COMMERCIAL,,,,128.736,OTHER,120.7,157.7,PERCENT OF CHARGES BASED ON HCPCS CODE
SOLUBLE FIBRIN MONOMER CHARGE,85366,CPT,300,RC,,OUTPATIENT,,,160.92,64.368,MONUMENT,COMMERCIAL,,,,128.7,,120.7,157.7,
PT MIX 1:1,85611,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENZYME DETECTION PER ENZYME,87185,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
ENZYME DETECTION PER ENZYME,87185,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
DRVVT DILUTED,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.69,127.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FECAL REDUCING SUBSTANCE,84376,CPT,301,RC,,OUTPATIENT,,,191.75,76.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,153.4,OTHER,143.81,187.92,PERCENT OF CHARGES BASED ON HCPCS CODE
FECAL REDUCING SUBSTANCE,84376,CPT,301,RC,,OUTPATIENT,,,191.75,76.7,MONUMENT,COMMERCIAL,,,,153.4,,143.81,187.92,
Z DRVVT MIX,85613,CPT,305,RC,,OUTPATIENT,,,70.75,28.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,53.06,69.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOBACTERIUM TB AMPLIFIED,87556,CPT,306,RC,,OUTPATIENT,,,529.75,211.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,423.8,OTHER,397.31,519.16,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOBACTERIUM TB AMPLIFIED,87556,CPT,306,RC,,OUTPATIENT,,,529.75,211.9,MONUMENT,COMMERCIAL,,,,423.8,,397.31,519.16,
DILUTE RUSSELL VIPER VENOM,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.69,127.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,BLUE CROSS ANTHEM,COMMERCIAL,,,,84,OTHER,78.8,102.9,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,MONUMENT,COMMERCIAL,,,,84,,78.8,102.9,
REPTILASE TIME,85635,CPT,300,RC,,OUTPATIENT,,,113,45.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.75,110.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,BLUE CROSS ANTHEM,COMMERCIAL,,,,84,OTHER,78.8,102.9,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,MONUMENT,COMMERCIAL,,,,84,,78.8,102.9,
ESR (AUTO),85652,CPT,305,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NOCARDIA SPECIES  MIC,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
NOCARDIA SPECIES  MIC,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
SICKLE CELL,85660,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INFECTIOUS AGENT ANTIGEN DETEC,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.2,OTHER,38.63,50.47,PERCENT OF CHARGES BASED ON HCPCS CODE
INFECTIOUS AGENT ANTIGEN DETEC,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,MONUMENT,COMMERCIAL,,,,41.2,,38.63,50.47,
Z THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.44,109.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SUSCEPTABILITY STUDIES,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
SUSCEPTABILITY STUDIES,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.44,109.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA HOMINIS PCR,87798,CPT,306,RC,,OUTPATIENT,,,195,78,BLUE CROSS ANTHEM,COMMERCIAL,,,,156,OTHER,146.3,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA HOMINIS PCR,87798,CPT,306,RC,,OUTPATIENT,,,195,78,MONUMENT,COMMERCIAL,,,,156,,146.3,191.1,
Z APTT,85730,CPT,300,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,BLUE CROSS ANTHEM,COMMERCIAL,,,,68,OTHER,63.8,83.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,MONUMENT,COMMERCIAL,,,,68,,63.8,83.3,
PTT (PARTIAL THROMBO TIME),85730,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,BLUE CROSS ANTHEM,COMMERCIAL,,,,68,OTHER,63.8,83.3,PERCENT OF CHARGES BASED ON HCPCS CODE
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,MONUMENT,COMMERCIAL,,,,68,,63.8,83.3,
APTT MIX 1:1,85732,CPT,300,RC,,OUTPATIENT,,,163.5,65.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.63,160.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GLUCOSE BODY FLUID  NOT BLOOD,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,59.4,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE BODY FLUID  NOT BLOOD,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
BLOOD VISCOSITY EXAM,85810,CPT,305,RC,,OUTPATIENT,,,170.25,68.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.69,166.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHCV GENTYPE RESOLUTION,87902,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,BLUE CROSS ANTHEM,COMMERCIAL,,,,411.92,OTHER,386.2,504.6,PERCENT OF CHARGES BASED ON HCPCS CODE
CHCV GENTYPE RESOLUTION,87902,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,MONUMENT,COMMERCIAL,,,,411.9,,386.2,504.6,
TULAREMIA ANTIBODY,86000,CPT,302,RC,,OUTPATIENT,,,159,63.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.25,155.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYCOPLASMA GENITALIUM TMA,87563,CPT,306,RC,,OUTPATIENT,,,136,54.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.8,OTHER,102,133.3,PERCENT OF CHARGES BASED ON HCPCS CODE
MYCOPLASMA GENITALIUM TMA,87563,CPT,306,RC,,OUTPATIENT,,,136,54.4,MONUMENT,COMMERCIAL,,,,108.8,,102,133.3,
ALLERGEN DOG DANDER IGG,86001,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICROSTREP PLUS 1,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
MICROSTREP PLUS 1,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.94,52.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOXOPLASMA GONDII PCR BLD,87798,CPT,306,RC,,OUTPATIENT,,,513.75,205.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,411,OTHER,385.3,503.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TOXOPLASMA GONDII PCR BLD,87798,CPT,306,RC,,OUTPATIENT,,,513.75,205.5,MONUMENT,COMMERCIAL,,,,411,,385.3,503.5,
BELL PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.3,65.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHIGELLA CULTURE FECES,87046,CPT,306,RC,,OUTPATIENT,,,149.51,59.804,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.608,OTHER,112.1,146.5,PERCENT OF CHARGES BASED ON HCPCS CODE
SHIGELLA CULTURE FECES,87046,CPT,306,RC,,OUTPATIENT,,,149.51,59.804,MONUMENT,COMMERCIAL,,,,119.6,,112.1,146.5,
BLACK PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.3,65.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"CRYPTOCOCCUS AG TITER,LFA,CSF",87899,CPT,300,RC,,OUTPATIENT,,,87.66,35.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.128,OTHER,65.7,85.9,PERCENT OF CHARGES BASED ON HCPCS CODE
"CRYPTOCOCCUS AG TITER,LFA,CSF",87899,CPT,300,RC,,OUTPATIENT,,,87.66,35.064,MONUMENT,COMMERCIAL,,,,70.1,,65.7,85.9,
PEA GREEN IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.3,65.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUCONAZOLE (DIFLUCAN) SENS,87999,CPT,306,RC,,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUCONAZOLE (DIFLUCAN) SENS,87999,CPT,306,RC,,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
CANDIDA ALBICANS IGG,86001,CPT,300,RC,,OUTPATIENT,,,65.44,26.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.1,64.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MONKEYPOX PCR,87593,CPT,306,RC,,OUTPATIENT,,,120,48,BLUE CROSS ANTHEM,COMMERCIAL,,,,96,OTHER,90,117.6,PERCENT OF CHARGES BASED ON HCPCS CODE
MONKEYPOX PCR,87593,CPT,306,RC,,OUTPATIENT,,,120,48,MONUMENT,COMMERCIAL,,,,96,,90,117.6,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RICKETTSIA SPECIEIS DNA PCR,87798,CPT,306,RC,,OUTPATIENT,,,406.66,162.664,BLUE CROSS ANTHEM,COMMERCIAL,,,,325.328,OTHER,305,398.5,PERCENT OF CHARGES BASED ON HCPCS CODE
RICKETTSIA SPECIEIS DNA PCR,87798,CPT,306,RC,,OUTPATIENT,,,406.66,162.664,MONUMENT,COMMERCIAL,,,,325.3,,305,398.5,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.072,OTHER,26.3,34.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,MONUMENT,COMMERCIAL,,,,28.1,,26.3,34.4,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,BLUE CROSS ANTHEM,COMMERCIAL,,,,28.072,OTHER,26.3,34.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,MONUMENT,COMMERCIAL,,,,28.1,,26.3,34.4,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ZLYME DIS DNA AMP PROBE,87476,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.144,OTHER,52.6,68.8,PERCENT OF CHARGES BASED ON HCPCS CODE
ZLYME DIS DNA AMP PROBE,87476,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,MONUMENT,COMMERCIAL,,,,56.1,,52.6,68.8,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FUNGAL CULTURE ROUTINE,87102,CPT,306,RC,,OUTPATIENT,,,149.16,59.664,BLUE CROSS ANTHEM,COMMERCIAL,,,,119.328,OTHER,111.9,146.2,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGAL CULTURE ROUTINE,87102,CPT,306,RC,,OUTPATIENT,,,149.16,59.664,MONUMENT,COMMERCIAL,,,,119.3,,111.9,146.2,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FUNGITELL CSF,87449,CPT,300,RC,,OUTPATIENT,,,204,81.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,163.2,OTHER,153,199.9,PERCENT OF CHARGES BASED ON HCPCS CODE
FUNGITELL CSF,87449,CPT,300,RC,,OUTPATIENT,,,204,81.6,MONUMENT,COMMERCIAL,,,,163.2,,153,199.9,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,2316,926.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1852.8,OTHER,1737,2269.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,2316,926.4,MONUMENT,COMMERCIAL,,,,1852.8,,1737,2269.7,
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.2,32.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,833.56,333.424,BLUE CROSS ANTHEM,COMMERCIAL,,,,666.848,OTHER,625.2,816.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,833.56,333.424,MONUMENT,COMMERCIAL,,,,666.8,,625.2,816.9,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,70.18,28.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.144,OTHER,52.6,68.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,70.18,28.072,MONUMENT,COMMERCIAL,,,,56.1,,52.6,68.8,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,56.144,OTHER,52.6,68.8,PERCENT OF CHARGES BASED ON HCPCS CODE
Z TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,MONUMENT,COMMERCIAL,,,,56.1,,52.6,68.8,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.32,OTHER,105.3,137.6,PERCENT OF CHARGES BASED ON HCPCS CODE
Z DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,MONUMENT,COMMERCIAL,,,,112.3,,105.3,137.6,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CULTURE FECES W/ISO PRE EXAM,87046,CPT,306,RC,,OUTPATIENT,,,27.25,10.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,21.8,OTHER,20.44,26.71,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CULTURE FECES W/ISO PRE EXAM,87046,CPT,306,RC,,OUTPATIENT,,,27.25,10.9,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CULTURE FECES W/ISO PRE EXAM,8704691,CPT,306,RC,91,OUTPATIENT,,,27.25,10.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,21.8,OTHER,20.44,26.71,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CULTURE FECES W/ISO PRE EXAM,8704691,CPT,306,RC,91,OUTPATIENT,,,27.25,10.9,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CULTURE SPECIMEN CONCENTRATN,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,49.8,OTHER,46.69,61.01,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CULTURE SPECIMEN CONCENTRATN,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,MONUMENT,COMMERCIAL,,,,49.8,,46.69,61.01,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VISBY SEXUAL HEALTH TEST,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.32,OTHER,105.3,137.6,PERCENT OF CHARGES BASED ON HCPCS CODE
VISBY SEXUAL HEALTH TEST,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,MONUMENT,COMMERCIAL,,,,112.3,,105.3,137.6,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UA  NON AUTOMATED  NO MICRO,81002,CPT,307,RC,,OUTPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,35,OTHER,32.81,42.88,PERCENT OF CHARGES BASED ON HCPCS CODE
UA  NON AUTOMATED  NO MICRO,81002,CPT,307,RC,,OUTPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATH LIQUID BASED NON GYN,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATH LIQUID BASED NON GYN,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATHOLOGY NON-GYN,88106,CPT,300,RC,,OUTPATIENT,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.6,OTHER,65.25,85.26,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATHOLOGY NON-GYN,88106,CPT,300,RC,,OUTPATIENT,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
PINEAPPLE IGG,86001,CPT,300,RC,,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAYO RESP PANEL PCR,0202U,HCPCS,310,RC,,INPATIENT,,,833.56,333.424,BLUE CROSS ANTHEM,COMMERCIAL,,,,758.54,OTHER,625.2,816.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MAYO RESP PANEL PCR,0202U,HCPCS,310,RC,,INPATIENT,,,833.56,333.424,MONUMENT,COMMERCIAL,,,,666.8,,625.2,816.9,
MAYO RESP PANEL PCR,0202U,HCPCS,310,RC,,INPATIENT,,,833.56,333.424,UNITED HEALTH,UNITED COMMERCIAL,,,,625.2,,625.2,816.9,
JAK2 EX12 NON-V617F MUT DETECT,81403,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.2,OTHER,564.56,737.7,PERCENT OF CHARGES BASED ON HCPCS CODE
JAK2 EX12 NON-V617F MUT DETECT,81403,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,MONUMENT,COMMERCIAL,,,,602.2,,564.56,737.7,
ALL FRUIT PANEL,86001,CPT,300,RC,,OUTPATIENT,,,305.35,122.14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,229,299.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IN SITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,189,246.96,PERCENT OF CHARGES BASED ON HCPCS CODE
IN SITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,201.6,,189,246.96,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GENE POLYMORPHISM,81400,CPT,300,RC,,OUTPATIENT,,,653.4,261.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,522.72,OTHER,490.1,640.3,PERCENT OF CHARGES BASED ON HCPCS CODE
GENE POLYMORPHISM,81400,CPT,300,RC,,OUTPATIENT,,,653.4,261.36,MONUMENT,COMMERCIAL,,,,522.7,,490.1,640.3,
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.7,15.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOFLUORESCENT STUDY,88347,CPT,310,RC,,OUTPATIENT,,,315.75,126.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,252.6,OTHER,236.81,309.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOFLUORESCENT STUDY,88347,CPT,310,RC,,OUTPATIENT,,,315.75,126.3,MONUMENT,COMMERCIAL,,,,252.6,,236.81,309.44,
MUCOR IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z IMMUNOFLUORESCENT STUDY,8834791,CPT,310,RC,91,OUTPATIENT,,,315.75,126.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,252.6,OTHER,236.81,309.44,PERCENT OF CHARGES BASED ON HCPCS CODE
Z IMMUNOFLUORESCENT STUDY,8834791,CPT,310,RC,91,OUTPATIENT,,,315.75,126.3,MONUMENT,COMMERCIAL,,,,252.6,,236.81,309.44,
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
M/PHMTRC ALYS ISHQUANT/SEMIQ,88373,CPT,310,RC,,OUTPATIENT,,,228.69,91.476,BLUE CROSS ANTHEM,COMMERCIAL,,,,182.952,OTHER,171.5,224.1,PERCENT OF CHARGES BASED ON HCPCS CODE
M/PHMTRC ALYS ISHQUANT/SEMIQ,88373,CPT,310,RC,,OUTPATIENT,,,228.69,91.476,MONUMENT,COMMERCIAL,,,,183,,171.5,224.1,
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
Z ALLERGEN TREE PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,310,RC,,OUTPATIENT,,,174,69.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,139.2,OTHER,130.5,170.52,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,310,RC,,OUTPATIENT,,,174,69.6,MONUMENT,COMMERCIAL,,,,139.2,,130.5,170.52,
Z ALLERGEN TREE PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLT3 GENE,81245,CPT,310,RC,,OUTPATIENT,,,331.02,132.408,BLUE CROSS ANTHEM,COMMERCIAL,,,,264.816,OTHER,248.3,324.4,PERCENT OF CHARGES BASED ON HCPCS CODE
FLT3 GENE,81245,CPT,310,RC,,OUTPATIENT,,,331.02,132.408,MONUMENT,COMMERCIAL,,,,264.8,,248.3,324.4,
Z ALLERGEN EPITHELIA PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NPM1 GENE,81310,CPT,310,RC,,OUTPATIENT,,,493.04,197.216,BLUE CROSS ANTHEM,COMMERCIAL,,,,394.432,OTHER,369.8,483.2,PERCENT OF CHARGES BASED ON HCPCS CODE
NPM1 GENE,81310,CPT,310,RC,,OUTPATIENT,,,493.04,197.216,MONUMENT,COMMERCIAL,,,,394.4,,369.8,483.2,
Z ALLERGEN GRASS PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LACTOTYPE,81400,CPT,300,RC,,OUTPATIENT,,,531.75,212.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,425.4,OTHER,398.81,521.12,PERCENT OF CHARGES BASED ON HCPCS CODE
LACTOTYPE,81400,CPT,300,RC,,OUTPATIENT,,,531.75,212.7,MONUMENT,COMMERCIAL,,,,425.4,,398.81,521.12,
Z ALLERGEN GRASS PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,314,RC,,INPATIENT,,,588.62,235.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,535.64,OTHER,441.5,576.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,314,RC,,INPATIENT,,,588.62,235.448,MONUMENT,COMMERCIAL,,,,470.9,,441.5,576.8,
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,314,RC,,INPATIENT,,,588.62,235.448,UNITED HEALTH,UNITED COMMERCIAL,,,,441.5,,441.5,576.8,
TARGETED GENOMIC SEQ ANALYS,81450,CPT,310,RC,,OUTPATIENT,,,1080,432,BLUE CROSS ANTHEM,COMMERCIAL,,,,864,OTHER,810,1058.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TARGETED GENOMIC SEQ ANALYS,81450,CPT,310,RC,,OUTPATIENT,,,1080,432,MONUMENT,COMMERCIAL,,,,864,,810,1058.4,
Z ALLERGEN GRASS PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,312,RC,,OUTPATIENT,,,322,128.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,257.6,OTHER,241.5,315.6,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,312,RC,,OUTPATIENT,,,322,128.8,MONUMENT,COMMERCIAL,,,,257.6,,241.5,315.6,
Z ALLERGEN HOUSE DUST PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z UROVYSION DETECTION BLAD CA,88368,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,146.25,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
Z UROVYSION DETECTION BLAD CA,88368,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,156,,146.25,191.1,
Z ALLERGEN WEED PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z UROVYSION DETECTION BLAD CA,8836891,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,146.25,191.1,PERCENT OF CHARGES BASED ON HCPCS CODE
Z UROVYSION DETECTION BLAD CA,8836891,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,156,,146.25,191.1,
Z ALLERGEN WEED PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,OUTPATIENT,,,350.8,140.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.64,OTHER,263.1,343.8,PERCENT OF CHARGES BASED ON HCPCS CODE
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,OUTPATIENT,,,350.8,140.32,MONUMENT,COMMERCIAL,,,,280.6,,263.1,343.8,
ALLERGENS-SINGLE ASSAY,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION,19086,CPT,610,RC,,OUTPATIENT,,,2441.25,976.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1953,OTHER,1830.94,2392.43,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION,19086,CPT,610,RC,,OUTPATIENT,,,2441.25,976.5,MONUMENT,COMMERCIAL,,,,1953,,1830.94,2392.43,
ALLERGEN HAZELNUT TEST,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBOSOME P ANTIBODIES IGG,83516,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,121.8,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBOSOME P ANTIBODIES IGG,83516,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CENTROMERE ANTIBODIES,83516,CPT,300,RC,,OUTPATIENT,,,143,57.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,114.4,OTHER,107.25,140.14,PERCENT OF CHARGES BASED ON HCPCS CODE
CENTROMERE ANTIBODIES,83516,CPT,300,RC,,OUTPATIENT,,,143,57.2,MONUMENT,COMMERCIAL,,,,114.4,,107.25,140.14,
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,580,232,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,435,568.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,OUTPATIENT,,,2730,1092,BLUE CROSS ANTHEM,COMMERCIAL,,,,2184,OTHER,2047.5,2675.4,PERCENT OF CHARGES BASED ON HCPCS CODE
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,OUTPATIENT,,,2730,1092,MONUMENT,COMMERCIAL,,,,2184,,2047.5,2675.4,
LATEX IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPREHENSIVE ANTIBODY ASSMNT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IGH VARI REGIONAL MUTATION,81263,CPT,300,RC,,OUTPATIENT,,,1682.14,672.856,BLUE CROSS ANTHEM,COMMERCIAL,,,,1345.712,OTHER,1261.6,1648.5,PERCENT OF CHARGES BASED ON HCPCS CODE
IGH VARI REGIONAL MUTATION,81263,CPT,300,RC,,OUTPATIENT,,,1682.14,672.856,MONUMENT,COMMERCIAL,,,,1345.7,,1261.6,1648.5,
ALLERGEN LATEX,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHRONIC LYMPHOCYTIC LEUKEMIA,81351,CPT,,,,OUTPATIENT,,,2141.85,856.74,BLUE CROSS ANTHEM,COMMERCIAL,,,,1713.48,OTHER,1606.4,2099,PERCENT OF CHARGES BASED ON HCPCS CODE
CHRONIC LYMPHOCYTIC LEUKEMIA,81351,CPT,,,,OUTPATIENT,,,2141.85,856.74,MONUMENT,COMMERCIAL,,,,1713.5,,1606.4,2099,
ALLERGEN PECAN-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELODYSPLASTIC SYNDROME,81219,CPT,300,RC,,OUTPATIENT,,,243.26,97.304,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.608,OTHER,182.4,238.4,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELODYSPLASTIC SYNDROME,81219,CPT,300,RC,,OUTPATIENT,,,243.26,97.304,MONUMENT,COMMERCIAL,,,,194.6,,182.4,238.4,
ALLERGEN COCONUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELODYSPLASTIC SYNDROME,81338,CPT,310,RC,,OUTPATIENT,,,300.66,120.264,BLUE CROSS ANTHEM,COMMERCIAL,,,,240.528,OTHER,225.5,294.6,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELODYSPLASTIC SYNDROME,81338,CPT,310,RC,,OUTPATIENT,,,300.66,120.264,MONUMENT,COMMERCIAL,,,,240.5,,225.5,294.6,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,OUTPATIENT,,,327.92,131.168,BLUE CROSS ANTHEM,COMMERCIAL,,,,262.336,OTHER,245.9,321.4,PERCENT OF CHARGES BASED ON HCPCS CODE
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,OUTPATIENT,,,327.92,131.168,MONUMENT,COMMERCIAL,,,,262.3,,245.9,321.4,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TGSAP SO NEO 5-50DNA/DNA&RNA,81445,CPT,310,RC,,OUTPATIENT,,,1195.82,478.328,BLUE CROSS ANTHEM,COMMERCIAL,,,,956.656,OTHER,896.9,1171.9,PERCENT OF CHARGES BASED ON HCPCS CODE
TGSAP SO NEO 5-50DNA/DNA&RNA,81445,CPT,310,RC,,OUTPATIENT,,,1195.82,478.328,MONUMENT,COMMERCIAL,,,,956.7,,896.9,1171.9,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THINPREP SCREEN  W/O PHYS INTR,88142,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
THINPREP SCREEN  W/O PHYS INTR,88142,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THINPREP PAP RESCREEN,88143,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
THINPREP PAP RESCREEN,88143,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINE NEEDLE BIOPSY INTRP&RPT,88173,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
FINE NEEDLE BIOPSY INTRP&RPT,88173,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
ALLERGEN FOOD & GRAIN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PAP SMEAR  TECHNICAL FEE,88150,CPT,311,RC,,OUTPATIENT,,,40.75,16.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.6,OTHER,30.56,39.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PAP SMEAR  TECHNICAL FEE,88150,CPT,311,RC,,OUTPATIENT,,,40.75,16.3,MONUMENT,COMMERCIAL,,,,32.6,,30.56,39.94,
ALLERGEN WALNUT-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PAP W/MATURATION INDEX,88165,CPT,311,RC,,OUTPATIENT,,,84.44,33.776,BLUE CROSS ANTHEM,COMMERCIAL,,,,67.552,OTHER,40.5,52.92,PERCENT OF CHARGES BASED ON HCPCS CODE
PAP W/MATURATION INDEX,88165,CPT,311,RC,,OUTPATIENT,,,84.44,33.776,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.92,
ALLERGEN DAIRY & GRAIN PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATHOLOGY BODY FLUIDS MULT,88162,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATHOLOGY BODY FLUIDS MULT,88162,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.94,52.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATH SMEAR,88108,CPT,311,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATH SMEAR,88108,CPT,311,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVALUATION OF FINE NEEDLE BX,88172,CPT,311,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
EVALUATION OF FINE NEEDLE BX,88172,CPT,311,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVALUATION OF TOUCH PREP,88333,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,BLUE CROSS ANTHEM,COMMERCIAL,,,,1046.248,OTHER,117.19,153.13,PERCENT OF CHARGES BASED ON HCPCS CODE
EVALUATION OF TOUCH PREP,88333,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,MONUMENT,COMMERCIAL,,,,125,,117.19,153.13,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATHLOGY FLUIDS WASH/BRUSH,88104,CPT,310,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.75,95.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATHLOGY FLUIDS WASH/BRUSH,88104,CPT,310,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UROVYSION FISH,88120,CPT,311,RC,,OUTPATIENT,,,414.75,165.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,331.8,OTHER,311.06,406.46,PERCENT OF CHARGES BASED ON HCPCS CODE
UROVYSION FISH,88120,CPT,311,RC,,OUTPATIENT,,,414.75,165.9,MONUMENT,COMMERCIAL,,,,331.8,,311.06,406.46,
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FISH TESTING,88271,CPT,300,RC,,OUTPATIENT,,,320,128,BLUE CROSS ANTHEM,COMMERCIAL,,,,256,OTHER,240,313.6,PERCENT OF CHARGES BASED ON HCPCS CODE
FISH TESTING,88271,CPT,300,RC,,OUTPATIENT,,,320,128,MONUMENT,COMMERCIAL,,,,256,,240,313.6,
ALLERGEN FOOD MEAT PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOGENETIC TESTING,88274,CPT,311,RC,,OUTPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,32,OTHER,30,39.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOGENETIC TESTING,88274,CPT,311,RC,,OUTPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
ALLERGEN PEANUT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PATH REVIEW,85060,CPT,305,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
PATH REVIEW,85060,CPT,305,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
ALLERGEN FLAXSEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATH TBS  C/V  MANUAL,88164,CPT,311,RC,,OUTPATIENT,,,43.75,17.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,35,OTHER,32.81,42.88,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATH TBS  C/V  MANUAL,88164,CPT,311,RC,,OUTPATIENT,,,43.75,17.5,MONUMENT,COMMERCIAL,,,,35,,32.81,42.88,
ALLERGEN PISTACHIO,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
ALLERGEN SESAME SEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
ALLERGEN SOYBEAN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,272.4,OTHER,255.38,333.69,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,MONUMENT,COMMERCIAL,,,,272.4,,255.38,333.69,
ALL BLACK/WHITE PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,47,OTHER,44.06,57.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,MONUMENT,COMMERCIAL,,,,47,,44.06,57.58,
ALL GREEN PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTO MOLECULAR REPORT,G0452,HCPCS,310,RC,,INPATIENT,,,86.5,34.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.72,OTHER,64.88,84.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z CYTO MOLECULAR REPORT,G0452,HCPCS,310,RC,,INPATIENT,,,86.5,34.6,MONUMENT,COMMERCIAL,,,,69.2,,64.88,84.77,
Z CYTO MOLECULAR REPORT,G0452,HCPCS,310,RC,,INPATIENT,,,86.5,34.6,UNITED HEALTH,UNITED COMMERCIAL,,,,64.88,,64.88,84.77,
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,47,OTHER,44.06,57.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,MONUMENT,COMMERCIAL,,,,47,,44.06,57.58,
ALL CARROT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONSULTATION COMPREHENSIVE,88325,CPT,310,RC,,OUTPATIENT,,,567,226.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,453.6,OTHER,425.25,555.66,PERCENT OF CHARGES BASED ON HCPCS CODE
CONSULTATION COMPREHENSIVE,88325,CPT,310,RC,,OUTPATIENT,,,567,226.8,MONUMENT,COMMERCIAL,,,,453.6,,425.25,555.66,
ALL AVOCADO IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PATHOLOGY CONSULATION,88323,CPT,310,RC,,OUTPATIENT,,,279,111.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,223.2,OTHER,209.25,273.42,PERCENT OF CHARGES BASED ON HCPCS CODE
PATHOLOGY CONSULATION,88323,CPT,310,RC,,OUTPATIENT,,,279,111.6,MONUMENT,COMMERCIAL,,,,223.2,,209.25,273.42,
ALL ONION IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,73.25,29.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,58.6,OTHER,54.94,71.79,PERCENT OF CHARGES BASED ON HCPCS CODE
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,73.25,29.3,MONUMENT,COMMERCIAL,,,,58.6,,54.94,71.79,
ALL GARLIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BCR/ABL RNA QUANT MONITOR CML,81206,CPT,310,RC,,OUTPATIENT,,,600.25,240.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,480.2,OTHER,450.19,588.25,PERCENT OF CHARGES BASED ON HCPCS CODE
BCR/ABL RNA QUANT MONITOR CML,81206,CPT,310,RC,,OUTPATIENT,,,600.25,240.1,MONUMENT,COMMERCIAL,,,,480.2,,450.19,588.25,
ALL LENTIL IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OR CONS FRZ SEC ADDL TECHNICAL,88332,CPT,312,RC,,OUTPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.8,OTHER,37.31,48.76,PERCENT OF CHARGES BASED ON HCPCS CODE
OR CONS FRZ SEC ADDL TECHNICAL,88332,CPT,312,RC,,OUTPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
ALL GREEN STRING BEAN IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPECIAL STAINS GROUP II,88313,CPT,300,RC,,OUTPATIENT,,,145,58,BLUE CROSS ANTHEM,COMMERCIAL,,,,116,OTHER,108.75,142.1,PERCENT OF CHARGES BASED ON HCPCS CODE
SPECIAL STAINS GROUP II,88313,CPT,300,RC,,OUTPATIENT,,,145,58,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
ALL CHILI PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PATHOLOGY CONSULT DURING SURG,88329,CPT,310,RC,,OUTPATIENT,,,199.5,79.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,159.6,OTHER,149.63,195.51,PERCENT OF CHARGES BASED ON HCPCS CODE
PATHOLOGY CONSULT DURING SURG,88329,CPT,310,RC,,OUTPATIENT,,,199.5,79.8,MONUMENT,COMMERCIAL,,,,159.6,,149.63,195.51,
ALL OLIVE FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY EA ADD'L MRKR,88185,CPT,310,RC,,OUTPATIENT,,,271.75,108.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,217.4,OTHER,203.81,266.32,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY EA ADD'L MRKR,88185,CPT,310,RC,,OUTPATIENT,,,271.75,108.7,MONUMENT,COMMERCIAL,,,,217.4,,203.81,266.32,
ALL CURRY IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLINICAL PATHOLOGY CONSULT,80500,CPT,,,,OUTPATIENT,,,113.25,45.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.6,OTHER,84.94,110.99,PERCENT OF CHARGES BASED ON HCPCS CODE
CLINICAL PATHOLOGY CONSULT,80500,CPT,,,,OUTPATIENT,,,113.25,45.3,MONUMENT,COMMERCIAL,,,,90.6,,84.94,110.99,
ALL GINGER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTOMETRY CELL SURFACE,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY CELL SURFACE,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
ALL LETTUCE IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.4,35.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY CYTOPLASMIC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY CYTOPLASMIC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
LOCUST BLACK IGE,86003,CPT,300,RC,,OUTPATIENT,,,88.72,35.488,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.5,86.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MORPHOMETRIC ANALYUSIS TMR IMM,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
MORPHOMETRIC ANALYUSIS TMR IMM,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
FEATHER PANEL 2 ALLERGENS,86003,CPT,300,RC,,OUTPATIENT,,,52.82,21.128,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.6,51.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICRO GEN ANA OF TISSUE ADD'L,88369,CPT,310,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.6,223,PERCENT OF CHARGES BASED ON HCPCS CODE
MICRO GEN ANA OF TISSUE ADD'L,88369,CPT,310,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.6,223,
EASTERN SYCAMORE IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,9,11.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE CULTURE FOR NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.8,OTHER,403.88,527.73,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE CULTURE FOR NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,MONUMENT,COMMERCIAL,,,,430.8,,403.88,527.73,
JOHNSONS GRASS IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,9,11.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROMOSOME ANALYSIS 20-25 CELL,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,746.8,OTHER,700.13,914.83,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME ANALYSIS 20-25 CELL,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,MONUMENT,COMMERCIAL,,,,746.8,,700.13,914.83,
LAMBS QUARTER IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,9,11.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYTOPATHOLOGY SMEARS INTREPRET,88108,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
CYTOPATHOLOGY SMEARS INTREPRET,88108,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
CASHEW IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONSULT AND REPORT SLIDES,88321,CPT,312,RC,,OUTPATIENT,,,567,226.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,453.6,OTHER,425.25,555.66,PERCENT OF CHARGES BASED ON HCPCS CODE
CONSULT AND REPORT SLIDES,88321,CPT,312,RC,,OUTPATIENT,,,567,226.8,MONUMENT,COMMERCIAL,,,,453.6,,425.25,555.66,
MACADAMIA NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROMO ANALY ADD'L KARYOTYPES,88280,CPT,310,RC,,OUTPATIENT,,,77,30.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,61.6,OTHER,57.75,75.46,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMO ANALY ADD'L KARYOTYPES,88280,CPT,310,RC,,OUTPATIENT,,,77,30.8,MONUMENT,COMMERCIAL,,,,61.6,,57.75,75.46,
PINE NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SKIN OR OTH SOLID TISSUE BPSY,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,532.6,OTHER,499.31,652.44,PERCENT OF CHARGES BASED ON HCPCS CODE
SKIN OR OTH SOLID TISSUE BPSY,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,MONUMENT,COMMERCIAL,,,,532.6,,499.31,652.44,
PEANUT IGE COMPONENTS REFLEX,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DECALCIFICATION-TECHNICAL,88311,CPT,312,RC,,OUTPATIENT,,,33.75,13.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,27,OTHER,25.31,33.08,PERCENT OF CHARGES BASED ON HCPCS CODE
DECALCIFICATION-TECHNICAL,88311,CPT,312,RC,,OUTPATIENT,,,33.75,13.5,MONUMENT,COMMERCIAL,,,,27,,25.31,33.08,
TAPIOCA IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,57.41,22.964,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,43.1,56.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOHISTOCHEMISTRY INITIAL,88342,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOHISTOCHEMISTRY INITIAL,88342,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
JALAPENO CHIPOTLE IGE,86003,CPT,300,RC,,OUTPATIENT,,,96,38.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72,94.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOHISTOCHEMISTRY MULTIPLEX,G0462,HCPCS,312,RC,,BOTH,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,528.28,OTHER,170.63,222.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IMMUNOHISTOCHEMISTRY MULTIPLEX,G0462,HCPCS,312,RC,,BOTH,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
IMMUNOHISTOCHEMISTRY MULTIPLEX,G0462,HCPCS,312,RC,,BOTH,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,,170.63,,170.63,222.95,
OR CONSULT W/FROZ SECTION SING,88331,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,159.38,208.25,PERCENT OF CHARGES BASED ON HCPCS CODE
OR CONSULT W/FROZ SECTION SING,88331,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,170,,159.38,208.25,
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPEC GROUP STAIN I TECHNICAL,88312,CPT,312,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
SPEC GROUP STAIN I TECHNICAL,88312,CPT,312,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE CULTURE ADD'L STUDY,87253,CPT,300,RC,,OUTPATIENT,,,442,176.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,353.6,OTHER,331.5,433.16,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE CULTURE ADD'L STUDY,87253,CPT,300,RC,,OUTPATIENT,,,442,176.8,MONUMENT,COMMERCIAL,,,,353.6,,331.5,433.16,
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SURGICAL MACRO MICRO I,88302,CPT,312,RC,,OUTPATIENT,,,188.75,75.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,151,OTHER,141.56,184.98,PERCENT OF CHARGES BASED ON HCPCS CODE
SURGICAL MACRO MICRO I,88302,CPT,312,RC,,OUTPATIENT,,,188.75,75.5,MONUMENT,COMMERCIAL,,,,151,,141.56,184.98,
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SURGICAL MACRO I,88300,CPT,312,RC,,OUTPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.4,OTHER,49.13,64.19,PERCENT OF CHARGES BASED ON HCPCS CODE
SURGICAL MACRO I,88300,CPT,312,RC,,OUTPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE 1 COMPLEX TECHNICAL,88304,CPT,312,RC,,OUTPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,99.4,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE 1 COMPLEX TECHNICAL,88304,CPT,312,RC,,OUTPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
BRAZIL NUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE 2 COMPLEX  TECHNICAL,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.8,OTHER,109.5,143.08,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE 2 COMPLEX  TECHNICAL,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,MONUMENT,COMMERCIAL,,,,116.8,,109.5,143.08,
COW EPITHELIUM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE 3 COMPLEX--TECHNICAL,88307,CPT,312,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,296.06,386.86,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE 3 COMPLEX--TECHNICAL,88307,CPT,312,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
ALL POTATO,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TISSUE 4 COMPLEX--TECHNICAL,88309,CPT,312,RC,,OUTPATIENT,,,1307.81,523.124,BLUE CROSS ANTHEM,COMMERCIAL,,,,1046.248,OTHER,296.06,386.86,PERCENT OF CHARGES BASED ON HCPCS CODE
TISSUE 4 COMPLEX--TECHNICAL,88309,CPT,312,RC,,OUTPATIENT,,,1307.81,523.124,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
ALL SQUASH,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTOMETRY INTRO 16+MRUS,88189,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY INTRO 16+MRUS,88189,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
ALL WASP VENOM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTOMETRY INTRP 2-8 MRUS,88187,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY INTRP 2-8 MRUS,88187,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
ALL DOG DANDER IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MICRODISSECTION - MANUAL,88381,CPT,312,RC,,OUTPATIENT,,,180.5,72.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,144.4,OTHER,135.38,176.89,PERCENT OF CHARGES BASED ON HCPCS CODE
MICRODISSECTION - MANUAL,88381,CPT,312,RC,,OUTPATIENT,,,180.5,72.2,MONUMENT,COMMERCIAL,,,,144.4,,135.38,176.89,
ALL ROUGH PIGWEED IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,7.8,10.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPIDERMAL GROWTH FACTOR RCPTR,81235,CPT,312,RC,,OUTPATIENT,,,905.25,362.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,724.2,OTHER,678.94,887.15,PERCENT OF CHARGES BASED ON HCPCS CODE
EPIDERMAL GROWTH FACTOR RCPTR,81235,CPT,312,RC,,OUTPATIENT,,,905.25,362.1,MONUMENT,COMMERCIAL,,,,724.2,,678.94,887.15,
GRANULOCYTE ANTIBODIES,86021,CPT,300,RC,,OUTPATIENT,,,232.5,93,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,174.38,227.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMMUNOHISTOCHEMISTRY ADD'L,88341,CPT,312,RC,,OUTPATIENT,,,227.5,91,BLUE CROSS ANTHEM,COMMERCIAL,,,,182,OTHER,170.63,222.95,PERCENT OF CHARGES BASED ON HCPCS CODE
IMMUNOHISTOCHEMISTRY ADD'L,88341,CPT,312,RC,,OUTPATIENT,,,227.5,91,MONUMENT,COMMERCIAL,,,,182,,170.63,222.95,
PLATELET ANTIBODIES SERUM,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,250.13,326.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHROMOSOME ANALYSIS 15-20 CELL,88262,CPT,310,RC,,OUTPATIENT,,,351.25,140.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,281,OTHER,263.44,344.23,PERCENT OF CHARGES BASED ON HCPCS CODE
CHROMOSOME ANALYSIS 15-20 CELL,88262,CPT,310,RC,,OUTPATIENT,,,351.25,140.5,MONUMENT,COMMERCIAL,,,,281,,263.44,344.23,
HEPARIN - PF4 ANTIBODY,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,250.13,326.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTOMETRY INTRP 9-15 MRKS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY INTRP 9-15 MRKS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
ANTI PLATELET DIRECT ASSAY,86023,CPT,300,RC,,OUTPATIENT,,,196,78.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147,192.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
R FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
R FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
ANA,86038,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLOW CYTOMETRY EA ADD'L MRKER,88185,CPT,310,RC,,OUTPATIENT,,,432.75,173.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,346.2,OTHER,324.56,424.1,PERCENT OF CHARGES BASED ON HCPCS CODE
FLOW CYTOMETRY EA ADD'L MRKER,88185,CPT,310,RC,,OUTPATIENT,,,432.75,173.1,MONUMENT,COMMERCIAL,,,,346.2,,324.56,424.1,
Z ANA 2,86038,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,114.19,149.21,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,121.8,,114.19,149.21,
Z ANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.1,35.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.4,OTHER,110.06,143.82,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,MONUMENT,COMMERCIAL,,,,117.4,,110.06,143.82,
ZANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,110,44,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,82.5,107.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z FLOW CYTOMETRY ADD ON,88185,CPT,310,RC,,OUTPATIENT,,,52.25,20.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,41.8,OTHER,39.19,51.21,PERCENT OF CHARGES BASED ON HCPCS CODE
Z FLOW CYTOMETRY ADD ON,88185,CPT,310,RC,,OUTPATIENT,,,52.25,20.9,MONUMENT,COMMERCIAL,,,,41.8,,39.19,51.21,
ANA REFLEX TITER,86039,CPT,300,RC,,OUTPATIENT,,,90.75,36.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.06,88.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MORPHOMETRIC ANALYSIS MANUAL,88368,CPT,310,RC,,OUTPATIENT,,,622.75,249.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,498.2,OTHER,467.06,610.3,PERCENT OF CHARGES BASED ON HCPCS CODE
MORPHOMETRIC ANALYSIS MANUAL,88368,CPT,310,RC,,OUTPATIENT,,,622.75,249.1,MONUMENT,COMMERCIAL,,,,498.2,,467.06,610.3,
Z ANTISTREPTOLYSIN O,86060,CPT,300,RC,,OUTPATIENT,,,19.75,7.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,14.81,19.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.63,356.23,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.63,356.23,
STREPTOZYME,86063,CPT,302,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.63,356.23,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.63,356.23,
INTERPRETATION & WRITTEN REPRT,86078,CPT,300,RC,,OUTPATIENT,,,136.5,54.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.38,133.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.6,356.2,PERCENT OF CHARGES BASED ON HCPCS CODE
KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.6,356.2,
BLOOD BANK PROC DEVIATION,86079,CPT,302,RC,,OUTPATIENT,,,158.25,63.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,118.69,155.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SITZ MARKER CAPSULE,A9698,HCPCS,636,RC,,INPATIENT,,,40,16,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.4,OTHER,30,39.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SITZ MARKER CAPSULE,A9698,HCPCS,636,RC,,INPATIENT,,,40,16,MONUMENT,COMMERCIAL,,,,32,,30,39.2,
SITZ MARKER CAPSULE,A9698,HCPCS,636,RC,,INPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,,30,,30,39.2,
ABDOMEN SERIES 3 VIEWS  ACUTE,74022,CPT,320,RC,,OUTPATIENT,,,494.75,197.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,395.8,OTHER,371.06,484.86,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMEN SERIES 3 VIEWS  ACUTE,74022,CPT,320,RC,,OUTPATIENT,,,494.75,197.9,MONUMENT,COMMERCIAL,,,,395.8,,371.06,484.86,
C-REACTIVE PROTEIN,86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SITZ MARKER KUB SUBSEQUENT,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.6,356.2,PERCENT OF CHARGES BASED ON HCPCS CODE
SITZ MARKER KUB SUBSEQUENT,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.6,356.2,
C-REACTIVE PROTEIN (BABY),86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABCESS O GRAM,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,BLUE CROSS ANTHEM,COMMERCIAL,,,,769.984,OTHER,515.25,673.26,PERCENT OF CHARGES BASED ON HCPCS CODE
ABCESS O GRAM,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,MONUMENT,COMMERCIAL,,,,549.6,,515.25,673.26,
CRP HIGH SENSITIVITY,86141,CPT,302,RC,,OUTPATIENT,,,125.75,50.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.31,123.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOLEY CATH INSERTION SIMPLE,51702,CPT,320,RC,,OUTPATIENT,,,244.25,97.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,195.4,OTHER,183.19,239.37,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLEY CATH INSERTION SIMPLE,51702,CPT,320,RC,,OUTPATIENT,,,244.25,97.7,MONUMENT,COMMERCIAL,,,,195.4,,183.19,239.37,
Z BETA-2 GLYCOPROTEIN 1 AB IGA,86146,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOLEY CATH INSERTION COMPLCTD,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.4,OTHER,337.88,441.49,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLEY CATH INSERTION COMPLCTD,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,MONUMENT,COMMERCIAL,,,,360.4,,337.88,441.49,
Z BETA-2 GLYCOPROTIEN 1 AB IGG,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTOSTOMY TUBE COMPLD CHANGE,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2053.4,OTHER,1925.06,2515.42,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOSTOMY TUBE COMPLD CHANGE,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,MONUMENT,COMMERCIAL,,,,2053.4,,1925.06,2515.42,
Z BETA-2 GLYCOPROTIEN 1 AB IGM,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.25,61.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTOSTOMY TUBE CHNG IMAGE GD,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,824.2,OTHER,772.69,1009.65,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOSTOMY TUBE CHNG IMAGE GD,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,MONUMENT,COMMERCIAL,,,,824.2,,772.69,1009.65,
BETA 2 GLYCOPROTEIN 1 ANTIBODY,86146,CPT,300,RC,,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.8,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LOWER EXTREMITY INFANT,73592,CPT,320,RC,,OUTPATIENT,,,229,91.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,183.2,OTHER,171.75,224.42,PERCENT OF CHARGES BASED ON HCPCS CODE
LOWER EXTREMITY INFANT,73592,CPT,320,RC,,OUTPATIENT,,,229,91.6,MONUMENT,COMMERCIAL,,,,183.2,,171.75,224.42,
CARDIOLIPIN AB IGG  IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXTREMITY INFANT,73092,CPT,320,RC,,OUTPATIENT,,,229,91.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,183.2,OTHER,171.75,224.42,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXTREMITY INFANT,73092,CPT,320,RC,,OUTPATIENT,,,229,91.6,MONUMENT,COMMERCIAL,,,,183.2,,171.75,224.42,
CARDIOLIPIN ANTIBODY IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXTREMITY INFANT BIL,7309250,CPT,320,RC,50,OUTPATIENT,,,350,140,BLUE CROSS ANTHEM,COMMERCIAL,,,,280,OTHER,262.5,343,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXTREMITY INFANT BIL,7309250,CPT,320,RC,50,OUTPATIENT,,,350,140,MONUMENT,COMMERCIAL,,,,280,,262.5,343,
CARDIOLIPIN ANTIBODIES IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BE SCREENING,G0120,HCPCS,320,RC,,INPATIENT,,,910.75,364.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,828.78,OTHER,683.06,892.54,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BE SCREENING,G0120,HCPCS,320,RC,,INPATIENT,,,910.75,364.3,MONUMENT,COMMERCIAL,,,,728.6,,683.06,892.54,
BE SCREENING,G0120,HCPCS,320,RC,,INPATIENT,,,910.75,364.3,UNITED HEALTH,UNITED COMMERCIAL,,,,683.06,,683.06,892.54,
VENOUS CATHETER REMOVAL,36589,CPT,760,RC,,OUTPATIENT,,,1885.5,754.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1508.4,OTHER,1414.13,1847.79,PERCENT OF CHARGES BASED ON HCPCS CODE
VENOUS CATHETER REMOVAL,36589,CPT,760,RC,,OUTPATIENT,,,1885.5,754.2,MONUMENT,COMMERCIAL,,,,1508.4,,1414.13,1847.79,
Z CARDIOLIPIN AB IGG (MAYO),86147,CPT,300,RC,,OUTPATIENT,,,50.9,20.36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.38,39.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEEDING TUBE REPLACEMENT,43999,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,675,882,PERCENT OF CHARGES BASED ON HCPCS CODE
FEEDING TUBE REPLACEMENT,43999,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,720,,675,882,
CARDIOLIPIN AB IGA,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOMY TUBE REPLACEMENT,75984,CPT,320,RC,,OUTPATIENT,,,1100,440,BLUE CROSS ANTHEM,COMMERCIAL,,,,880,OTHER,2333.81,3049.52,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOMY TUBE REPLACEMENT,75984,CPT,320,RC,,OUTPATIENT,,,1100,440,MONUMENT,COMMERCIAL,,,,2489.4,,2333.81,3049.52,
PHOSPHATIDYLSERINE AB A,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.63,140.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOMY TUBE REPLACEMENT,50435,CPT,361,RC,,OUTPATIENT,,,3000,1200,BLUE CROSS ANTHEM,COMMERCIAL,,,,2400,OTHER,2064.56,2697.7,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOMY TUBE REPLACEMENT,50435,CPT,361,RC,,OUTPATIENT,,,3000,1200,MONUMENT,COMMERCIAL,,,,2202.2,,2064.56,2697.7,
PHOSPHATIDYLSERINE AB G,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.63,140.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROGRAFIN ABDOMEN 1 VIEW,74000,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.63,356.23,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROGRAFIN ABDOMEN 1 VIEW,74000,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.63,356.23,
PHOSPHATIDYLSERINE AB M,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.63,140.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJECT JOINT/BURSA LT,20605LT,CPT,361,RC,LT,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJECT JOINT/BURSA LT,20605LT,CPT,361,RC,LT,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
COLD AGGLUTININ TITER,86156,CPT,302,RC,,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJECT JOINT/BURSA,20605RT,CPT,320,RC,RT,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJECT JOINT/BURSA,20605RT,CPT,320,RC,RT,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SELLA TURCICA EXAM,70240,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
SELLA TURCICA EXAM,70240,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
C5 COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJECT JOINT/BURSA BI,2060550,CPT,320,RC,50,OUTPATIENT,,,1124.25,449.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,899.4,OTHER,843.19,1101.77,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJECT JOINT/BURSA BI,2060550,CPT,320,RC,50,OUTPATIENT,,,1124.25,449.7,MONUMENT,COMMERCIAL,,,,899.4,,843.19,1101.77,
C4ADES,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABDOMEN 2 VIEWS,74019,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,345.4,OTHER,323.81,423.12,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMEN 2 VIEWS,74019,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,MONUMENT,COMMERCIAL,,,,345.4,,323.81,423.12,
C3A LEVEL,86160,CPT,300,RC,,OUTPATIENT,,,208.5,83.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,156.38,204.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CENTRAL VENOUS ACCESS EVAL,36598,CPT,320,RC,,OUTPATIENT,,,568,227.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,454.4,OTHER,426,556.64,PERCENT OF CHARGES BASED ON HCPCS CODE
CENTRAL VENOUS ACCESS EVAL,36598,CPT,320,RC,,OUTPATIENT,,,568,227.2,MONUMENT,COMMERCIAL,,,,454.4,,426,556.64,
COMPLEMENT C3,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BILIARY CATH CHANGE,47525,CPT,320,RC,,OUTPATIENT,,,6430.08,2572.032,BLUE CROSS ANTHEM,COMMERCIAL,,,,5144.064,OTHER,1387.13,1812.51,PERCENT OF CHARGES BASED ON HCPCS CODE
BILIARY CATH CHANGE,47525,CPT,320,RC,,OUTPATIENT,,,6430.08,2572.032,MONUMENT,COMMERCIAL,,,,1479.6,,1387.13,1812.51,
COMPLEMENT C1Q,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST TUBE PLACEMENT,32557,CPT,320,RC,,OUTPATIENT,,,1708,683.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1366.4,OTHER,1281,1673.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST TUBE PLACEMENT,32557,CPT,320,RC,,OUTPATIENT,,,1708,683.2,MONUMENT,COMMERCIAL,,,,1366.4,,1281,1673.84,
COMPLEMENT C2 ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION FOR KNEE XRAY,27370,CPT,320,RC,,OUTPATIENT,,,275.75,110.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,220.6,OTHER,206.81,270.24,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION FOR KNEE XRAY,27370,CPT,320,RC,,OUTPATIENT,,,275.75,110.3,MONUMENT,COMMERCIAL,,,,220.6,,206.81,270.24,
COMPLEMENT C4,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ACROMIOCLAVICULAR JOINTS,73050,CPT,320,RC,,OUTPATIENT,,,348.5,139.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,278.8,OTHER,261.38,341.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ACROMIOCLAVICULAR JOINTS,73050,CPT,320,RC,,OUTPATIENT,,,348.5,139.4,MONUMENT,COMMERCIAL,,,,278.8,,261.38,341.53,
COMPLEMENT FACTOR B,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.81,129.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE LOCAL BY XRAY BILATERAL,7700250,CPT,,,50,OUTPATIENT,,,550,220,BLUE CROSS ANTHEM,COMMERCIAL,,,,440,OTHER,412.5,539,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE LOCAL BY XRAY BILATERAL,7700250,CPT,,,50,OUTPATIENT,,,550,220,MONUMENT,COMMERCIAL,,,,440,,412.5,539,
C5 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJ JNT/BURSA W/O US BIL,2061050,CPT,320,RC,50,OUTPATIENT,,,1300,520,BLUE CROSS ANTHEM,COMMERCIAL,,,,1040,OTHER,975,1274,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJ JNT/BURSA W/O US BIL,2061050,CPT,320,RC,50,OUTPATIENT,,,1300,520,MONUMENT,COMMERCIAL,,,,1040,,975,1274,
C2 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.13,166.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEEDING TUBE PLACEMENT,43752,CPT,320,RC,,OUTPATIENT,,,538.59,215.436,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.872,OTHER,393.75,514.5,PERCENT OF CHARGES BASED ON HCPCS CODE
FEEDING TUBE PLACEMENT,43752,CPT,320,RC,,OUTPATIENT,,,538.59,215.436,MONUMENT,COMMERCIAL,,,,420,,393.75,514.5,
COMPLEMENT TOTAL (CH5O),86162,CPT,300,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE ARTHROGRAM RT,73615RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,318.75,416.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE ARTHROGRAM RT,73615RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,340,,318.75,416.5,
CYCLIC CITRULLINATED  PEP AB,86200,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.81,109.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE ARTHROGRAM LT,73615LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,318.75,416.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE ARTHROGRAM LT,73615LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,340,,318.75,416.5,
DNASE-B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE 3 VIEWS RT,73610RT,CPT,320,RC,RT,OUTPATIENT,,,320.25,128.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,256.2,OTHER,240.19,313.85,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE 3 VIEWS RT,73610RT,CPT,320,RC,RT,OUTPATIENT,,,320.25,128.1,MONUMENT,COMMERCIAL,,,,256.2,,240.19,313.85,
Z DNASE B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,39.5,15.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.63,38.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE 3 VIEWS LT,73610LT,CPT,320,RC,LT,OUTPATIENT,,,320.25,128.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,256.2,OTHER,240.19,313.85,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE 3 VIEWS LT,73610LT,CPT,320,RC,LT,OUTPATIENT,,,320.25,128.1,MONUMENT,COMMERCIAL,,,,256.2,,240.19,313.85,
DNA ANTIBODY IGG,86225,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102.94,134.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE 2 VIEWS RT,73600RT,CPT,320,RC,RT,OUTPATIENT,,,218,87.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,174.4,OTHER,163.5,213.64,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE 2 VIEWS RT,73600RT,CPT,320,RC,RT,OUTPATIENT,,,218,87.2,MONUMENT,COMMERCIAL,,,,174.4,,163.5,213.64,
Z DNA,86225,CPT,300,RC,,OUTPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,37.31,48.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE 2 VIEWS LT,73600LT,CPT,320,RC,LT,OUTPATIENT,,,218,87.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,174.4,OTHER,163.5,213.64,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE 2 VIEWS LT,73600LT,CPT,320,RC,LT,OUTPATIENT,,,218,87.2,MONUMENT,COMMERCIAL,,,,174.4,,163.5,213.64,
ANTI DNA AB SINGLE STRAND,86226,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE INJECTION RT,27648RT,CPT,320,RC,RT,OUTPATIENT,,,343.75,137.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,275,OTHER,257.81,336.88,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE INJECTION RT,27648RT,CPT,320,RC,RT,OUTPATIENT,,,343.75,137.5,MONUMENT,COMMERCIAL,,,,275,,257.81,336.88,
SCLERODERMA ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE INJECTION LT,27648LT,CPT,320,RC,LT,OUTPATIENT,,,343.75,137.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,275,OTHER,257.81,336.88,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE INJECTION LT,27648LT,CPT,320,RC,LT,OUTPATIENT,,,343.75,137.5,MONUMENT,COMMERCIAL,,,,275,,257.81,336.88,
Z ENA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE BILATERAL,7361050,CPT,320,RC,50,OUTPATIENT,,,640,256,BLUE CROSS ANTHEM,COMMERCIAL,,,,512,OTHER,480,627.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE BILATERAL,7361050,CPT,320,RC,50,OUTPATIENT,,,640,256,MONUMENT,COMMERCIAL,,,,512,,480,627.2,
Z ENA SSA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUOROSCOPIC GUIDANCE INJ PROC,77003,CPT,320,RC,,OUTPATIENT,,,296.5,118.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.2,OTHER,222.38,290.57,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUOROSCOPIC GUIDANCE INJ PROC,77003,CPT,320,RC,,OUTPATIENT,,,296.5,118.6,MONUMENT,COMMERCIAL,,,,237.2,,222.38,290.57,
SMITH (ENA) ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTRO GASTROINTESTINAL TUBE,44500,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,525,686,PERCENT OF CHARGES BASED ON HCPCS CODE
INTRO GASTROINTESTINAL TUBE,44500,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,560,,525,686,
JO 1 ANTIBODY   IGG,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLURO GUIDED SI JOINT INJECTIO,27096,CPT,350,RC,,OUTPATIENT,,,2455.25,982.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1964.2,OTHER,1841.4,2406.1,PERCENT OF CHARGES BASED ON HCPCS CODE
FLURO GUIDED SI JOINT INJECTIO,27096,CPT,350,RC,,OUTPATIENT,,,2455.25,982.1,MONUMENT,COMMERCIAL,,,,1964.2,,1841.4,2406.1,
SS-A,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE INJECT RT,27369RT,CPT,361,RC,RT,OUTPATIENT,,,357,142.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,285.6,OTHER,267.75,349.86,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE INJECT RT,27369RT,CPT,361,RC,RT,OUTPATIENT,,,357,142.8,MONUMENT,COMMERCIAL,,,,285.6,,267.75,349.86,
SS-B,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE INJECT LT,27369LT,CPT,361,RC,LT,OUTPATIENT,,,357,142.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,285.6,OTHER,267.75,349.86,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE INJECT LT,27369LT,CPT,361,RC,LT,OUTPATIENT,,,357,142.8,MONUMENT,COMMERCIAL,,,,285.6,,267.75,349.86,
NUCLEAR ANTIGEN ANITBODY,86235,CPT,300,RC,,OUTPATIENT,,,45.5,18.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.13,44.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROSTOMY TUBE CHANGE,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,490.5,640.92,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROSTOMY TUBE CHANGE,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,523.2,,490.5,640.92,
ANTI TIF 1GAMMA AB,86235,CPT,300,RC,,OUTPATIENT,,,185.73,74.292,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.3,182,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROSTOMY TUBE CHANGE,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,824.2,OTHER,772.69,1009.65,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROSTOMY TUBE CHANGE,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,MONUMENT,COMMERCIAL,,,,824.2,,772.69,1009.65,
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.3,22.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE CATH DEVICE,C1729,HCPCS,272,RC,,INPATIENT,,,395.5,158.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.91,OTHER,296.63,387.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DRAINAGE CATH DEVICE,C1729,HCPCS,272,RC,,INPATIENT,,,395.5,158.2,MONUMENT,COMMERCIAL,,,,316.4,,296.63,387.59,
DRAINAGE CATH DEVICE,C1729,HCPCS,272,RC,,INPATIENT,,,395.5,158.2,UNITED HEALTH,UNITED COMMERCIAL,,,,296.63,,296.63,387.59,
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1961.5,784.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1569.2,OTHER,1471.13,1922.27,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1961.5,784.6,MONUMENT,COMMERCIAL,,,,1569.2,,1471.13,1922.27,
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.3,22.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BABYGRAM,71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,259,OTHER,242.81,317.28,PERCENT OF CHARGES BASED ON HCPCS CODE
BABYGRAM,71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.3,22.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BABYGRAM,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.8,OTHER,272.63,356.23,PERCENT OF CHARGES BASED ON HCPCS CODE
BABYGRAM,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,MONUMENT,COMMERCIAL,,,,290.8,,272.63,356.23,
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.3,22.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
XRAY FILTER GUIDANCE,37191,CPT,361,RC,,OUTPATIENT,,,3145.75,1258.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2516.6,OTHER,2359.31,3082.84,PERCENT OF CHARGES BASED ON HCPCS CODE
XRAY FILTER GUIDANCE,37191,CPT,361,RC,,OUTPATIENT,,,3145.75,1258.3,MONUMENT,COMMERCIAL,,,,2516.6,,2359.31,3082.84,
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,17.3,22.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO GUIDED NEEDLE PLACEMENT,77002,CPT,320,RC,,OUTPATIENT,,,709,283.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,567.2,OTHER,531.8,694.8,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO GUIDED NEEDLE PLACEMENT,77002,CPT,320,RC,,OUTPATIENT,,,709,283.6,MONUMENT,COMMERCIAL,,,,567.2,,531.8,694.8,
NMO IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BARIUM ENEMA W/AIR CONTRAST,74280,CPT,320,RC,,OUTPATIENT,,,910.75,364.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,728.6,OTHER,683.06,892.54,PERCENT OF CHARGES BASED ON HCPCS CODE
BARIUM ENEMA W/AIR CONTRAST,74280,CPT,320,RC,,OUTPATIENT,,,910.75,364.3,MONUMENT,COMMERCIAL,,,,728.6,,683.06,892.54,
GLOMERULAR (GBM) IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BARIUM ENEMA SINGLE CONTRAST,74270,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,604.2,OTHER,566.44,740.15,PERCENT OF CHARGES BASED ON HCPCS CODE
BARIUM ENEMA SINGLE CONTRAST,74270,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,MONUMENT,COMMERCIAL,,,,604.2,,566.44,740.15,
GLOMERULAR (GBM) IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE AGE STUDIES,77072,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.4,OTHER,186.94,244.27,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE AGE STUDIES,77072,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,MONUMENT,COMMERCIAL,,,,199.4,,186.94,244.27,
FLUORESCENT ANTIBODY SCREENING,86255,CPT,300,RC,,OUTPATIENT,,,90,36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA BONE DENSITY/IVA,77082,CPT,320,RC,,OUTPATIENT,,,246.75,98.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,197.4,OTHER,185.06,241.82,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA BONE DENSITY/IVA,77082,CPT,320,RC,,OUTPATIENT,,,246.75,98.7,MONUMENT,COMMERCIAL,,,,197.4,,185.06,241.82,
Z CUTANEOUS IMMUNOFLUOR AB IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE SURVEY COMPLETE,77075,CPT,320,RC,,OUTPATIENT,,,1182,472.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,945.6,OTHER,886.5,1158.36,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE SURVEY COMPLETE,77075,CPT,320,RC,,OUTPATIENT,,,1182,472.8,MONUMENT,COMMERCIAL,,,,945.6,,886.5,1158.36,
GLOMERULAR ANTIBODIES IGA&IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE SURVEY LIMITED,77074,CPT,320,RC,,OUTPATIENT,,,679.25,271.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,543.4,OTHER,509.44,665.67,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE SURVEY LIMITED,77074,CPT,320,RC,,OUTPATIENT,,,679.25,271.7,MONUMENT,COMMERCIAL,,,,543.4,,509.44,665.67,
ANCA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE SURVEY INFANT,77076,CPT,320,RC,,OUTPATIENT,,,598,239.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,478.4,OTHER,448.5,586.04,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE SURVEY INFANT,77076,CPT,320,RC,,OUTPATIENT,,,598,239.2,MONUMENT,COMMERCIAL,,,,478.4,,448.5,586.04,
NEUTROPHIL CYTOLOGY ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA W/O WRIST,77080,CPT,320,RC,,OUTPATIENT,,,428,171.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,342.4,OTHER,321,419.44,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA W/O WRIST,77080,CPT,320,RC,,OUTPATIENT,,,428,171.2,MONUMENT,COMMERCIAL,,,,342.4,,321,419.44,
PURKINJE CELL ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHOLANGIOGRAM PTOP,47531,CPT,320,RC,,OUTPATIENT,,,6345.05,2538.02,BLUE CROSS ANTHEM,COMMERCIAL,,,,5076.04,OTHER,478.31,625,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLANGIOGRAM PTOP,47531,CPT,320,RC,,OUTPATIENT,,,6345.05,2538.02,MONUMENT,COMMERCIAL,,,,510.2,,478.31,625,
SMOOTH MUSCLE ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHOLANGIOGRAM ADD SET,74301,CPT,320,RC,,OUTPATIENT,,,150.75,60.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.6,OTHER,113.06,147.74,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLANGIOGRAM ADD SET,74301,CPT,320,RC,,OUTPATIENT,,,150.75,60.3,MONUMENT,COMMERCIAL,,,,120.6,,113.06,147.74,
RETICULIN ANTIBODY  IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FNA BX W/CT GDN EA ADDL,10010,CPT,320,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
FNA BX W/CT GDN EA ADDL,10010,CPT,320,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
ANTI-NEURONAL NUCLEAR ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHOLANGIOGRAM OPERATIVE,74300,CPT,320,RC,,OUTPATIENT,,,279,111.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,223.2,OTHER,209.25,273.42,PERCENT OF CHARGES BASED ON HCPCS CODE
CHOLANGIOGRAM OPERATIVE,74300,CPT,320,RC,,OUTPATIENT,,,279,111.6,MONUMENT,COMMERCIAL,,,,223.2,,209.25,273.42,
C DSDNA AB CRITHIDIA IFA IGG,86255,CPT,300,RC,,OUTPATIENT,,,223,89.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,167.3,218.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLAVICLE RT,73000RT,CPT,320,RC,RT,OUTPATIENT,,,260.5,104.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.4,OTHER,195.38,255.29,PERCENT OF CHARGES BASED ON HCPCS CODE
CLAVICLE RT,73000RT,CPT,320,RC,RT,OUTPATIENT,,,260.5,104.2,MONUMENT,COMMERCIAL,,,,208.4,,195.38,255.29,
THSD7A AB S CHARGE,86255,CPT,300,RC,,OUTPATIENT,,,380,152,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,285,372.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLAVICLE LT,73000LT,CPT,320,RC,LT,OUTPATIENT,,,260.5,104.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.4,OTHER,195.38,255.29,PERCENT OF CHARGES BASED ON HCPCS CODE
CLAVICLE LT,73000LT,CPT,320,RC,LT,OUTPATIENT,,,260.5,104.2,MONUMENT,COMMERCIAL,,,,208.4,,195.38,255.29,
Z FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,36.16,14.464,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.1,35.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CERVICAL SPINE 4 OR 5 VIEWS,72050,CPT,320,RC,,OUTPATIENT,,,560.25,224.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,448.2,OTHER,420.19,549.05,PERCENT OF CHARGES BASED ON HCPCS CODE
CERVICAL SPINE 4 OR 5 VIEWS,72050,CPT,320,RC,,OUTPATIENT,,,560.25,224.1,MONUMENT,COMMERCIAL,,,,448.2,,420.19,549.05,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CERVICAL SPINE 3 VIEWS,72040,CPT,320,RC,,OUTPATIENT,,,364,145.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,291.2,OTHER,273,356.72,PERCENT OF CHARGES BASED ON HCPCS CODE
CERVICAL SPINE 3 VIEWS,72040,CPT,320,RC,,OUTPATIENT,,,364,145.6,MONUMENT,COMMERCIAL,,,,291.2,,273,356.72,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CERVICAL SPINE 6 OR MORE VIEWS,72052,CPT,320,RC,,OUTPATIENT,,,618,247.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,494.4,OTHER,463.5,605.64,PERCENT OF CHARGES BASED ON HCPCS CODE
CERVICAL SPINE 6 OR MORE VIEWS,72052,CPT,320,RC,,OUTPATIENT,,,618,247.2,MONUMENT,COMMERCIAL,,,,494.4,,463.5,605.64,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUROSCOPY,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,538.2,OTHER,504.56,659.3,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUROSCOPY,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,MONUMENT,COMMERCIAL,,,,538.2,,504.56,659.3,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST 2 VIEWS,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,266.8,OTHER,250.13,326.83,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST 2 VIEWS,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,MONUMENT,COMMERCIAL,,,,266.8,,250.13,326.83,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST 1 VIEW,71045,CPT,320,RC,,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,242.81,317.28,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST 1 VIEW,71045,CPT,320,RC,,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ NEEDLE PLACEMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,504.8,OTHER,473.25,618.38,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ NEEDLE PLACEMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,MONUMENT,COMMERCIAL,,,,504.8,,473.25,618.38,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE LOCALIZATION BY XRAY,77002,CPT,320,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE LOCALIZATION BY XRAY,77002,CPT,320,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST 4 VIEWS,71048,CPT,320,RC,,OUTPATIENT,,,384.5,153.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,307.6,OTHER,288.38,376.81,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST 4 VIEWS,71048,CPT,320,RC,,OUTPATIENT,,,384.5,153.8,MONUMENT,COMMERCIAL,,,,307.6,,288.38,376.81,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST 3 VIEWS,71047,CPT,320,RC,,OUTPATIENT,,,371.75,148.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,297.4,OTHER,278.81,364.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST 3 VIEWS,71047,CPT,320,RC,,OUTPATIENT,,,371.75,148.7,MONUMENT,COMMERCIAL,,,,297.4,,278.81,364.32,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST (MINE),71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,259,OTHER,242.81,317.28,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST (MINE),71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,MONUMENT,COMMERCIAL,,,,259,,242.81,317.28,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST (MINE) 2 VIEWS PRE-EMP,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,266.8,OTHER,250.13,326.83,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST (MINE) 2 VIEWS PRE-EMP,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,MONUMENT,COMMERCIAL,,,,266.8,,250.13,326.83,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTOGRAPHY 3 VIEWS,74430,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,408,533.12,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOGRAPHY 3 VIEWS,74430,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,435.2,,408,533.12,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PROC CYSTOGRAPHY,51600,CPT,320,RC,,OUTPATIENT,,,436.5,174.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,349.2,OTHER,327.38,427.77,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PROC CYSTOGRAPHY,51600,CPT,320,RC,,OUTPATIENT,,,436.5,174.6,MONUMENT,COMMERCIAL,,,,349.2,,327.38,427.77,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA/ARM W/WRIST RT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.2,OTHER,156.75,204.82,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA/ARM W/WRIST RT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,MONUMENT,COMMERCIAL,,,,167.2,,156.75,204.82,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA/ARM W/WRIST LT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,167.2,OTHER,156.75,204.82,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA/ARM W/WRIST LT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,MONUMENT,COMMERCIAL,,,,167.2,,156.75,204.82,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA HIP (R),76075RT,CPT,320,RC,RT,OUTPATIENT,,,62.75,25.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,50.2,OTHER,47.06,61.5,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA HIP (R),76075RT,CPT,320,RC,RT,OUTPATIENT,,,62.75,25.1,MONUMENT,COMMERCIAL,,,,50.2,,47.06,61.5,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW 3 VIEWS RT,73080RT,CPT,320,RC,RT,OUTPATIENT,,,317,126.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,253.6,OTHER,237.75,310.66,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW 3 VIEWS RT,73080RT,CPT,320,RC,RT,OUTPATIENT,,,317,126.8,MONUMENT,COMMERCIAL,,,,253.6,,237.75,310.66,
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW 3 VIEWS LT,73080LT,CPT,320,RC,LT,OUTPATIENT,,,317,126.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,253.6,OTHER,237.75,310.66,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW 3 VIEWS LT,73080LT,CPT,320,RC,LT,OUTPATIENT,,,317,126.8,MONUMENT,COMMERCIAL,,,,253.6,,237.75,310.66,
ZFLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,380,152,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,285,372.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW 2 VIEWS RT,73070RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,171,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW 2 VIEWS RT,73070RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
FLUROESCENT ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW 2 VIEWS LT,73070LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,171,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW 2 VIEWS LT,73070LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
FLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,138.5,55.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.88,135.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW ARTHROGRAM RT,73085RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,641,OTHER,600.94,785.23,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW ARTHROGRAM RT,73085RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,MONUMENT,COMMERCIAL,,,,641,,600.94,785.23,
ZFLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,109,43.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.8,106.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOW ARTHROGRAM LT,73085LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,641,OTHER,600.94,785.23,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOW ARTHROGRAM LT,73085LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,MONUMENT,COMMERCIAL,,,,641,,600.94,785.23,
GLIADIN DEAMIDATED AB,86258,CPT,300,RC,,OUTPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.3,61.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ESOPHAGRAM,74220,CPT,320,RC,,OUTPATIENT,,,496.25,198.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,397,OTHER,372.19,486.33,PERCENT OF CHARGES BASED ON HCPCS CODE
ESOPHAGRAM,74220,CPT,320,RC,,OUTPATIENT,,,496.25,198.5,MONUMENT,COMMERCIAL,,,,397,,372.19,486.33,
CA 15-3,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FACE BONE 3 VIEWS,70150,CPT,320,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
FACE BONE 3 VIEWS,70150,CPT,320,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
CA 27.29,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR 2 VIEWS RT,73552RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR 2 VIEWS RT,73552RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
CA19-9 (GI),86301,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.56,79.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR 2 VIEWS LT,73552LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR 2 VIEWS LT,73552LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
CA 125,86304,CPT,300,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.25,97.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR 2 VIEWS BILATERAL,73552,CPT,320,RC,,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR 2 VIEWS BILATERAL,73552,CPT,320,RC,,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
"HUMAN EPIDIDYMIS PROTEIN 4,SER",86305,CPT,302,RC,,OUTPATIENT,,,277,110.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,207.75,271.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR BILATERAL,7355250,CPT,320,RC,50,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR BILATERAL,7355250,CPT,320,RC,50,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
CHROMOGRANIN A,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.44,183.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER THUMB LT,73140FA,CPT,320,RC,FA,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER THUMB LT,73140FA,CPT,320,RC,FA,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
ALPHA FETO PROTEIN BODY FLUIDS,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.44,183.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 2ND DIGIT LT,73140F1,CPT,320,RC,F1,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 2ND DIGIT LT,73140F1,CPT,320,RC,F1,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
CA 72 4,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.44,183.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 3RD DIGIT LT,73140F2,CPT,320,RC,F2,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 3RD DIGIT LT,73140F2,CPT,320,RC,F2,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
DIPTHERIA TOXOID IGG AB,86317,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 4TH DIGIT LT,73140F3,CPT,320,RC,F3,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 4TH DIGIT LT,73140F3,CPT,320,RC,F3,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
TETANUS ANTIBODY,86317,CPT,300,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 5TH DIGIT LT,73140F4,CPT,320,RC,F4,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 5TH DIGIT LT,73140F4,CPT,320,RC,F4,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
STREPTOCOCCUS PHEUM IGG 7 SER,86317,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER THUMB RT,73140F5,CPT,320,RC,F5,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER THUMB RT,73140F5,CPT,320,RC,F5,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.1,65.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 2ND DIGIT RT,73140F6,CPT,320,RC,F6,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 2ND DIGIT RT,73140F6,CPT,320,RC,F6,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.1,65.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 3RD DIGIT RT,73140F7,CPT,320,RC,F7,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 3RD DIGIT RT,73140F7,CPT,320,RC,F7,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.1,65.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 4TH DIGIT RT,73140F8,CPT,320,RC,F8,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 4TH DIGIT RT,73140F8,CPT,320,RC,F8,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.1,65.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER 5TH DIGIT RT,73140F9,CPT,320,RC,F9,OUTPATIENT,,,233.75,93.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,187,OTHER,175.31,229.08,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER 5TH DIGIT RT,73140F9,CPT,320,RC,F9,OUTPATIENT,,,233.75,93.5,MONUMENT,COMMERCIAL,,,,187,,175.31,229.08,
HELICOBACTER PYLORI (DCMH),86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.81,109.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FISTULA SINUS W/CONTRAST,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,BLUE CROSS ANTHEM,COMMERCIAL,,,,769.984,OTHER,515.25,673.26,PERCENT OF CHARGES BASED ON HCPCS CODE
FISTULA SINUS W/CONTRAST,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,MONUMENT,COMMERCIAL,,,,549.6,,515.25,673.26,
MONO SCREEN,86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.81,109.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OR HIP LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,639.5,255.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.6,OTHER,479.63,626.71,PERCENT OF CHARGES BASED ON HCPCS CODE
OR HIP LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,639.5,255.8,MONUMENT,COMMERCIAL,,,,511.6,,479.63,626.71,
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,538.2,OTHER,504.56,659.3,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,MONUMENT,COMMERCIAL,,,,538.2,,504.56,659.3,
PM SCL ANTIBODY ID,86331,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO MORE THAN 1HR EXTENSIVE,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,538.2,OTHER,504.56,659.3,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO MORE THAN 1HR EXTENSIVE,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,MONUMENT,COMMERCIAL,,,,538.2,,504.56,659.3,
PARAKEET DROPPINGS BY GEL DIFF,86331,CPT,300,RC,,OUTPATIENT,,,106.25,42.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.69,104.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PICC PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,3124,1249.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2499.2,OTHER,2343,3061.52,PERCENT OF CHARGES BASED ON HCPCS CODE
PICC PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,3124,1249.6,MONUMENT,COMMERCIAL,,,,2499.2,,2343,3061.52,
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18,23.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MIDLINE INSERTION,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,390.4,OTHER,366,478.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MIDLINE INSERTION,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,MONUMENT,COMMERCIAL,,,,390.4,,366,478.2,
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18,23.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO GUIDED NEEDLE PLCMNT,77002,CPT,320,RC,,OUTPATIENT,,,295,118,BLUE CROSS ANTHEM,COMMERCIAL,,,,236,OTHER,221.25,289.1,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO GUIDED NEEDLE PLCMNT,77002,CPT,320,RC,,OUTPATIENT,,,295,118,MONUMENT,COMMERCIAL,,,,236,,221.25,289.1,
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18,23.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ/DRAIN MAJOR JOINT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,662.75,265.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.2,OTHER,497.06,649.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ/DRAIN MAJOR JOINT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,662.75,265.1,MONUMENT,COMMERCIAL,,,,530.2,,497.06,649.5,
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18,23.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,550,220,BLUE CROSS ANTHEM,COMMERCIAL,,,,440,OTHER,412.5,539,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,550,220,MONUMENT,COMMERCIAL,,,,440,,412.5,539,
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,18,23.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C1Q BINDING ASSAY,86332,CPT,302,RC,,OUTPATIENT,,,48.74,19.496,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.6,47.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR PUNCTURE SPINAL FLUID,62328,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,687.75,898.66,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR PUNCTURE SPINAL FLUID,62328,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,733.6,,687.75,898.66,
IMMUNOFIXATION REFLEX SERUM,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,163.13,213.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION FOR BLADDER XRAY,51610,CPT,320,RC,,OUTPATIENT,,,856.5,342.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,685.2,OTHER,642.38,839.37,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION FOR BLADDER XRAY,51610,CPT,320,RC,,OUTPATIENT,,,856.5,342.6,MONUMENT,COMMERCIAL,,,,685.2,,642.38,839.37,
IMMUNOELECTRO-SERUM (IFE),86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,163.13,213.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URETHROCYSTOGRAM,74450,CPT,320,RC,,OUTPATIENT,,,537,214.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,429.6,OTHER,402.75,526.26,PERCENT OF CHARGES BASED ON HCPCS CODE
URETHROCYSTOGRAM,74450,CPT,320,RC,,OUTPATIENT,,,537,214.8,MONUMENT,COMMERCIAL,,,,429.6,,402.75,526.26,
IMMUNOFIXATION,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,163.13,213.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C-ARM LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,699.6,OTHER,655.88,857.01,PERCENT OF CHARGES BASED ON HCPCS CODE
C-ARM LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,MONUMENT,COMMERCIAL,,,,699.6,,655.88,857.01,
IMMUNOFIXATION CRYOGLOBULIN,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,163.13,213.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C-ARM CENTRAL VENOUS ACCESS,77001,CPT,320,RC,,OUTPATIENT,,,350,140,BLUE CROSS ANTHEM,COMMERCIAL,,,,280,OTHER,262.5,343,PERCENT OF CHARGES BASED ON HCPCS CODE
C-ARM CENTRAL VENOUS ACCESS,77001,CPT,320,RC,,OUTPATIENT,,,350,140,MONUMENT,COMMERCIAL,,,,280,,262.5,343,
ZIMMUNOFIX E-PHORESIS SERUM,86334,CPT,300,RC,,OUTPATIENT,,,100,40,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75,98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
C-ARM PAIN CLINIC,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,699.6,OTHER,655.9,857,PERCENT OF CHARGES BASED ON HCPCS CODE
C-ARM PAIN CLINIC,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,MONUMENT,COMMERCIAL,,,,699.6,,655.9,857,
IMMUNDFIXATION REFLEX URINE,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,168.19,219.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOREARM AP/LAT RT,73090RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,BLUE CROSS ANTHEM,COMMERCIAL,,,,250,OTHER,234.38,306.25,PERCENT OF CHARGES BASED ON HCPCS CODE
FOREARM AP/LAT RT,73090RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,MONUMENT,COMMERCIAL,,,,250,,234.38,306.25,
BETA-2 TRANSFERRIN BODY FLUID,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,168.19,219.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOREARM AP/LAT LT,73090LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,BLUE CROSS ANTHEM,COMMERCIAL,,,,250,OTHER,234.38,306.25,PERCENT OF CHARGES BASED ON HCPCS CODE
FOREARM AP/LAT LT,73090LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,MONUMENT,COMMERCIAL,,,,250,,234.38,306.25,
INHIBIN A TUMOR MARKER,86336,CPT,300,RC,,OUTPATIENT,,,117,46.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,87.75,114.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOREARM BILATERAL,7309050,CPT,320,RC,50,OUTPATIENT,,,624.75,249.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,499.8,OTHER,468.56,612.26,PERCENT OF CHARGES BASED ON HCPCS CODE
FOREARM BILATERAL,7309050,CPT,320,RC,50,OUTPATIENT,,,624.75,249.9,MONUMENT,COMMERCIAL,,,,499.8,,468.56,612.26,
Z INHIBIN,86336,CPT,300,RC,,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT 2 VIEWS RT,73620RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,171,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT 2 VIEWS RT,73620RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
INSULIN ANTIBODY  SERUM,86337,CPT,302,RC,,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,69.56,90.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT 2 VIEWS LT,73620LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,171,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT 2 VIEWS LT,73620LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,OUTPATIENT,,,74.25,29.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT 3 VIEWS RT,73630RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT 3 VIEWS RT,73630RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
ISLET CELL ANITBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT 3 VIEWS LT,73630LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT 3 VIEWS LT,73630LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
ZINC TRANSPORT 8 AB,86341,CPT,302,RC,,OUTPATIENT,,,665.19,266.076,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,498.9,651.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEET TWO VIEWS BILATERAL,73620,CPT,,,,OUTPATIENT,,,427.5,171,BLUE CROSS ANTHEM,COMMERCIAL,,,,342,OTHER,320.6,419,PERCENT OF CHARGES BASED ON HCPCS CODE
FEET TWO VIEWS BILATERAL,73620,CPT,,,,OUTPATIENT,,,427.5,171,MONUMENT,COMMERCIAL,,,,342,,320.6,419,
ISLET CELL ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,135,54,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.3,132.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND 3 VIEWS RT,73130RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND 3 VIEWS RT,73130RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
ISLET ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND 3 VIEWS LT,73130LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND 3 VIEWS LT,73130LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
LEUKOCYTE HISTAMINE RELEASE,86343,CPT,300,RC,,OUTPATIENT,,,240,96,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,180,235.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEEL CALCANEOUS RT,73650RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HEEL CALCANEOUS RT,73650RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
ASSAY CELLULAR FUNCTION,86352,CPT,300,RC,,OUTPATIENT,,,323.75,129.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,242.81,317.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEEL CALCANEOUS LT,73650LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HEEL CALCANEOUS LT,73650LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,OUTPATIENT,,,521.25,208.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,390.94,510.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEEL CALCANEUS BILATERAL,7365050,CPT,320,RC,50,OUTPATIENT,,,525,210,BLUE CROSS ANTHEM,COMMERCIAL,,,,420,OTHER,393.75,514.5,PERCENT OF CHARGES BASED ON HCPCS CODE
HEEL CALCANEUS BILATERAL,7365050,CPT,320,RC,50,OUTPATIENT,,,525,210,MONUMENT,COMMERCIAL,,,,420,,393.75,514.5,
Z B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP INJECTION,73525,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,382.31,499.56,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP INJECTION,73525,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,407.8,,382.31,499.56,
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,383.25,153.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,287.44,375.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP INJECT FOR HIP XRAY,27093,CPT,320,RC,,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP INJECT FOR HIP XRAY,27093,CPT,320,RC,,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
TBNK QN,86355,CPT,300,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,164.06,214.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP BILATERAL WITH PELVIS,73522,CPT,320,RC,,OUTPATIENT,,,550,220,BLUE CROSS ANTHEM,COMMERCIAL,,,,440,OTHER,412.5,539,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP BILATERAL WITH PELVIS,73522,CPT,320,RC,,OUTPATIENT,,,550,220,MONUMENT,COMMERCIAL,,,,440,,412.5,539,
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.81,254.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER BILATERAL,7303050,CPT,320,RC,50,OUTPATIENT,,,696.25,278.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,557,OTHER,522.19,682.33,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER BILATERAL,7303050,CPT,320,RC,50,OUTPATIENT,,,696.25,278.5,MONUMENT,COMMERCIAL,,,,557,,522.19,682.33,
CD20 TOTAL COUNT,86356,CPT,300,RC,,OUTPATIENT,,,272.25,108.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,204.19,266.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST BILATERAL,7311050,CPT,320,RC,50,OUTPATIENT,,,490.5,196.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,392.4,OTHER,367.88,480.69,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST BILATERAL,7311050,CPT,320,RC,50,OUTPATIENT,,,490.5,196.2,MONUMENT,COMMERCIAL,,,,392.4,,367.88,480.69,
Z N K CELLS TOTAL COUNT,86357,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE BILATERAL,7356250,CPT,320,RC,50,OUTPATIENT,,,749.75,299.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,599.8,OTHER,562.31,734.76,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE BILATERAL,7356250,CPT,320,RC,50,OUTPATIENT,,,749.75,299.9,MONUMENT,COMMERCIAL,,,,599.8,,562.31,734.76,
FLOW CYTO,86357,CPT,300,RC,,OUTPATIENT,,,214.75,85.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,161.06,210.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND BILATERAL,7313050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,539.8,OTHER,506.06,661.26,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND BILATERAL,7313050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,MONUMENT,COMMERCIAL,,,,539.8,,506.06,661.26,
NATURAL KILLER CELLS,86357,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.81,254.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT BILATERAL,7363050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,539.8,OTHER,506.06,661.26,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT BILATERAL,7363050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,MONUMENT,COMMERCIAL,,,,539.8,,506.06,661.26,
Z T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELBOWS BILATERAL,7308050,CPT,320,RC,50,OUTPATIENT,,,633.5,253.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,506.8,OTHER,475.13,620.83,PERCENT OF CHARGES BASED ON HCPCS CODE
ELBOWS BILATERAL,7308050,CPT,320,RC,50,OUTPATIENT,,,633.5,253.4,MONUMENT,COMMERCIAL,,,,506.8,,475.13,620.83,
BAL,86359,CPT,300,RC,,OUTPATIENT,,,240,96,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,180,235.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND 2 VIEWS RT,73120RT,CPT,320,RC,RT,OUTPATIENT,,,217.19,86.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.752,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND 2 VIEWS RT,73120RT,CPT,320,RC,RT,OUTPATIENT,,,217.19,86.876,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
Z T CELLS  TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND 2 VIEWS LT,73120LT,CPT,320,RC,LT,OUTPATIENT,,,217.19,86.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.752,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND 2 VIEWS LT,73120LT,CPT,320,RC,LT,OUTPATIENT,,,217.19,86.876,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.81,254.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HAND 2 VIEWS BILATERAL,73120,CPT,,,,OUTPATIENT,,,434.38,173.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,347.504,OTHER,325.8,425.7,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND 2 VIEWS BILATERAL,73120,CPT,,,,OUTPATIENT,,,434.38,173.752,MONUMENT,COMMERCIAL,,,,347.5,,325.8,425.7,
Z T CELL ABSOLUTE COUNT RATIO,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.81,105.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP 2 VIEW RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,BLUE CROSS ANTHEM,COMMERCIAL,,,,250,OTHER,234.38,306.25,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP 2 VIEW RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,MONUMENT,COMMERCIAL,,,,250,,234.38,306.25,
ABSOLUTE CD4 & CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.81,105.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP 2 VIEW LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,BLUE CROSS ANTHEM,COMMERCIAL,,,,250,OTHER,234.38,306.25,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP 2 VIEW LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,MONUMENT,COMMERCIAL,,,,250,,234.38,306.25,
Z CD4 & CD8 ABSOLUTE COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.81,105.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP/PELVIS CHILD 2 VIEWS,73502,CPT,320,RC,,OUTPATIENT,,,273.75,109.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,219,OTHER,205.31,268.28,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP/PELVIS CHILD 2 VIEWS,73502,CPT,320,RC,,OUTPATIENT,,,273.75,109.5,MONUMENT,COMMERCIAL,,,,219,,205.31,268.28,
ABSOLUTE CD4/CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,276.5,110.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,207.38,270.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP 1 VIEW RIGHT,73501RT,CPT,320,RC,RT,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,237.19,309.93,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP 1 VIEW RIGHT,73501RT,CPT,320,RC,RT,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,253,,237.19,309.93,
LIVER CYTOSOL AUTOANTIBODIES,86376,CPT,300,RC,,OUTPATIENT,,,269,107.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,201.75,263.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP 1 VIEW LEFT,73501LT,CPT,320,RC,LT,OUTPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,120,OTHER,237.19,309.93,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP 1 VIEW LEFT,73501LT,CPT,320,RC,LT,OUTPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,253,,237.19,309.93,
THYROID PEROXIDASE ANTIBODY,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP ARTHROGRAM RT,73525RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,382.31,499.56,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP ARTHROGRAM RT,73525RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,407.8,,382.31,499.56,
LIVER-KIDNEY MICROSOMAL ANTBDS,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.06,120.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP ARTHROGRAM LT,73525LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,382.31,499.56,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP ARTHROGRAM LT,73525LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,407.8,,382.31,499.56,
Z THYROGLOBULIN AB,86376,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ/DRAIN MAJOR JOINT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,662.75,265.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.2,OTHER,497.06,649.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ/DRAIN MAJOR JOINT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,662.75,265.1,MONUMENT,COMMERCIAL,,,,530.2,,497.06,649.5,
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,1524.5,609.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1143.38,1494.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEROID/CONTRAST INJECTION,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.2,OTHER,497.06,649.5,PERCENT OF CHARGES BASED ON HCPCS CODE
STEROID/CONTRAST INJECTION,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,MONUMENT,COMMERCIAL,,,,530.2,,497.06,649.5,
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,132.5,53,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.38,129.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEROID/CONTRAST INJ LG JOINT,20610,CPT,320,RC,,OUTPATIENT,,,631,252.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,504.8,OTHER,473.25,618.38,PERCENT OF CHARGES BASED ON HCPCS CODE
STEROID/CONTRAST INJ LG JOINT,20610,CPT,320,RC,,OUTPATIENT,,,631,252.4,MONUMENT,COMMERCIAL,,,,504.8,,473.25,618.38,
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ/DRAIN MAJOR JOINT,2061050,CPT,320,RC,50,OUTPATIENT,,,1324.75,529.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1059.8,OTHER,993.56,1298.26,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ/DRAIN MAJOR JOINT,2061050,CPT,320,RC,50,OUTPATIENT,,,1324.75,529.9,MONUMENT,COMMERCIAL,,,,1059.8,,993.56,1298.26,
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUMERUS AP/LAT RT,73060RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMERUS AP/LAT RT,73060RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUMERUS AP/LAT LT,73060LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.2,OTHER,253.31,331,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMERUS AP/LAT LT,73060LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,MONUMENT,COMMERCIAL,,,,270.2,,253.31,331,
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HUMERUS BILATERAL,7306050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,539.8,OTHER,506.06,661.26,PERCENT OF CHARGES BASED ON HCPCS CODE
HUMERUS BILATERAL,7306050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,MONUMENT,COMMERCIAL,,,,539.8,,506.06,661.26,
CANDIDA ALBICANS ANTIGEN DETEC,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HYSTEO INJECTION,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,415.8,OTHER,389.81,509.36,PERCENT OF CHARGES BASED ON HCPCS CODE
HYSTEO INJECTION,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,MONUMENT,COMMERCIAL,,,,415.8,,389.81,509.36,
GROUP B STREP ANTIGEN - SERUM,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HYSTEROSALPINGOGRAM,74740,CPT,320,RC,,OUTPATIENT,,,458.69,183.476,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.952,OTHER,327.38,427.77,PERCENT OF CHARGES BASED ON HCPCS CODE
HYSTEROSALPINGOGRAM,74740,CPT,320,RC,,OUTPATIENT,,,458.69,183.476,MONUMENT,COMMERCIAL,,,,349.2,,327.38,427.77,
CRYPTOCOCCUS ANTIGEN LTX AGGLU,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.63,152.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IVP LIMITED,7440052,CPT,,,52,OUTPATIENT,,,752.25,300.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,601.8,OTHER,564.19,737.21,PERCENT OF CHARGES BASED ON HCPCS CODE
IVP LIMITED,7440052,CPT,,,52,OUTPATIENT,,,752.25,300.9,MONUMENT,COMMERCIAL,,,,601.8,,564.19,737.21,
STREPTOZYME SCREEN,86403,CPT,300,RC,,OUTPATIENT,,,159,63.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.25,155.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUOROSCOPIC PROCEDURE,76496,CPT,320,RC,,OUTPATIENT,,,347.5,139,BLUE CROSS ANTHEM,COMMERCIAL,,,,278,OTHER,260.63,340.55,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUOROSCOPIC PROCEDURE,76496,CPT,320,RC,,OUTPATIENT,,,347.5,139,MONUMENT,COMMERCIAL,,,,278,,260.63,340.55,
STREPTOZYME TITER,86406,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.63,121.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 3 VIEWS RT,73562RT,CPT,320,RC,RT,OUTPATIENT,,,375,150,BLUE CROSS ANTHEM,COMMERCIAL,,,,300,OTHER,281.25,367.5,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 3 VIEWS RT,73562RT,CPT,320,RC,RT,OUTPATIENT,,,375,150,MONUMENT,COMMERCIAL,,,,300,,281.25,367.5,
RHEUMATOID FACTOR,86431,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 3 VIEWS LT,73562LT,CPT,320,RC,LT,OUTPATIENT,,,375,150,BLUE CROSS ANTHEM,COMMERCIAL,,,,300,OTHER,281.25,367.5,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 3 VIEWS LT,73562LT,CPT,320,RC,LT,OUTPATIENT,,,375,150,MONUMENT,COMMERCIAL,,,,300,,281.25,367.5,
QUANTIFERON-TB GOLD BLOOD,86481,CPT,300,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,147.56,192.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 2 VIEWS RT,73560RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 2 VIEWS RT,73560RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
VDRL CSF,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.25,65.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 2 VIEWS LT,73560LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 2 VIEWS LT,73560LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
R.P.R.,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.25,65.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE ARTHROGRAPHY RT,73580RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,411.19,537.29,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE ARTHROGRAPHY RT,73580RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,438.6,,411.19,537.29,
Z SYPHILIS AB IGG,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.25,65.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE ARTHROGRAPHY LT,73580LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,411.19,537.29,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE ARTHROGRAPHY LT,73580LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,438.6,,411.19,537.29,
RPR TITER S,86593,CPT,300,RC,,OUTPATIENT,,,32,12.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24,31.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 4 VIEWS RT,73564RT,CPT,320,RC,RT,OUTPATIENT,,,440.75,176.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,352.6,OTHER,330.56,431.94,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 4 VIEWS RT,73564RT,CPT,320,RC,RT,OUTPATIENT,,,440.75,176.3,MONUMENT,COMMERCIAL,,,,352.6,,330.56,431.94,
Z VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,OUTPATIENT,,,188.05,75.22,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,141,184.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
KNEE 4 VIEWS LT,73564LT,CPT,320,RC,LT,OUTPATIENT,,,440.75,176.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,352.6,OTHER,330.56,431.94,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE 4 VIEWS LT,73564LT,CPT,320,RC,LT,OUTPATIENT,,,440.75,176.3,MONUMENT,COMMERCIAL,,,,352.6,,330.56,431.94,
ADENOVIRUS AB BY CF,86603,CPT,300,RC,,OUTPATIENT,,,496.25,198.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,372.19,486.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TIB/FIB RT,73590RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB/FIB RT,73590RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
ASPERGILLUS FUMIGATUS,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TIB/FIB LT,73590LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,BLUE CROSS ANTHEM,COMMERCIAL,,,,200,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB/FIB LT,73590LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
ASPERGILLUS IGM ANTIBODIES,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TIB FIB BILATERAL,7359050,CPT,320,RC,50,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB FIB BILATERAL,7359050,CPT,320,RC,50,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
N GONORHEA ANTIBODY SERUM,86609,CPT,300,RC,,OUTPATIENT,,,192,76.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144,188.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TIB/FIB BILATERAL,73590,CPT,320,RC,,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB/FIB BILATERAL,73590,CPT,320,RC,,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
LISTERIA AB,86609,CPT,300,RC,,OUTPATIENT,,,63.75,25.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,47.81,62.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR AP & LAT 2 OR 3 VIEWS,72100,CPT,320,RC,,OUTPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,354,OTHER,331.88,433.65,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR AP & LAT 2 OR 3 VIEWS,72100,CPT,320,RC,,OUTPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
Z BARTONELLA HENSELAE IGG,86611,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR 4 VIEWS,72110,CPT,320,RC,,OUTPATIENT,,,595,238,BLUE CROSS ANTHEM,COMMERCIAL,,,,476,OTHER,446.25,583.1,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR 4 VIEWS,72110,CPT,320,RC,,OUTPATIENT,,,595,238,MONUMENT,COMMERCIAL,,,,476,,446.25,583.1,
BLASTOMYCES AB  CF,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.38,78.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR FLEX/EXT 5 VIEWS,72114,CPT,320,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR FLEX/EXT 5 VIEWS,72114,CPT,320,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
BLASTOMYCES AB,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.38,78.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MANDIBLE 4 VIEWS,70110,CPT,320,RC,,OUTPATIENT,,,420.75,168.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,336.6,OTHER,315.56,412.34,PERCENT OF CHARGES BASED ON HCPCS CODE
MANDIBLE 4 VIEWS,70110,CPT,320,RC,,OUTPATIENT,,,420.75,168.3,MONUMENT,COMMERCIAL,,,,336.6,,315.56,412.34,
BORDETELLA PERTUSSIS AB IGG,86615,CPT,300,RC,,OUTPATIENT,,,178.5,71.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,133.88,174.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELOGRAM/FLUOROSCOPY,72270,CPT,320,RC,,OUTPATIENT,,,2314,925.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1851.2,OTHER,1735.5,2267.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELOGRAM/FLUOROSCOPY,72270,CPT,320,RC,,OUTPATIENT,,,2314,925.6,MONUMENT,COMMERCIAL,,,,1851.2,,1735.5,2267.72,
BORDETELLA PERTUSSIS AB IGA,86615,CPT,300,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYELOGRAM/FLUOROSCOPY,62284,CPT,350,RC,,OUTPATIENT,,,1052.5,421,BLUE CROSS ANTHEM,COMMERCIAL,,,,842,OTHER,789.38,1031.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MYELOGRAM/FLUOROSCOPY,62284,CPT,350,RC,,OUTPATIENT,,,1052.5,421,MONUMENT,COMMERCIAL,,,,842,,789.38,1031.45,
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.5,147,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NECK SOFT TISSUE,70360,CPT,320,RC,,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
NECK SOFT TISSUE,70360,CPT,320,RC,,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.5,147,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOGRAM,50431,CPT,320,RC,,OUTPATIENT,,,1542.5,617,BLUE CROSS ANTHEM,COMMERCIAL,,,,1234,OTHER,1156.88,1511.65,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOGRAM,50431,CPT,320,RC,,OUTPATIENT,,,1542.5,617,MONUMENT,COMMERCIAL,,,,1234,,1156.88,1511.65,
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.5,147,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOGRAM,74425,CPT,320,RC,,OUTPATIENT,,,814.25,325.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,651.4,OTHER,610.69,797.97,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOGRAM,74425,CPT,320,RC,,OUTPATIENT,,,814.25,325.7,MONUMENT,COMMERCIAL,,,,651.4,,610.69,797.97,
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.5,147,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NASAL BONES,70160,CPT,320,RC,,OUTPATIENT,,,292,116.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,233.6,OTHER,219,286.16,PERCENT OF CHARGES BASED ON HCPCS CODE
NASAL BONES,70160,CPT,320,RC,,OUTPATIENT,,,292,116.8,MONUMENT,COMMERCIAL,,,,233.6,,219,286.16,
LYME DISEASE SEROLOGY SERUM,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ORTHO ROENT,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,283.2,OTHER,265.5,346.92,PERCENT OF CHARGES BASED ON HCPCS CODE
ORTHO ROENT,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,MONUMENT,COMMERCIAL,,,,283.2,,265.5,346.92,
LYME DISEASE ANTIBODY  CSF,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OR HIP RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,639.5,255.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.6,OTHER,479.63,626.71,PERCENT OF CHARGES BASED ON HCPCS CODE
OR HIP RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,639.5,255.8,MONUMENT,COMMERCIAL,,,,511.6,,479.63,626.71,
BRUCELLA AB,86622,CPT,300,RC,,OUTPATIENT,,,73.25,29.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.94,71.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OBSTRUCTION REMOVAL FROM TUBE,49460,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,543.38,710.01,PERCENT OF CHARGES BASED ON HCPCS CODE
OBSTRUCTION REMOVAL FROM TUBE,49460,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,579.6,,543.38,710.01,
Z CANDIDA ANTIBODY IGG,86628,CPT,300,RC,,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.5,103.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PELVIS 3 VIEWS,72190,CPT,320,RC,,OUTPATIENT,,,409.5,163.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,327.6,OTHER,307.13,401.31,PERCENT OF CHARGES BASED ON HCPCS CODE
PELVIS 3 VIEWS,72190,CPT,320,RC,,OUTPATIENT,,,409.5,163.8,MONUMENT,COMMERCIAL,,,,327.6,,307.13,401.31,
CHLAMYDIA ANTIBODY IGG,86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PELVIS AP,72170,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,199.4,OTHER,186.94,244.27,PERCENT OF CHARGES BASED ON HCPCS CODE
PELVIS AP,72170,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,MONUMENT,COMMERCIAL,,,,199.4,,186.94,244.27,
CHLAM IGG (PANEL TEST),86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS-UNILAT/PA CHEST 3 VWS LT,71101LT,CPT,320,RC,LT,OUTPATIENT,,,431.75,172.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,345.4,OTHER,323.81,423.12,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS-UNILAT/PA CHEST 3 VWS LT,71101LT,CPT,320,RC,LT,OUTPATIENT,,,431.75,172.7,MONUMENT,COMMERCIAL,,,,345.4,,323.81,423.12,
CHLAM IGM (PANEL TEST),86632,CPT,300,RC,,OUTPATIENT,,,35.75,14.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.81,35.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS UNILATERAL 2 VIEWS,71100,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,345.4,OTHER,323.81,423.12,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS UNILATERAL 2 VIEWS,71100,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,MONUMENT,COMMERCIAL,,,,345.4,,323.81,423.12,
Z COCCIDIOIDES AB IGG BY CF,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS UNILATERAL W/ 1 VIEW CHES,71101,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS UNILATERAL W/ 1 VIEW CHES,71101,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
Z COCCIDIOIDES AB IGM BY IMMUN,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS BILATERAL,71110,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,426.8,OTHER,400.13,522.83,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS BILATERAL,71110,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,MONUMENT,COMMERCIAL,,,,426.8,,400.13,522.83,
Z Q FEVER AB IGG,86638,CPT,300,RC,,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.75,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS BILATERAL W/ 1 VIEW CHEST,71111,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS BILATERAL W/ 1 VIEW CHEST,71111,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
CMV IGG ANTIBODY,86644,CPT,302,RC,,OUTPATIENT,,,119.75,47.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.81,117.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RIBS-BILAT/PA CHEST 4 VIEWS,71111,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,426.8,OTHER,400.13,522.83,PERCENT OF CHARGES BASED ON HCPCS CODE
RIBS-BILAT/PA CHEST 4 VIEWS,71111,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,MONUMENT,COMMERCIAL,,,,426.8,,400.13,522.83,
CYTOMEGALOVIRUS IGG AVIDITY,86644,CPT,302,RC,,OUTPATIENT,,,217.82,87.128,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,163.37,213.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RETROGRADE PYLEOGRAM,3202150,CDM,320,RC,,INPATIENT,,,595,238,BLUE CROSS ANTHEM,COMMERCIAL,,,,541.45,OTHER,446.25,583.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RETROGRADE PYLEOGRAM,3202150,CDM,320,RC,,INPATIENT,,,595,238,MONUMENT,COMMERCIAL,,,,476,,446.25,583.1,
RETROGRADE PYLEOGRAM,3202150,CDM,320,RC,,INPATIENT,,,595,238,UNITED HEALTH,UNITED COMMERCIAL,,,,446.25,,446.25,583.1,
SACRUM & COCCYX 2 VIEWS,72220,CPT,320,RC,,OUTPATIENT,,,362,144.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,289.6,OTHER,271.5,354.76,PERCENT OF CHARGES BASED ON HCPCS CODE
SACRUM & COCCYX 2 VIEWS,72220,CPT,320,RC,,OUTPATIENT,,,362,144.8,MONUMENT,COMMERCIAL,,,,289.6,,271.5,354.76,
CYTOMEGALOVIRUS ANTIBODY IGM,86645,CPT,300,RC,,OUTPATIENT,,,159.25,63.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.44,156.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SACROILIAC REGION 3 VIEWS,72202,CPT,320,RC,,OUTPATIENT,,,458.5,183.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.8,OTHER,343.88,449.33,PERCENT OF CHARGES BASED ON HCPCS CODE
SACROILIAC REGION 3 VIEWS,72202,CPT,320,RC,,OUTPATIENT,,,458.5,183.4,MONUMENT,COMMERCIAL,,,,366.8,,343.88,449.33,
Z CMV IGM,86645,CPT,300,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SMALL BOWEL SERIES,74250,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,604.2,OTHER,566.44,740.15,PERCENT OF CHARGES BASED ON HCPCS CODE
SMALL BOWEL SERIES,74250,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,MONUMENT,COMMERCIAL,,,,604.2,,566.44,740.15,
DIPTHERIA ANTIBODY,86648,CPT,300,RC,,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SCAPULA RT,73010RT,CPT,320,RC,RT,OUTPATIENT,,,258.75,103.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,207,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
SCAPULA RT,73010RT,CPT,320,RC,RT,OUTPATIENT,,,258.75,103.5,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
CALIF VIRUS LAC AB IGG,86651,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SCAPULA LT,73010LT,CPT,320,RC,LT,OUTPATIENT,,,258.75,103.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,207,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
SCAPULA LT,73010LT,CPT,320,RC,LT,OUTPATIENT,,,258.75,103.5,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
CALIF VIRUS LAC AB IGM,86651,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STERNOCLAVICULAR JT 3 VIEWS,71130,CPT,320,RC,,OUTPATIENT,,,357,142.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,285.6,OTHER,267.75,349.86,PERCENT OF CHARGES BASED ON HCPCS CODE
STERNOCLAVICULAR JT 3 VIEWS,71130,CPT,320,RC,,OUTPATIENT,,,357,142.8,MONUMENT,COMMERCIAL,,,,285.6,,267.75,349.86,
EAST EQUINE ENCEP IGG CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SCOLIOSIS AP,72082,CPT,320,RC,,OUTPATIENT,,,320.25,128.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,256.2,OTHER,240.19,313.85,PERCENT OF CHARGES BASED ON HCPCS CODE
SCOLIOSIS AP,72082,CPT,320,RC,,OUTPATIENT,,,320.25,128.1,MONUMENT,COMMERCIAL,,,,256.2,,240.19,313.85,
EAST EQUINE ENCEP IGM CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER 1 VIEW RT,73020RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER 1 VIEW RT,73020RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
ST LOUIS ENCEPHALITIS IGG,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER 1 VIEW LT,73020LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER 1 VIEW LT,73020LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
ST LOUIS ENCEPHALITIS IGM,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER ARTHROGRAM RT,73040RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,641,OTHER,600.94,785.23,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER ARTHROGRAM RT,73040RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,MONUMENT,COMMERCIAL,,,,641,,600.94,785.23,
WEST EQUINE ENCEP IGG CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER ARTHROGRAM LT,73040LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,641,OTHER,600.94,785.23,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER ARTHROGRAM LT,73040LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,MONUMENT,COMMERCIAL,,,,641,,600.94,785.23,
WEST EQUINE EHCEP IGM CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER 2 OR MORE VIEWS RT,73030RT,CPT,320,RC,RT,OUTPATIENT,,,348.5,139.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,278.8,OTHER,261.38,341.53,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER 2 OR MORE VIEWS RT,73030RT,CPT,320,RC,RT,OUTPATIENT,,,348.5,139.4,MONUMENT,COMMERCIAL,,,,278.8,,261.38,341.53,
ENTROVIRUS PANEL II,86658,CPT,300,RC,,OUTPATIENT,,,1295.25,518.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,971.44,1269.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER 2 OR MORE VIEWS LT,73030LT,CPT,320,RC,LT,OUTPATIENT,,,348.5,139.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,278.8,OTHER,261.38,341.53,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER 2 OR MORE VIEWS LT,73030LT,CPT,320,RC,LT,OUTPATIENT,,,348.5,139.4,MONUMENT,COMMERCIAL,,,,278.8,,261.38,341.53,
COXSACKIE B VIRUS ANTIBODIES,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.94,67.87,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER INJECT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,520.55,208.22,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.44,OTHER,238.13,311.15,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER INJECT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,520.55,208.22,MONUMENT,COMMERCIAL,,,,254,,238.13,311.15,
COXSACKIE A9 VIRUS ANTIBODY,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.94,67.87,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER INJECT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,520.55,208.22,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.44,OTHER,238.13,311.15,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER INJECT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,520.55,208.22,MONUMENT,COMMERCIAL,,,,254,,238.13,311.15,
EPSTEIN BARR VIRUS IGG ERLY AG,86663,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.81,109.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP INJECT FOR MRI ARTHRO RT,27093RT,CPT,320,RC,RT,OUTPATIENT,,,685,274,BLUE CROSS ANTHEM,COMMERCIAL,,,,548,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP INJECT FOR MRI ARTHRO RT,27093RT,CPT,320,RC,RT,OUTPATIENT,,,685,274,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
EBNA,86664,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.88,45.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP INJECT FOR MR ARTHRO LT,27093LT,CPT,320,RC,LT,OUTPATIENT,,,685,274,BLUE CROSS ANTHEM,COMMERCIAL,,,,548,OTHER,187.5,245,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP INJECT FOR MR ARTHRO LT,27093LT,CPT,320,RC,LT,OUTPATIENT,,,685,274,MONUMENT,COMMERCIAL,,,,200,,187.5,245,
EPSTEIN-BARR VIRUS PANEL 2,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JOINT ARTHROCENTISIS ASSIST ME,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
JOINT ARTHROCENTISIS ASSIST ME,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
EPSTEIN BARR VIRUS AB VIRAL,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHLDER INJ FOR MR/CT ARTHRO L,23350,CPT,,,,OUTPATIENT,,,598,239.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,478.4,OTHER,448.5,586,PERCENT OF CHARGES BASED ON HCPCS CODE
SHLDER INJ FOR MR/CT ARTHRO L,23350,CPT,,,,OUTPATIENT,,,598,239.2,MONUMENT,COMMERCIAL,,,,478.4,,448.5,586,
EBV IGG,86665,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.19,43.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHLDER INJ FOR MR/CT ARTHRO R,23350,CPT,,,,OUTPATIENT,,,598,239.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,478.4,OTHER,448.5,586,PERCENT OF CHARGES BASED ON HCPCS CODE
SHLDER INJ FOR MR/CT ARTHRO R,23350,CPT,,,,OUTPATIENT,,,598,239.2,MONUMENT,COMMERCIAL,,,,478.4,,448.5,586,
EHRLICHIA CHAFFEENSIS AB,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.38,110.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST INJ FOR MR/CT ARTHRO LT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,466.4,OTHER,437.3,571.3,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST INJ FOR MR/CT ARTHRO LT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,MONUMENT,COMMERCIAL,,,,466.4,,437.3,571.3,
ANAPLASMA PHAGOCYTOPHILIUM IGG,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.38,110.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST INJ FOR MR/CR ARTHRO RT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,466.4,OTHER,437.3,571.3,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST INJ FOR MR/CR ARTHRO RT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,MONUMENT,COMMERCIAL,,,,466.4,,437.3,571.3,
FUNGUS ANTIBODY,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SHOULDER BILATERAL 1 VIEW,7302050,CPT,320,RC,50,OUTPATIENT,,,491,196.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,392.8,OTHER,368.25,481.18,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER BILATERAL 1 VIEW,7302050,CPT,320,RC,50,OUTPATIENT,,,491,196.4,MONUMENT,COMMERCIAL,,,,392.8,,368.25,481.18,
SACCHAROMYCES CERERISIAL PANEL,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIALAGRAM,70390,CPT,320,RC,,OUTPATIENT,,,563.5,225.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.8,OTHER,422.63,552.23,PERCENT OF CHARGES BASED ON HCPCS CODE
SIALAGRAM,70390,CPT,320,RC,,OUTPATIENT,,,563.5,225.4,MONUMENT,COMMERCIAL,,,,450.8,,422.63,552.23,
PIGEON BREEDERS DISEASE,86671,CPT,300,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SINUS 1 VIEW,70210,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,119.63,156.31,PERCENT OF CHARGES BASED ON HCPCS CODE
SINUS 1 VIEW,70210,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
Z GIARDIA LAMBLIA AB IGG,86674,CPT,302,RC,,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SINUS 4 VIEWS,70220,CPT,320,RC,,OUTPATIENT,,,425,170,BLUE CROSS ANTHEM,COMMERCIAL,,,,340,OTHER,318.75,416.5,PERCENT OF CHARGES BASED ON HCPCS CODE
SINUS 4 VIEWS,70220,CPT,320,RC,,OUTPATIENT,,,425,170,MONUMENT,COMMERCIAL,,,,340,,318.75,416.5,
HELICOBACTER PYLORI IGM,86677,CPT,302,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SKULL COMPLETE,70260,CPT,320,RC,,OUTPATIENT,,,542.25,216.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,433.8,OTHER,406.69,531.41,PERCENT OF CHARGES BASED ON HCPCS CODE
SKULL COMPLETE,70260,CPT,320,RC,,OUTPATIENT,,,542.25,216.9,MONUMENT,COMMERCIAL,,,,433.8,,406.69,531.41,
Z HELICOBACTER PYLORI IGG,86677,CPT,302,RC,,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SKULL 3 VIEWS,70250,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,345.4,OTHER,323.81,423.12,PERCENT OF CHARGES BASED ON HCPCS CODE
SKULL 3 VIEWS,70250,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,MONUMENT,COMMERCIAL,,,,345.4,,323.81,423.12,
CYSTICERCUS ANTIBODY CFS,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STERNUM 2 VIEWS,71120,CPT,320,RC,,OUTPATIENT,,,350.25,140.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.2,OTHER,262.69,343.25,PERCENT OF CHARGES BASED ON HCPCS CODE
STERNUM 2 VIEWS,71120,CPT,320,RC,,OUTPATIENT,,,350.25,140.1,MONUMENT,COMMERCIAL,,,,280.2,,262.69,343.25,
CYSTICERCOSIS IGG SERUM,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPINE SINGLE VIEW,72020,CPT,320,RC,,OUTPATIENT,,,196,78.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.8,OTHER,147,192.08,PERCENT OF CHARGES BASED ON HCPCS CODE
SPINE SINGLE VIEW,72020,CPT,320,RC,,OUTPATIENT,,,196,78.4,MONUMENT,COMMERCIAL,,,,156.8,,147,192.08,
FILARIA IGG 4 ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPINE ENTIRE 1 VIEW,72081,CPT,,,,OUTPATIENT,,,196,78.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,156.8,OTHER,147,192.08,PERCENT OF CHARGES BASED ON HCPCS CODE
SPINE ENTIRE 1 VIEW,72081,CPT,,,,OUTPATIENT,,,196,78.4,MONUMENT,COMMERCIAL,,,,156.8,,147,192.08,
TOXOCARA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TEMPEROMANDIBULAR JT,70328,CPT,320,RC,,OUTPATIENT,,,581.75,232.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,465.4,OTHER,436.31,570.12,PERCENT OF CHARGES BASED ON HCPCS CODE
TEMPEROMANDIBULAR JT,70328,CPT,320,RC,,OUTPATIENT,,,581.75,232.7,MONUMENT,COMMERCIAL,,,,465.4,,436.31,570.12,
FASCIOLA HEPATICA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE GREAT LT,73660TA,CPT,320,RC,TA,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE GREAT LT,73660TA,CPT,320,RC,TA,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
ECHINOCOCCUS GRANULOSUS AB IGG,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 2ND DIGIT LT,73660T1,CPT,320,RC,T1,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 2ND DIGIT LT,73660T1,CPT,320,RC,T1,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
STRONGYLOIDES IGG AB,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.25,144.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 3RD DIGIT LT,73660T2,CPT,320,RC,T2,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 3RD DIGIT LT,73660T2,CPT,320,RC,T2,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HAEMOPHILUS INFLUENZA B IGG,86684,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.94,107.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 4TH DIGIT LT,73660T3,CPT,320,RC,T3,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 4TH DIGIT LT,73660T3,CPT,320,RC,T3,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HIV TYPE 1/2 CONFIRMATORY EVAL,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.94,181.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 5TH DIGIT LT,73660T4,CPT,320,RC,T4,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 5TH DIGIT LT,73660T4,CPT,320,RC,T4,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HIV TYPE 1 CONFIRMATION BY IFA,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.94,181.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE GREAT RT,73660T5,CPT,320,RC,T5,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE GREAT RT,73660T5,CPT,320,RC,T5,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HTLV I/II AB CONFIRMATION S,86689,CPT,300,RC,,OUTPATIENT,,,494.75,197.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,371.06,484.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 2ND DIGIT RT,73660T6,CPT,320,RC,T6,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 2ND DIGIT RT,73660T6,CPT,320,RC,T6,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HEPATITIS D TOTAL AB,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 3RD DIGIT RT,73660T7,CPT,320,RC,T7,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 3RD DIGIT RT,73660T7,CPT,320,RC,T7,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HEPATITIS D VIRUS AB IGM,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 4TH DIGIT RT,73660T8,CPT,320,RC,T8,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 4TH DIGIT RT,73660T8,CPT,320,RC,T8,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
Z HERPES SIMPLEX NON SPEC TYPE,86694,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.56,36.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TOE 5TH DIGIT RT,73660T9,CPT,320,RC,T9,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
TOE 5TH DIGIT RT,73660T9,CPT,320,RC,T9,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HSV AB IGM BY IFA,86694,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
T-TUBE INJECTION,47505,CPT,320,RC,,OUTPATIENT,,,308,123.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,246.4,OTHER,231,301.84,PERCENT OF CHARGES BASED ON HCPCS CODE
T-TUBE INJECTION,47505,CPT,320,RC,,OUTPATIENT,,,308,123.2,MONUMENT,COMMERCIAL,,,,246.4,,231,301.84,
HERPES SIMPLEX VIRUS TYPE 1,86695,CPT,300,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.25,34.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THORACIC SPINE,72072,CPT,320,RC,,OUTPATIENT,,,375,150,BLUE CROSS ANTHEM,COMMERCIAL,,,,300,OTHER,281.25,367.5,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACIC SPINE,72072,CPT,320,RC,,OUTPATIENT,,,375,150,MONUMENT,COMMERCIAL,,,,300,,281.25,367.5,
HERPES SIMPLEX VIRUS TYPE 2,86696,CPT,300,RC,,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THORACIC SPINE 2VIEWS,72070,CPT,320,RC,,OUTPATIENT,,,305.75,122.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.6,OTHER,229.31,299.64,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACIC SPINE 2VIEWS,72070,CPT,320,RC,,OUTPATIENT,,,305.75,122.3,MONUMENT,COMMERCIAL,,,,244.6,,229.31,299.64,
HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,91.5,36.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.63,89.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THORACOLUMBAR 2 VIEWS,72080,CPT,320,RC,,OUTPATIENT,,,375,150,BLUE CROSS ANTHEM,COMMERCIAL,,,,300,OTHER,281.25,367.5,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACOLUMBAR 2 VIEWS,72080,CPT,320,RC,,OUTPATIENT,,,375,150,MONUMENT,COMMERCIAL,,,,300,,281.25,367.5,
Z HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER GI SERIES,74240,CPT,320,RC,,OUTPATIENT,,,694.75,277.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.8,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER GI SERIES,74240,CPT,320,RC,,OUTPATIENT,,,694.75,277.9,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
Z HISTOPLASMA ANTIBODY,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UGI/SMALL BOWEL-NO AIR,74240,CPT,320,RC,,OUTPATIENT,,,743.25,297.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,594.6,OTHER,557.44,728.39,PERCENT OF CHARGES BASED ON HCPCS CODE
UGI/SMALL BOWEL-NO AIR,74240,CPT,320,RC,,OUTPATIENT,,,743.25,297.3,MONUMENT,COMMERCIAL,,,,594.6,,557.44,728.39,
HIV 1 ANTIBODY RAPID SCREEN,86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
X-RAY SM INT F-THRU STD,74248,CPT,320,RC,,OUTPATIENT,,,200,80,BLUE CROSS ANTHEM,COMMERCIAL,,,,160,OTHER,150,196,PERCENT OF CHARGES BASED ON HCPCS CODE
X-RAY SM INT F-THRU STD,74248,CPT,320,RC,,OUTPATIENT,,,200,80,MONUMENT,COMMERCIAL,,,,160,,150,196,
HIV 1 ANTIBODY DIFFERENTIATION,86701,CPT,300,RC,,OUTPATIENT,,,174.5,69.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.88,171.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER GI W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,760.75,304.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,608.6,OTHER,570.56,745.54,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER GI W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,760.75,304.3,MONUMENT,COMMERCIAL,,,,608.6,,570.56,745.54,
EMPLOYEE HEALTH HIV (SOURCE),86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER GI/SMALL BOWEL W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,785.75,314.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,628.6,OTHER,589.31,770.04,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER GI/SMALL BOWEL W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,785.75,314.3,MONUMENT,COMMERCIAL,,,,628.6,,589.31,770.04,
HIV ANTIBODY TYPE 2 SCREEN,86702,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TUBE PLACEMENT FLUORO/FILM,74340,CPT,320,RC,,OUTPATIENT,,,440,176,BLUE CROSS ANTHEM,COMMERCIAL,,,,352,OTHER,330,431.2,PERCENT OF CHARGES BASED ON HCPCS CODE
TUBE PLACEMENT FLUORO/FILM,74340,CPT,320,RC,,OUTPATIENT,,,440,176,MONUMENT,COMMERCIAL,,,,352,,330,431.2,
Z EH HIV,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URETHROCYSTOGRAPH,74450,CPT,320,RC,,OUTPATIENT,,,474.25,189.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,379.4,OTHER,355.69,464.77,PERCENT OF CHARGES BASED ON HCPCS CODE
URETHROCYSTOGRAPH,74450,CPT,320,RC,,OUTPATIENT,,,474.25,189.7,MONUMENT,COMMERCIAL,,,,379.4,,355.69,464.77,
EH HIV NEEDLESTICK F/U,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
URETHRA/BLADDER,74455,CPT,320,RC,,OUTPATIENT,,,1399,559.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1119.2,OTHER,1049.25,1371.02,PERCENT OF CHARGES BASED ON HCPCS CODE
URETHRA/BLADDER,74455,CPT,320,RC,,OUTPATIENT,,,1399,559.6,MONUMENT,COMMERCIAL,,,,1119.2,,1049.25,1371.02,
HIV 1/2 AB. EVALUATION DIAGNOS,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.9,151.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VENOGRAM UNILATERAL RT,75820RT,CPT,320,RC,RT,OUTPATIENT,,,2802.66,1121.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2242.128,OTHER,846,1105.44,PERCENT OF CHARGES BASED ON HCPCS CODE
VENOGRAM UNILATERAL RT,75820RT,CPT,320,RC,RT,OUTPATIENT,,,2802.66,1121.064,MONUMENT,COMMERCIAL,,,,902.4,,846,1105.44,
HIV-1,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VENOGRAM UNILATERAL LT,75820LT,CPT,320,RC,LT,OUTPATIENT,,,2802.66,1121.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,2242.128,OTHER,846,1105.44,PERCENT OF CHARGES BASED ON HCPCS CODE
VENOGRAM UNILATERAL LT,75820LT,CPT,320,RC,LT,OUTPATIENT,,,2802.66,1121.064,MONUMENT,COMMERCIAL,,,,902.4,,846,1105.44,
Z ANTI HBC TOTAL,86704,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST RT,73110RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST RT,73110RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HEPATITIS B CORE ANTIBODY,86704,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.19,121.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST LT,73110LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,196.4,OTHER,184.13,240.59,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST LT,73110LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,MONUMENT,COMMERCIAL,,,,196.4,,184.13,240.59,
HEPATITIS B CORE AB IGM,86705,CPT,300,RC,,OUTPATIENT,,,180.5,72.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,135.38,176.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRISTS BILAT 4 VIEWS ONLY,73100,CPT,,,,OUTPATIENT,,,491,196.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,392.8,OTHER,368.3,481.2,PERCENT OF CHARGES BASED ON HCPCS CODE
WRISTS BILAT 4 VIEWS ONLY,73100,CPT,,,,OUTPATIENT,,,491,196.4,MONUMENT,COMMERCIAL,,,,392.8,,368.3,481.2,
Z HBS AB QUAL QUANT,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.25,116.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST 2 VIEWS RT,73100RT,CPT,320,RC,RT,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,85.69,111.97,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST 2 VIEWS RT,73100RT,CPT,320,RC,RT,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
Z EH HEP B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.25,116.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST 2 VIEWS LT,73100LT,CPT,320,RC,LT,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,85.69,111.97,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST 2 VIEWS LT,73100LT,CPT,320,RC,LT,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,91.4,,85.69,111.97,
HEPATITIS B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.25,116.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST ARTHRO RT,73115RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,438.19,572.57,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST ARTHRO RT,73115RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,467.4,,438.19,572.57,
HEPATITIS BE ANTIBODY,86707,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,67.88,88.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WRIST ARTHRO LT,73115LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,BLUE CROSS ANTHEM,COMMERCIAL,,,,586.976,OTHER,438.19,572.57,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST ARTHRO LT,73115LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,MONUMENT,COMMERCIAL,,,,467.4,,438.19,572.57,
Z HEP A TOTAL ANTIBODIES,86708,CPT,300,RC,,OUTPATIENT,,,32.25,12.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24.19,31.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"LUMBAR AP,FLEX/EXT",72120,CPT,320,RC,,OUTPATIENT,,,215.38,86.152,BLUE CROSS ANTHEM,COMMERCIAL,,,,172.304,OTHER,161.5,211.1,PERCENT OF CHARGES BASED ON HCPCS CODE
"LUMBAR AP,FLEX/EXT",72120,CPT,320,RC,,OUTPATIENT,,,215.38,86.152,MONUMENT,COMMERCIAL,,,,172.3,,161.5,211.1,
HEP A TOTAL WITH REFLEX,86708,CPT,300,RC,,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.75,122.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOREIGN BODY EVALUATION  CHILD,76010,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.8,OTHER,200.44,261.91,PERCENT OF CHARGES BASED ON HCPCS CODE
FOREIGN BODY EVALUATION  CHILD,76010,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,MONUMENT,COMMERCIAL,,,,213.8,,200.44,261.91,
HEPATITIS A ANTIBODY IGM,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,95.06,124.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
X-RAY XM SWLNG FUNCJ C+,74230,CPT,320,RC,,OUTPATIENT,,,363.42,145.368,BLUE CROSS ANTHEM,COMMERCIAL,,,,290.736,OTHER,272.6,356.2,PERCENT OF CHARGES BASED ON HCPCS CODE
X-RAY XM SWLNG FUNCJ C+,74230,CPT,320,RC,,OUTPATIENT,,,363.42,145.368,MONUMENT,COMMERCIAL,,,,290.7,,272.6,356.2,
HAAB IGM ANTIBODY,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,95.06,124.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOMY TUBE CHANGE FLUORO,50435,CPT,361,RC,,OUTPATIENT,,,3738.02,1495.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,2990.416,OTHER,2803.5,3663.3,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOMY TUBE CHANGE FLUORO,50435,CPT,361,RC,,OUTPATIENT,,,3738.02,1495.208,MONUMENT,COMMERCIAL,,,,2990.4,,2803.5,3663.3,
INFLUENZA A&B VIRUS ANTIBODIES,86710,CPT,302,RC,,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.5,103.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANKLE BILATERAL 4 VIEWS,73600,CPT,,,,OUTPATIENT,,,350.16,140.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.128,OTHER,262.6,343.2,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE BILATERAL 4 VIEWS,73600,CPT,,,,OUTPATIENT,,,350.16,140.064,MONUMENT,COMMERCIAL,,,,280.1,,262.6,343.2,
Z INFLUENZA VIRUS ANTIBODY IGG,86710,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US PICC LINE PLACEMENT,36569,CPT,361,RC,,OUTPATIENT,,,2033,813.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1626.4,OTHER,1524.75,1992.34,PERCENT OF CHARGES BASED ON HCPCS CODE
US PICC LINE PLACEMENT,36569,CPT,361,RC,,OUTPATIENT,,,2033,813.2,MONUMENT,COMMERCIAL,,,,1626.4,,1524.75,1992.34,
LEGIONELLA PNEUMOPHILA,86713,CPT,302,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEST DECUBITUS,71046,CPT,320,RC,,OUTPATIENT,,,243.5,97.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,194.8,OTHER,182.63,238.63,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST DECUBITUS,71046,CPT,320,RC,,OUTPATIENT,,,243.5,97.4,MONUMENT,COMMERCIAL,,,,194.8,,182.63,238.63,
LEISHMANIASIS AB,86717,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.19,137.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ORBITS FOR MRI,70030,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.8,OTHER,200.44,261.91,PERCENT OF CHARGES BASED ON HCPCS CODE
ORBITS FOR MRI,70030,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,MONUMENT,COMMERCIAL,,,,213.8,,200.44,261.91,
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,OUTPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,90.56,118.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ORBITS,70190,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,213.8,OTHER,200.44,261.91,PERCENT OF CHARGES BASED ON HCPCS CODE
ORBITS,70190,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,MONUMENT,COMMERCIAL,,,,213.8,,200.44,261.91,
Z EH MUMPS (IMMUNITY),86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.13,119.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLURO,36573,CPT,320,RC,,OUTPATIENT,,,660.75,264.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,528.6,OTHER,495.56,647.54,PERCENT OF CHARGES BASED ON HCPCS CODE
FLURO,36573,CPT,320,RC,,OUTPATIENT,,,660.75,264.3,MONUMENT,COMMERCIAL,,,,528.6,,495.56,647.54,
MUMPS IGG  SCREEN,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.13,119.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA HIPS/PELVIS/SPINE,77080XU,CPT,320,RC,XU,OUTPATIENT,,,428,171.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,342.4,OTHER,321,419.44,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA HIPS/PELVIS/SPINE,77080XU,CPT,320,RC,XU,OUTPATIENT,,,428,171.2,MONUMENT,COMMERCIAL,,,,342.4,,321,419.44,
Z MUMPS VIRUS AB  IGG,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.13,119.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEXA RADIUS/WRIST/HEEL,77081,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,129,OTHER,62.06,81.1,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXA RADIUS/WRIST/HEEL,77081,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,66.2,,62.06,81.1,
Z MUMPS VIRUS AB IGM,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.13,119.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PROCEDURE LEVEL I,3210001,CDM,320,RC,,INPATIENT,,,856.5,342.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,779.42,OTHER,642.38,839.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROCEDURE LEVEL I,3210001,CDM,320,RC,,INPATIENT,,,856.5,342.6,MONUMENT,COMMERCIAL,,,,685.2,,642.38,839.37,
PROCEDURE LEVEL I,3210001,CDM,320,RC,,INPATIENT,,,856.5,342.6,UNITED HEALTH,UNITED COMMERCIAL,,,,642.38,,642.38,839.37,
PROCEDURE LEVEL II,3210002,CDM,320,RC,,INPATIENT,,,1497.75,599.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1362.95,OTHER,1123.31,1467.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROCEDURE LEVEL II,3210002,CDM,320,RC,,INPATIENT,,,1497.75,599.1,MONUMENT,COMMERCIAL,,,,1198.2,,1123.31,1467.8,
PROCEDURE LEVEL II,3210002,CDM,320,RC,,INPATIENT,,,1497.75,599.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1123.31,,1123.31,1467.8,
PROCEDURE LEVEL III,3210003,CDM,361,RC,,INPATIENT,,,2139.5,855.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1946.95,OTHER,1604.63,2096.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROCEDURE LEVEL III,3210003,CDM,361,RC,,INPATIENT,,,2139.5,855.8,MONUMENT,COMMERCIAL,,,,1711.6,,1604.63,2096.71,
PROCEDURE LEVEL III,3210003,CDM,361,RC,,INPATIENT,,,2139.5,855.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1604.63,,1604.63,2096.71,
PROCEDURE LEVEL IV,3210004,CDM,320,RC,,INPATIENT,,,2781,1112.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2530.71,OTHER,2085.75,2725.38,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROCEDURE LEVEL IV,3210004,CDM,320,RC,,INPATIENT,,,2781,1112.4,MONUMENT,COMMERCIAL,,,,2224.8,,2085.75,2725.38,
PROCEDURE LEVEL IV,3210004,CDM,320,RC,,INPATIENT,,,2781,1112.4,UNITED HEALTH,UNITED COMMERCIAL,,,,2085.75,,2085.75,2725.38,
PROCEDURE LEVEL V,3210005,CDM,320,RC,,INPATIENT,,,3422,1368.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3114.02,OTHER,2566.5,3353.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PROCEDURE LEVEL V,3210005,CDM,320,RC,,INPATIENT,,,3422,1368.8,MONUMENT,COMMERCIAL,,,,2737.6,,2566.5,3353.56,
PROCEDURE LEVEL V,3210005,CDM,320,RC,,INPATIENT,,,3422,1368.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2566.5,,2566.5,3353.56,
BONE BIOPSY TROCAR/NEEDLE,20220,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1711.6,OTHER,1604.63,2096.71,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE BIOPSY TROCAR/NEEDLE,20220,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,MONUMENT,COMMERCIAL,,,,1711.6,,1604.63,2096.71,
MYCOPLASMA PNEUMONIAE AB,86738,CPT,300,RC,,OUTPATIENT,,,98,39.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.5,96.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE BIOPSY TROCAR/NEEDLE DEEP,20225,CPT,321,RC,,OUTPATIENT,,,2139.5,855.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1711.6,OTHER,1604.63,2096.71,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE BIOPSY TROCAR/NEEDLE DEEP,20225,CPT,321,RC,,OUTPATIENT,,,2139.5,855.8,MONUMENT,COMMERCIAL,,,,1711.6,,1604.63,2096.71,
PARVOVIRUS B19 AB IGM,86747,CPT,300,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
XRAY SHOULDER INJECTION,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,426.2,OTHER,399.56,522.1,PERCENT OF CHARGES BASED ON HCPCS CODE
XRAY SHOULDER INJECTION,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,MONUMENT,COMMERCIAL,,,,426.2,,399.56,522.1,
MALARIA ANTIBODY SCREEN,86750,CPT,300,RC,,OUTPATIENT,,,344.25,137.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,258.19,337.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
XRAY SHOULDER INJECTION RT,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,426.2,OTHER,399.6,522.1,PERCENT OF CHARGES BASED ON HCPCS CODE
XRAY SHOULDER INJECTION RT,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,MONUMENT,COMMERCIAL,,,,426.2,,399.6,522.1,
AMEBIASIS ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.63,121.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
XRAY WRIST INJECTION,25246,CPT,320,RC,,OUTPATIENT,,,532.75,213.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,426.2,OTHER,399.56,522.1,PERCENT OF CHARGES BASED ON HCPCS CODE
XRAY WRIST INJECTION,25246,CPT,320,RC,,OUTPATIENT,,,532.75,213.1,MONUMENT,COMMERCIAL,,,,426.2,,399.56,522.1,
E. HISTOLYTICA ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.63,121.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO GUIDED FACET JOINT INJ,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,1358.64,OTHER,1273.7,1664.3,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO GUIDED FACET JOINT INJ,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,MONUMENT,COMMERCIAL,,,,1358.6,,1273.7,1664.3,
TRYPANOSOMA CRUZI AB IGG,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,92.63,121.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REFILL MAINTAIN PUMP,96521,CPT,760,RC,,OUTPATIENT,,,604.75,241.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,483.8,OTHER,453.56,592.66,PERCENT OF CHARGES BASED ON HCPCS CODE
REFILL MAINTAIN PUMP,96521,CPT,760,RC,,OUTPATIENT,,,604.75,241.9,MONUMENT,COMMERCIAL,,,,483.8,,453.56,592.66,
RESP SYNCYTIAL VIRUS ANTIBODY,86756,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTRAVESICAL CHEMO ADMIN,51720,CPT,331,RC,,OUTPATIENT,,,1252.97,501.188,BLUE CROSS ANTHEM,COMMERCIAL,,,,1002.376,OTHER,939.73,1227.91,PERCENT OF CHARGES BASED ON HCPCS CODE
INTRAVESICAL CHEMO ADMIN,51720,CPT,331,RC,,OUTPATIENT,,,1252.97,501.188,MONUMENT,COMMERCIAL,,,,1002.38,,939.73,1227.91,
Z SPOTTED FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.81,54.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEMO IV PUSH ADD'L DRUG,96411,CPT,331,RC,,OUTPATIENT,,,491.75,196.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,393.4,OTHER,368.81,481.92,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMO IV PUSH ADD'L DRUG,96411,CPT,331,RC,,OUTPATIENT,,,491.75,196.7,MONUMENT,COMMERCIAL,,,,393.4,,368.81,481.92,
Z TYPHUS FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.81,54.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEM ADMIN IVP SNGL/INT LVL I,96409,CPT,331,RC,,OUTPATIENT,,,602,240.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,481.6,OTHER,451.5,589.96,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEM ADMIN IVP SNGL/INT LVL I,96409,CPT,331,RC,,OUTPATIENT,,,602,240.8,MONUMENT,COMMERCIAL,,,,481.6,,451.5,589.96,
Z EH RUBELLA,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEM ADMIN IVP SNGL/INT LVL II,96409,CPT,331,RC,,OUTPATIENT,,,534,213.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.2,OTHER,400.5,523.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEM ADMIN IVP SNGL/INT LVL II,96409,CPT,331,RC,,OUTPATIENT,,,534,213.6,MONUMENT,COMMERCIAL,,,,427.2,,400.5,523.32,
Z RUBELLA IGM,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEM ADMIN IVP PICC LVL III,96409,CPT,331,RC,,OUTPATIENT,,,468.25,187.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,374.6,OTHER,351.19,458.89,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEM ADMIN IVP PICC LVL III,96409,CPT,331,RC,,OUTPATIENT,,,468.25,187.3,MONUMENT,COMMERCIAL,,,,374.6,,351.19,458.89,
RUBELLA IGG ANTIBODY,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEM ADMIN IVP PICC LVL IV,96409,CPT,331,RC,,OUTPATIENT,,,520.25,208.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.2,OTHER,390.19,509.85,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEM ADMIN IVP PICC LVL IV,96409,CPT,331,RC,,OUTPATIENT,,,520.25,208.1,MONUMENT,COMMERCIAL,,,,416.2,,390.19,509.85,
Z EH MEASLES,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUSION CHEMO EA ADD'L HR,96415,CPT,335,RC,,OUTPATIENT,,,148.75,59.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,119,OTHER,111.56,145.78,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION CHEMO EA ADD'L HR,96415,CPT,335,RC,,OUTPATIENT,,,148.75,59.5,MONUMENT,COMMERCIAL,,,,119,,111.56,145.78,
MEASLES RUBEOLA AB IGM,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EA ADD'L/SEQ INFUSED CHEMO<1HR,96417,CPT,335,RC,,OUTPATIENT,,,159.25,63.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,127.4,OTHER,119.44,156.07,PERCENT OF CHARGES BASED ON HCPCS CODE
EA ADD'L/SEQ INFUSED CHEMO<1HR,96417,CPT,335,RC,,OUTPATIENT,,,159.25,63.7,MONUMENT,COMMERCIAL,,,,127.4,,119.44,156.07,
MEASLES RUBEOLA AB IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUS CHEMO INIT LEVEL I,96413,CPT,335,RC,,OUTPATIENT,,,793.25,317.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,634.6,OTHER,594.94,777.39,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS CHEMO INIT LEVEL I,96413,CPT,335,RC,,OUTPATIENT,,,793.25,317.3,MONUMENT,COMMERCIAL,,,,634.6,,594.94,777.39,
RUBEOLA IGG ANTIBODY,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUS CHEMO INIT LEVEL II,96413,CPT,335,RC,,OUTPATIENT,,,694,277.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.2,OTHER,520.5,680.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS CHEMO INIT LEVEL II,96413,CPT,335,RC,,OUTPATIENT,,,694,277.6,MONUMENT,COMMERCIAL,,,,555.2,,520.5,680.12,
MEASLES  IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.13,130.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUS CHEMO INIT LEVEL III,96413,CPT,335,RC,,OUTPATIENT,,,740.75,296.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,592.6,OTHER,555.56,725.94,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS CHEMO INIT LEVEL III,96413,CPT,335,RC,,OUTPATIENT,,,740.75,296.3,MONUMENT,COMMERCIAL,,,,592.6,,555.56,725.94,
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.94,130.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUS CHEMO INIT LEVEL IV,96413,CPT,335,RC,,OUTPATIENT,,,662,264.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,529.6,OTHER,496.5,648.76,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS CHEMO INIT LEVEL IV,96413,CPT,335,RC,,OUTPATIENT,,,662,264.8,MONUMENT,COMMERCIAL,,,,529.6,,496.5,648.76,
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.94,130.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYSTOGRAM,78740,CPT,340,RC,,OUTPATIENT,,,1170.75,468.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,936.6,OTHER,878.06,1147.34,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOGRAM,78740,CPT,340,RC,,OUTPATIENT,,,1170.75,468.3,MONUMENT,COMMERCIAL,,,,936.6,,878.06,1147.34,
Z TOXOPLASMA  IGM,86778,CPT,300,RC,,OUTPATIENT,,,49.5,19.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,37.13,48.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROID CARCINOMA MET IMAGING,78018,CPT,340,RC,,OUTPATIENT,,,1658,663.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1326.4,OTHER,1243.5,1624.84,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROID CARCINOMA MET IMAGING,78018,CPT,340,RC,,OUTPATIENT,,,1658,663.2,MONUMENT,COMMERCIAL,,,,1326.4,,1243.5,1624.84,
TOXOPLASMA IGM,86778,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CEREBROSPINAL FLUID FLOW IMAGE,78630,CPT,340,RC,,OUTPATIENT,,,3353,1341.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2682.4,OTHER,2514.75,3285.94,PERCENT OF CHARGES BASED ON HCPCS CODE
CEREBROSPINAL FLUID FLOW IMAGE,78630,CPT,340,RC,,OUTPATIENT,,,3353,1341.2,MONUMENT,COMMERCIAL,,,,2682.4,,2514.75,3285.94,
FTA ABS IGG BY IFA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.88,104.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CAPTOPRIL RENAL,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1337.4,OTHER,1253.81,1638.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CAPTOPRIL RENAL,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,MONUMENT,COMMERCIAL,,,,1337.4,,1253.81,1638.32,
SYPHILIS ANTIBODY IGG,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.88,104.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE IMAGING LIMITED (BONL),78300,CPT,341,RC,,OUTPATIENT,,,1688.25,675.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1350.6,OTHER,1266.19,1654.49,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE IMAGING LIMITED (BONL),78300,CPT,341,RC,,OUTPATIENT,,,1688.25,675.3,MONUMENT,COMMERCIAL,,,,1350.6,,1266.19,1654.49,
SYPHILIS AB TP-PA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.88,104.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE WHOLE BODY (BONW),78306,CPT,341,RC,,OUTPATIENT,,,1814.25,725.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1451.4,OTHER,1360.69,1777.97,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE WHOLE BODY (BONW),78306,CPT,341,RC,,OUTPATIENT,,,1814.25,725.7,MONUMENT,COMMERCIAL,,,,1451.4,,1360.69,1777.97,
TRICHINELLA ANTIBODY,86784,CPT,302,RC,,OUTPATIENT,,,66,26.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.5,64.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE IMAGING 3 PHASE (BON3),78315,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1337.4,OTHER,1253.81,1638.32,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE IMAGING 3 PHASE (BON3),78315,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,MONUMENT,COMMERCIAL,,,,1337.4,,1253.81,1638.32,
Z EH VARICELLA ZOSTER IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.5,131.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAGGED RBC GI BLEED (TRBC),78278,CPT,341,RC,,OUTPATIENT,,,2035,814,BLUE CROSS ANTHEM,COMMERCIAL,,,,1628,OTHER,1526.25,1994.3,PERCENT OF CHARGES BASED ON HCPCS CODE
TAGGED RBC GI BLEED (TRBC),78278,CPT,341,RC,,OUTPATIENT,,,2035,814,MONUMENT,COMMERCIAL,,,,1628,,1526.25,1994.3,
VARICELLA-ZOSTER IGG&IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.5,131.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIDA W/O,78226,CPT,341,RC,,OUTPATIENT,,,952.25,380.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,761.8,OTHER,714.19,933.21,PERCENT OF CHARGES BASED ON HCPCS CODE
HIDA W/O,78226,CPT,341,RC,,OUTPATIENT,,,952.25,380.9,MONUMENT,COMMERCIAL,,,,761.8,,714.19,933.21,
VARICELLA-ZOSTER VIRUS AB IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.5,131.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VQ SCAN VENT/PERFUSION,78598,CPT,341,RC,,OUTPATIENT,,,1837,734.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1469.6,OTHER,1377.75,1800.26,PERCENT OF CHARGES BASED ON HCPCS CODE
VQ SCAN VENT/PERFUSION,78598,CPT,341,RC,,OUTPATIENT,,,1837,734.8,MONUMENT,COMMERCIAL,,,,1469.6,,1377.75,1800.26,
VARICELLA-ZOSTER AB-IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,100.5,131.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIDA W/CCK,78227,CPT,341,RC,,OUTPATIENT,,,1721.75,688.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1377.4,OTHER,1291.31,1687.32,PERCENT OF CHARGES BASED ON HCPCS CODE
HIDA W/CCK,78227,CPT,341,RC,,OUTPATIENT,,,1721.75,688.7,MONUMENT,COMMERCIAL,,,,1377.4,,1291.31,1687.32,
Z WEST NILE IGM,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.56,110.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUNG PERFUSION,78580,CPT,341,RC,,OUTPATIENT,,,1403.5,561.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1122.8,OTHER,1052.63,1375.43,PERCENT OF CHARGES BASED ON HCPCS CODE
LUNG PERFUSION,78580,CPT,341,RC,,OUTPATIENT,,,1403.5,561.4,MONUMENT,COMMERCIAL,,,,1122.8,,1052.63,1375.43,
Z WEST NILE VIRUS AB IGM CSF,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.56,110.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUNG VENTILATION,78582,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1337.4,OTHER,1253.81,1638.32,PERCENT OF CHARGES BASED ON HCPCS CODE
LUNG VENTILATION,78582,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,MONUMENT,COMMERCIAL,,,,1337.4,,1253.81,1638.32,
Z WEST NILE IGG,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.56,79.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MECKLES IMAGING (MECK),78290,CPT,341,RC,,OUTPATIENT,,,1462,584.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1169.6,OTHER,1096.5,1432.76,PERCENT OF CHARGES BASED ON HCPCS CODE
MECKLES IMAGING (MECK),78290,CPT,341,RC,,OUTPATIENT,,,1462,584.8,MONUMENT,COMMERCIAL,,,,1169.6,,1096.5,1432.76,
Z WEST NILE VIRUS AB IGG CSF,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.56,79.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RENAL FLOW/FUNCTION,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1337.4,OTHER,1253.81,1638.32,PERCENT OF CHARGES BASED ON HCPCS CODE
RENAL FLOW/FUNCTION,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,MONUMENT,COMMERCIAL,,,,1337.4,,1253.81,1638.32,
ZIKAVIRUS IGM,86790,CPT,300,RC,,OUTPATIENT,,,220.5,88.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,165.38,216.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROID IMAGING ONLY (THYI),78013,CPT,341,RC,,OUTPATIENT,,,751.66,300.664,BLUE CROSS ANTHEM,COMMERCIAL,,,,601.328,OTHER,491.81,642.64,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROID IMAGING ONLY (THYI),78013,CPT,341,RC,,OUTPATIENT,,,751.66,300.664,MONUMENT,COMMERCIAL,,,,524.6,,491.81,642.64,
"CHIKUNGUNYA IGM, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.63,191.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THYROID UPTAKE W/MULT DETE,78012,CPT,341,RC,,OUTPATIENT,,,1586,634.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1268.8,OTHER,1189.5,1554.28,PERCENT OF CHARGES BASED ON HCPCS CODE
THYROID UPTAKE W/MULT DETE,78012,CPT,341,RC,,OUTPATIENT,,,1586,634.4,MONUMENT,COMMERCIAL,,,,1268.8,,1189.5,1554.28,
"CHIKUNGUNYA IGG, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.63,191.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE SPECT (BNSP),78320,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1108.6,OTHER,1039.31,1358.04,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE SPECT (BNSP),78320,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,MONUMENT,COMMERCIAL,,,,1108.6,,1039.31,1358.04,
HANTA VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTRO EMPTYING STUDY (GASE),78264,CPT,341,RC,,OUTPATIENT,,,1586,634.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1268.8,OTHER,1189.5,1554.28,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTRO EMPTYING STUDY (GASE),78264,CPT,341,RC,,OUTPATIENT,,,1586,634.4,MONUMENT,COMMERCIAL,,,,1268.8,,1189.5,1554.28,
Z VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIVER/SPLEEN IMAGING W/FLOW,78216,CPT,341,RC,,OUTPATIENT,,,1237.5,495,BLUE CROSS ANTHEM,COMMERCIAL,,,,990,OTHER,928.13,1212.75,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER/SPLEEN IMAGING W/FLOW,78216,CPT,341,RC,,OUTPATIENT,,,1237.5,495,MONUMENT,COMMERCIAL,,,,990,,928.13,1212.75,
HEPATITIS E ANTIBODY IGM,86790,CPT,300,RC,,OUTPATIENT,,,200,80,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150,196,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIVER (SPECT) (LIVS),78205,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1108.6,OTHER,1039.31,1358.04,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER (SPECT) (LIVS),78205,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,MONUMENT,COMMERCIAL,,,,1108.6,,1039.31,1358.04,
HEPATITIS E ANTIBODY IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYMPH GLAND INJECTION,78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1418.8,OTHER,1330.13,1738.03,PERCENT OF CHARGES BASED ON HCPCS CODE
LYMPH GLAND INJECTION,78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,MONUMENT,COMMERCIAL,,,,1418.8,,1330.13,1738.03,
RABIES ANTIBODY,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYOCARDIAL PERFUSION,78452,CPT,341,RC,,OUTPATIENT,,,3980.75,1592.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3184.6,OTHER,2985.56,3901.14,PERCENT OF CHARGES BASED ON HCPCS CODE
MYOCARDIAL PERFUSION,78452,CPT,341,RC,,OUTPATIENT,,,3980.75,1592.3,MONUMENT,COMMERCIAL,,,,3184.6,,2985.56,3901.14,
HTLV I/II AB S,86790,CPT,300,RC,,OUTPATIENT,,,95.25,38.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.44,93.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYOCARDIAL PERF WALL MOTION,78453,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,BLUE CROSS ANTHEM,COMMERCIAL,,,,2082.36,OTHER,931.69,1217.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MYOCARDIAL PERF WALL MOTION,78453,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,MONUMENT,COMMERCIAL,,,,993.8,,931.69,1217.41,
Z HERPES VIRUS 6 IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MYOCARDIAL PERF EJECTION FRACT,78496,CPT,341,RC,,OUTPATIENT,,,811.25,324.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,649,OTHER,608.44,795.03,PERCENT OF CHARGES BASED ON HCPCS CODE
MYOCARDIAL PERF EJECTION FRACT,78496,CPT,341,RC,,OUTPATIENT,,,811.25,324.5,MONUMENT,COMMERCIAL,,,,649,,608.44,795.03,
Z HERPES VIRUS 6 IGM,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MUGA SCAN,78472,CPT,341,RC,,OUTPATIENT,,,2449,979.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1959.2,OTHER,1836.75,2400.02,PERCENT OF CHARGES BASED ON HCPCS CODE
MUGA SCAN,78472,CPT,341,RC,,OUTPATIENT,,,2449,979.6,MONUMENT,COMMERCIAL,,,,1959.2,,1836.75,2400.02,
Z DENGUE FEVER IGG,86790,CPT,300,RC,,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARATHYROID IMAGING,78070,CPT,341,RC,,OUTPATIENT,,,1799,719.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1439.2,OTHER,1349.25,1763.02,PERCENT OF CHARGES BASED ON HCPCS CODE
PARATHYROID IMAGING,78070,CPT,341,RC,,OUTPATIENT,,,1799,719.6,MONUMENT,COMMERCIAL,,,,1439.2,,1349.25,1763.02,
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.06,159.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPECT,78807,CPT,340,RC,,OUTPATIENT,,,2279.5,911.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1823.6,OTHER,1709.63,2233.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SPECT,78807,CPT,340,RC,,OUTPATIENT,,,2279.5,911.8,MONUMENT,COMMERCIAL,,,,1823.6,,1709.63,2233.91,
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.06,159.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARATHYROID IMAGING WITH SPECT,78071,CPT,341,RC,,OUTPATIENT,,,1984.5,793.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1587.6,OTHER,1488.38,1944.81,PERCENT OF CHARGES BASED ON HCPCS CODE
PARATHYROID IMAGING WITH SPECT,78071,CPT,341,RC,,OUTPATIENT,,,1984.5,793.8,MONUMENT,COMMERCIAL,,,,1587.6,,1488.38,1944.81,
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.06,159.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TUMOR LOCAL WHOLE BODY,78804,CPT,341,RC,,OUTPATIENT,,,2752,1100.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2201.6,OTHER,2064,2696.96,PERCENT OF CHARGES BASED ON HCPCS CODE
TUMOR LOCAL WHOLE BODY,78804,CPT,341,RC,,OUTPATIENT,,,2752,1100.8,MONUMENT,COMMERCIAL,,,,2201.6,,2064,2696.96,
MICROSOMAL ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TUMOR LOCAL (LTD) (TLLT),78800,CPT,341,RC,,OUTPATIENT,,,1799,719.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1439.2,OTHER,1349.25,1763.02,PERCENT OF CHARGES BASED ON HCPCS CODE
TUMOR LOCAL (LTD) (TLLT),78800,CPT,341,RC,,OUTPATIENT,,,1799,719.6,MONUMENT,COMMERCIAL,,,,1439.2,,1349.25,1763.02,
Z ANTITHYROID MICROSOMAL ANTBD,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAGGED WBC (LTD) (TWBL),78805,CPT,341,RC,,OUTPATIENT,,,3635,1454,BLUE CROSS ANTHEM,COMMERCIAL,,,,2908,OTHER,2726.25,3562.3,PERCENT OF CHARGES BASED ON HCPCS CODE
TAGGED WBC (LTD) (TWBL),78805,CPT,341,RC,,OUTPATIENT,,,3635,1454,MONUMENT,COMMERCIAL,,,,2908,,2726.25,3562.3,
THYROGLOBULIN ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAGGED WBC WHOLE BODY (TWBW),78806,CPT,341,RC,,OUTPATIENT,,,3823,1529.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3058.4,OTHER,2867.25,3746.54,PERCENT OF CHARGES BASED ON HCPCS CODE
TAGGED WBC WHOLE BODY (TWBW),78806,CPT,341,RC,,OUTPATIENT,,,3823,1529.2,MONUMENT,COMMERCIAL,,,,3058.4,,2867.25,3746.54,
THYROGLOBULIN AB,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LIVER IMAGING SPECT W/FLOW,78206,CPT,340,RC,,OUTPATIENT,,,1589.75,635.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1271.8,OTHER,1192.31,1557.96,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER IMAGING SPECT W/FLOW,78206,CPT,340,RC,,OUTPATIENT,,,1589.75,635.9,MONUMENT,COMMERCIAL,,,,1271.8,,1192.31,1557.96,
Z HCV,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAGGED WBC SPECT (TWBS),78807,CPT,340,RC,,OUTPATIENT,,,4529,1811.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3623.2,OTHER,3396.75,4438.42,PERCENT OF CHARGES BASED ON HCPCS CODE
TAGGED WBC SPECT (TWBS),78807,CPT,340,RC,,OUTPATIENT,,,4529,1811.6,MONUMENT,COMMERCIAL,,,,3623.2,,3396.75,4438.42,
Z EH HEPATITIS C VIRUS,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN LIMITED INITIAL,78814PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN LIMITED INITIAL,78814PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
HCV NEEDLESTICK F/U,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LOCAL TUMOR ONCOSCENT IN 111,78802,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,BLUE CROSS ANTHEM,COMMERCIAL,,,,2082.36,OTHER,1386.75,1812.02,PERCENT OF CHARGES BASED ON HCPCS CODE
LOCAL TUMOR ONCOSCENT IN 111,78802,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,MONUMENT,COMMERCIAL,,,,1479.2,,1386.75,1812.02,
HEPATITIS C VIRUS AB,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,122.81,160.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN SKULL TO THIGH INITAL,78815PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN SKULL TO THIGH INITAL,78815PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
HCV-RIBA SUPP,86804,CPT,300,RC,,OUTPATIENT,,,348.5,139.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,261.38,341.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRAIN IMAGINE WITH FLOW,78606,CPT,341,RC,,OUTPATIENT,,,1544.75,617.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1235.8,OTHER,1158.56,1513.86,PERCENT OF CHARGES BASED ON HCPCS CODE
BRAIN IMAGINE WITH FLOW,78606,CPT,341,RC,,OUTPATIENT,,,1544.75,617.9,MONUMENT,COMMERCIAL,,,,1235.8,,1158.56,1513.86,
NATURAL KILLER CYTOTOXICITY,86805,CPT,300,RC,,OUTPATIENT,,,379.02,151.608,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,270.56,353.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN WHOLE BODY INITIAL,78816PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN WHOLE BODY INITIAL,78816PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
HLA-B27,86812,CPT,300,RC,,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,120.94,158.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN LIMITED SUBSEQUENT,78814PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN LIMITED SUBSEQUENT,78814PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
HLA-A&B PHENOTYPE,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,484.31,632.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN WHOLE BODY SUBSEQUENT,78816PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN WHOLE BODY SUBSEQUENT,78816PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
HLA TYPING A B C,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,484.31,632.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN PROSTATE,78815,CPT,404,RC,,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.8,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN PROSTATE,78815,CPT,404,RC,,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.8,
HLA TYPING  DR/DQ,86817,CPT,300,RC,,OUTPATIENT,,,485.25,194.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,363.94,475.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PET SCAN SKULL-THIGH SUBSEQUET,78815PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6689.6,OTHER,6271.5,8194.76,PERCENT OF CHARGES BASED ON HCPCS CODE
PET SCAN SKULL-THIGH SUBSEQUET,78815PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,MONUMENT,COMMERCIAL,,,,6689.6,,6271.5,8194.76,
EXTENDEND CORD BLOOD TYPING,86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LYMPHOSCINTIGRAPHY (LYSC),78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1418.8,OTHER,1330.13,1738.03,PERCENT OF CHARGES BASED ON HCPCS CODE
LYMPHOSCINTIGRAPHY (LYSC),78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,MONUMENT,COMMERCIAL,,,,1418.8,,1330.13,1738.03,
ANTIBODY SCREENING (RBC),86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABDOMINAL SCINTIGRAPHY,78999,CPT,341,RC,,OUTPATIENT,,,1575,630,BLUE CROSS ANTHEM,COMMERCIAL,,,,1260,OTHER,1181.25,1543.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMINAL SCINTIGRAPHY,78999,CPT,341,RC,,OUTPATIENT,,,1575,630,MONUMENT,COMMERCIAL,,,,1260,,1181.25,1543.5,
ANTIBODY IDENTIFICATION,86870,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,269.81,352.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TC99M PERTECHNETATE,A9512,HCPCS,343,RC,,INPATIENT,,,142.5,57,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.68,OTHER,106.88,139.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M PERTECHNETATE,A9512,HCPCS,343,RC,,INPATIENT,,,142.5,57,MONUMENT,COMMERCIAL,,,,114,,106.88,139.65,
TC99M PERTECHNETATE,A9512,HCPCS,343,RC,,INPATIENT,,,142.5,57,UNITED HEALTH,UNITED COMMERCIAL,,,,106.88,,106.88,139.65,
TC99M DISOFENIN,A9510,HCPCS,343,RC,,INPATIENT,,,169.75,67.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.47,OTHER,127.31,166.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M DISOFENIN,A9510,HCPCS,343,RC,,INPATIENT,,,169.75,67.9,MONUMENT,COMMERCIAL,,,,135.8,,127.31,166.36,
TC99M DISOFENIN,A9510,HCPCS,343,RC,,INPATIENT,,,169.75,67.9,UNITED HEALTH,UNITED COMMERCIAL,,,,127.31,,127.31,166.36,
TC99M MAA,A9540,HCPCS,343,RC,,INPATIENT,,,142.5,57,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.68,OTHER,106.88,139.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M MAA,A9540,HCPCS,343,RC,,INPATIENT,,,142.5,57,MONUMENT,COMMERCIAL,,,,114,,106.88,139.65,
TC99M MAA,A9540,HCPCS,343,RC,,INPATIENT,,,142.5,57,UNITED HEALTH,UNITED COMMERCIAL,,,,106.88,,106.88,139.65,
TC99M BICISATE,A9557,HCPCS,343,RC,,INPATIENT,,,142.5,57,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.68,OTHER,106.88,139.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M BICISATE,A9557,HCPCS,343,RC,,INPATIENT,,,142.5,57,MONUMENT,COMMERCIAL,,,,114,,106.88,139.65,
TC99M BICISATE,A9557,HCPCS,343,RC,,INPATIENT,,,142.5,57,UNITED HEALTH,UNITED COMMERCIAL,,,,106.88,,106.88,139.65,
TC99M MERTIATIDE,A9562,HCPCS,343,RC,,INPATIENT,,,720.5,288.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,655.66,OTHER,540.38,706.09,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M MERTIATIDE,A9562,HCPCS,343,RC,,INPATIENT,,,720.5,288.2,MONUMENT,COMMERCIAL,,,,576.4,,540.38,706.09,
TC99M MERTIATIDE,A9562,HCPCS,343,RC,,INPATIENT,,,720.5,288.2,UNITED HEALTH,UNITED COMMERCIAL,,,,540.38,,540.38,706.09,
IODINE I-123 SOD IODIDE,A9584,HCPCS,343,RC,,INPATIENT,,,234,93.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.94,OTHER,175.5,229.32,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IODINE I-123 SOD IODIDE,A9584,HCPCS,343,RC,,INPATIENT,,,234,93.6,MONUMENT,COMMERCIAL,,,,187.2,,175.5,229.32,
IODINE I-123 SOD IODIDE,A9584,HCPCS,343,RC,,INPATIENT,,,234,93.6,UNITED HEALTH,UNITED COMMERCIAL,,,,175.5,,175.5,229.32,
TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,142.5,57,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.68,OTHER,106.88,139.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,142.5,57,MONUMENT,COMMERCIAL,,,,114,,106.88,139.65,
TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,142.5,57,UNITED HEALTH,UNITED COMMERCIAL,,,,106.88,,106.88,139.65,
TC99M SULFUR COLLOID,A9541,HCPCS,343,RC,,INPATIENT,,,259.25,103.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,235.92,OTHER,194.44,254.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M SULFUR COLLOID,A9541,HCPCS,343,RC,,INPATIENT,,,259.25,103.7,MONUMENT,COMMERCIAL,,,,207.4,,194.44,254.07,
TC99M SULFUR COLLOID,A9541,HCPCS,343,RC,,INPATIENT,,,259.25,103.7,UNITED HEALTH,UNITED COMMERCIAL,,,,194.44,,194.44,254.07,
TC99M SESTAMIBI (ONE DOSE),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,556.47,OTHER,458.63,599.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M SESTAMIBI (ONE DOSE),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,MONUMENT,COMMERCIAL,,,,489.2,,458.63,599.27,
TC99M SESTAMIBI (ONE DOSE),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,UNITED HEALTH,UNITED COMMERCIAL,,,,458.63,,458.63,599.27,
TC99M SESTAMIBI (2 DOSES),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,556.47,OTHER,458.63,599.27,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TC99M SESTAMIBI (2 DOSES),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,MONUMENT,COMMERCIAL,,,,489.2,,458.63,599.27,
TC99M SESTAMIBI (2 DOSES),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,UNITED HEALTH,UNITED COMMERCIAL,,,,458.63,,458.63,599.27,
GA67 GALLIUM,A9556,HCPCS,343,RC,,INPATIENT,,,275,110,BLUE CROSS ANTHEM,COMMERCIAL,,,,250.25,OTHER,206.25,269.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GA67 GALLIUM,A9556,HCPCS,343,RC,,INPATIENT,,,275,110,MONUMENT,COMMERCIAL,,,,220,,206.25,269.5,
GA67 GALLIUM,A9556,HCPCS,343,RC,,INPATIENT,,,275,110,UNITED HEALTH,UNITED COMMERCIAL,,,,206.25,,206.25,269.5,
IN111 OXYQUINOLINE,A9547,HCPCS,343,RC,,INPATIENT,,,2250.5,900.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2047.96,OTHER,1687.88,2205.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IN111 OXYQUINOLINE,A9547,HCPCS,343,RC,,INPATIENT,,,2250.5,900.2,MONUMENT,COMMERCIAL,,,,1800.4,,1687.88,2205.49,
IN111 OXYQUINOLINE,A9547,HCPCS,343,RC,,INPATIENT,,,2250.5,900.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1687.88,,1687.88,2205.49,
IN111 PENTERTEOTIDE,A9572,HCPCS,343,RC,,INPATIENT,,,4420.25,1768.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,4022.43,OTHER,3315.19,4331.85,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IN111 PENTERTEOTIDE,A9572,HCPCS,343,RC,,INPATIENT,,,4420.25,1768.1,MONUMENT,COMMERCIAL,,,,3536.2,,3315.19,4331.85,
IN111 PENTERTEOTIDE,A9572,HCPCS,343,RC,,INPATIENT,,,4420.25,1768.1,UNITED HEALTH,UNITED COMMERCIAL,,,,3315.19,,3315.19,4331.85,
CT AORTA,74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1512.38,1976.17,PERCENT OF CHARGES BASED ON HCPCS CODE
CT AORTA,74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,MONUMENT,COMMERCIAL,,,,1613.2,,1512.38,1976.17,
ANTIBODY TITER (COOMBS TEST),86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CALCIUM SCORING,75571,CPT,,,,OUTPATIENT,,,172,68.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.6,OTHER,129,168.56,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CALCIUM SCORING,75571,CPT,,,,OUTPATIENT,,,172,68.8,MONUMENT,COMMERCIAL,,,,137.6,,129,168.56,
DIRECT COOMBS,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD/PELVIS ANGIO W/RUNOFF,75635,CPT,350,RC,,OUTPATIENT,,,3501.5,1400.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2801.2,OTHER,2626.13,3431.47,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD/PELVIS ANGIO W/RUNOFF,75635,CPT,350,RC,,OUTPATIENT,,,3501.5,1400.6,MONUMENT,COMMERCIAL,,,,2801.2,,2626.13,3431.47,
Z PRE DAT,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD/PELVIS ANGIO W/RUNOFF,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2801.2,OTHER,2626.13,3431.47,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD/PELVIS ANGIO W/RUNOFF,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,MONUMENT,COMMERCIAL,,,,2801.2,,2626.13,3431.47,
DIRECT ANTIGLOBULIN IGG,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.4,110.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD/PELVIS W/CONT (ABPE),74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2985.4,OTHER,2798.81,3657.12,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD/PELVIS W/CONT (ABPE),74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,MONUMENT,COMMERCIAL,,,,2985.4,,2798.81,3657.12,
DIRECT ANTIGLOBULIN C3,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.4,110.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABDOMEN W/WO CONT (ABDB),74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1831,OTHER,1716.56,2242.98,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABDOMEN W/WO CONT (ABDB),74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,MONUMENT,COMMERCIAL,,,,1831,,1716.56,2242.98,
COOMBS TEST DIRECT IGG,86880,CPT,300,RC,,OUTPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.8,44.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABDOMEN W/WO CONTRAST,74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1831,OTHER,1716.56,2242.98,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABDOMEN W/WO CONTRAST,74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,MONUMENT,COMMERCIAL,,,,1831,,1716.56,2242.98,
COOMBS TEST DIRECT C3,86880,CPT,300,RC,,OUTPATIENT,,,45,18,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.8,44.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT BONE LENGTH SCANOGRAM,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,283.2,OTHER,265.5,346.92,PERCENT OF CHARGES BASED ON HCPCS CODE
CT BONE LENGTH SCANOGRAM,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,MONUMENT,COMMERCIAL,,,,283.2,,265.5,346.92,
COOMBS TEST DIRECT POLY,86880,CPT,300,RC,,OUTPATIENT,,,58,23.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,43.5,56.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHOLECYSTOSTOMY W DRAIN,47533,CPT,350,RC,,OUTPATIENT,,,6430.08,2572.032,BLUE CROSS ANTHEM,COMMERCIAL,,,,5144.064,OTHER,3633.94,4748.35,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHOLECYSTOSTOMY W DRAIN,47533,CPT,350,RC,,OUTPATIENT,,,6430.08,2572.032,MONUMENT,COMMERCIAL,,,,3876.2,,3633.94,4748.35,
INDIRECT COOMBS,86885,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,131.81,172.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LOWDOSE LUNG SCREENING,G0297,HCPCS,350,RC,,BOTH,,,1563.5,625.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1422.79,OTHER,1172.63,1532.23,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOWDOSE LUNG SCREENING,G0297,HCPCS,350,RC,,BOTH,,,1563.5,625.4,MONUMENT,COMMERCIAL,,,,1250.8,,1172.63,1532.23,
LOWDOSE LUNG SCREENING,G0297,HCPCS,350,RC,,BOTH,,,1563.5,625.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1172.63,,1172.63,1532.23,
CT FIDUCIAL MARKER PLACEMENT,32553,CPT,760,RC,,OUTPATIENT,,,2515.73,1006.292,BLUE CROSS ANTHEM,COMMERCIAL,,,,2012.584,OTHER,1541.25,2013.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FIDUCIAL MARKER PLACEMENT,32553,CPT,760,RC,,OUTPATIENT,,,2515.73,1006.292,MONUMENT,COMMERCIAL,,,,1644,,1541.25,2013.9,
ANTIBODY TITER,86886,CPT,390,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,151.31,197.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXT ANGIO BILATERAL,7320650,CPT,350,RC,50,OUTPATIENT,,,3097.5,1239,BLUE CROSS ANTHEM,COMMERCIAL,,,,2478,OTHER,2323.13,3035.55,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXT ANGIO BILATERAL,7320650,CPT,350,RC,50,OUTPATIENT,,,3097.5,1239,MONUMENT,COMMERCIAL,,,,2478,,2323.13,3035.55,
AUTOLOGOUS BLOOD,86890,CPT,300,RC,,OUTPATIENT,,,563.5,225.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,422.63,552.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABDOMEN W/CONT (ABDW),74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1597.4,OTHER,1497.56,1956.82,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABDOMEN W/CONT (ABDW),74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,MONUMENT,COMMERCIAL,,,,1597.4,,1497.56,1956.82,
AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.88,127.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABDOMEN W/CONTRAST,74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1597.4,OTHER,1497.56,1956.82,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABDOMEN W/CONTRAST,74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,MONUMENT,COMMERCIAL,,,,1597.4,,1497.56,1956.82,
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,OUTPATIENT,,,2927.25,1170.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2195.44,2868.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ADRENAL CORE BX,60699,CPT,,,,OUTPATIENT,,,1513,605.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1210.4,OTHER,1134.75,1482.74,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ADRENAL CORE BX,60699,CPT,,,,OUTPATIENT,,,1513,605.2,MONUMENT,COMMERCIAL,,,,1210.4,,1134.75,1482.74,
ABO (BLOOD TYPING),86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24,31.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ADRENAL CORE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ADRENAL CORE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
ABO BLOOD TYPING,86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,2275,910,BLUE CROSS ANTHEM,COMMERCIAL,,,,1820,OTHER,1706.25,2229.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,2275,910,MONUMENT,COMMERCIAL,,,,1820,,1706.25,2229.5,
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,32,12.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24,31.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO HEAD W/CONTRAST,70496QQ,CPT,350,RC,QQ,OUTPATIENT,,,2275,910,BLUE CROSS ANTHEM,COMMERCIAL,,,,1820,OTHER,1706.25,2229.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO HEAD W/CONTRAST,70496QQ,CPT,350,RC,QQ,OUTPATIENT,,,2275,910,MONUMENT,COMMERCIAL,,,,1820,,1706.25,2229.5,
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD AND PELVIS W CONTRAST,74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2985.4,OTHER,2798.81,3657.12,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD AND PELVIS W CONTRAST,74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,MONUMENT,COMMERCIAL,,,,2985.4,,2798.81,3657.12,
ANTIGEN TYPING (UNIT),86902,CPT,300,RC,,OUTPATIENT,,,295,118,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.44,26.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD & PELVIS W/WO CONTRAST,74178QQ,CPT,350,RC,QQ,OUTPATIENT,,,4262.75,1705.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3410.2,OTHER,3197.06,4177.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD & PELVIS W/WO CONTRAST,74178QQ,CPT,350,RC,QQ,OUTPATIENT,,,4262.75,1705.1,MONUMENT,COMMERCIAL,,,,3410.2,,3197.06,4177.5,
ANTIGEN TYPING (PATIENT),86905,CPT,300,RC,,OUTPATIENT,,,295,118,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.44,26.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD & PELVIS W/O CONTRAST,74176QQ,CPT,350,RC,QQ,OUTPATIENT,,,3079.5,1231.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2463.6,OTHER,2309.63,3017.91,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD & PELVIS W/O CONTRAST,74176QQ,CPT,350,RC,QQ,OUTPATIENT,,,3079.5,1231.8,MONUMENT,COMMERCIAL,,,,2463.6,,2309.63,3017.91,
ANTIGEN SCREENING,86906,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD & PELVIS W/WO CONTRAST,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3410.2,OTHER,3197.06,4177.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD & PELVIS W/WO CONTRAST,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,MONUMENT,COMMERCIAL,,,,3410.2,,3197.06,4177.5,
CROSSMATCH LEUKO REDUCED,86920,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.13,115.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABDOMEN W/O CONTRAST (ABWO),74150,CPT,350,RC,,OUTPATIENT,,,1705.25,682.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1364.2,OTHER,1278.94,1671.15,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABDOMEN W/O CONTRAST (ABWO),74150,CPT,350,RC,,OUTPATIENT,,,1705.25,682.1,MONUMENT,COMMERCIAL,,,,1364.2,,1278.94,1671.15,
FFP THAWING EA UNIT,86927,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD/PEL W/O,74176,CPT,350,RC,,OUTPATIENT,,,3079.5,1231.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2463.6,OTHER,2309.63,3017.91,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD/PEL W/O,74176,CPT,350,RC,,OUTPATIENT,,,3079.5,1231.8,MONUMENT,COMMERCIAL,,,,2463.6,,2309.63,3017.91,
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,300,RC,,OUTPATIENT,,,169,67.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,126.75,165.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD/PEL W/WO HEMATURIA(APWW,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3410.2,OTHER,3197.06,4177.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD/PEL W/WO HEMATURIA(APWW,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,MONUMENT,COMMERCIAL,,,,3410.2,,3197.06,4177.5,
HEMOLYSINS/AGGLUTININS,86941,CPT,300,RC,,OUTPATIENT,,,187,74.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,140.25,183.26,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABSCESS DRAINAGE W/CATH,49406,CPT,361,RC,,OUTPATIENT,,,4165.75,1666.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.6,OTHER,3124.31,4082.44,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABSCESS DRAINAGE W/CATH,49406,CPT,361,RC,,OUTPATIENT,,,4165.75,1666.3,MONUMENT,COMMERCIAL,,,,3332.6,,3124.31,4082.44,
IRRADIATION OF BLOOD PROD (EA),86945,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,274.88,359.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABSCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.2,OTHER,558,729.12,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABSCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,MONUMENT,COMMERCIAL,,,,595.2,,558,729.12,
SPLITTING OF BLD OR BLD PRODTS,86985,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NEPHROSTOMY TUBE PLACEMENT,50432,CPT,361,RC,,OUTPATIENT,,,2752.75,1101.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202.2,OTHER,2064.56,2697.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NEPHROSTOMY TUBE PLACEMENT,50432,CPT,361,RC,,OUTPATIENT,,,2752.75,1101.1,MONUMENT,COMMERCIAL,,,,2202.2,,2064.56,2697.7,
CYCLOSPORA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NEPHROSTOMY TUBE GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NEPHROSTOMY TUBE GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
MICROSPORIDIA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FACET INJ LEVEL 1,64493,CPT,350,RC,,OUTPATIENT,,,1777.25,710.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1421.8,OTHER,1332.94,1741.71,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FACET INJ LEVEL 1,64493,CPT,350,RC,,OUTPATIENT,,,1777.25,710.9,MONUMENT,COMMERCIAL,,,,1421.8,,1332.94,1741.71,
AFB SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST TUBE PLCMT FOR ABCESS,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,915.6,OTHER,858.38,1121.61,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST TUBE PLCMT FOR ABCESS,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
Z SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST TUBE PLCMT FOR PNEUMO,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,915.6,OTHER,858.38,1121.61,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST TUBE PLCMT FOR PNEUMO,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
Z CULTURE SPECIMEN CONCENTRATN,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NECK/CHEST BIOPSY,21550,CPT,350,RC,,OUTPATIENT,,,1862.25,744.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1489.8,OTHER,1396.69,1825.01,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NECK/CHEST BIOPSY,21550,CPT,350,RC,,OUTPATIENT,,,1862.25,744.9,MONUMENT,COMMERCIAL,,,,1489.8,,1396.69,1825.01,
CULTURE STOOL,87045,CPT,306,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT IAC/ORB/SELLA W/O CONT,70480,CPT,350,RC,,OUTPATIENT,,,1659.5,663.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1327.6,OTHER,1244.63,1626.31,PERCENT OF CHARGES BASED ON HCPCS CODE
CT IAC/ORB/SELLA W/O CONT,70480,CPT,350,RC,,OUTPATIENT,,,1659.5,663.8,MONUMENT,COMMERCIAL,,,,1327.6,,1244.63,1626.31,
SHIGELLA CULTURE FECES,87046,CPT,306,RC,,OUTPATIENT,,,149.51,59.804,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.1,146.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR INJECTION CT MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,825,330,BLUE CROSS ANTHEM,COMMERCIAL,,,,660,OTHER,618.75,808.5,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR INJECTION CT MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,825,330,MONUMENT,COMMERCIAL,,,,660,,618.75,808.5,
Z CULTURE FECES W/ISO PRE EXAM,87046,CPT,306,RC,,OUTPATIENT,,,27.25,10.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.44,26.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR INJECTION FOR MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,2329,931.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1863.2,OTHER,1746.75,2282.42,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR INJECTION FOR MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,2329,931.6,MONUMENT,COMMERCIAL,,,,1863.2,,1746.75,2282.42,
CULTURE ID NON URINE/OR,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR PUNCTURE CT MYELOGRAM,72265,CPT,320,RC,,OUTPATIENT,,,2314,925.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1851.2,OTHER,1735.5,2267.72,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR PUNCTURE CT MYELOGRAM,72265,CPT,320,RC,,OUTPATIENT,,,2314,925.6,MONUMENT,COMMERCIAL,,,,1851.2,,1735.5,2267.72,
CULTURE ID NON URI/PERITONEAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABSCESS DRAIN W/CATH ST,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.2,OTHER,558,729.12,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSCESS DRAIN W/CATH ST,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,MONUMENT,COMMERCIAL,,,,595.2,,558,729.12,
CULTURE SPECIMEN BACTERIA,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR SPINE W/WO CONTRAST,72133,CPT,350,RC,,OUTPATIENT,,,2495,998,BLUE CROSS ANTHEM,COMMERCIAL,,,,1996,OTHER,1871.25,2445.1,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR SPINE W/WO CONTRAST,72133,CPT,350,RC,,OUTPATIENT,,,2495,998,MONUMENT,COMMERCIAL,,,,1996,,1871.25,2445.1,
CULTURE AEROBIC,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR SPINE W/CONTRAST,72132,CPT,350,RC,,OUTPATIENT,,,2145.25,858.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1716.2,OTHER,1608.94,2102.35,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR SPINE W/CONTRAST,72132,CPT,350,RC,,OUTPATIENT,,,2145.25,858.1,MONUMENT,COMMERCIAL,,,,1716.2,,1608.94,2102.35,
CULTURE BODY FLUID,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT IAC/ORB/SELLA W/CONT (IACW),70481,CPT,350,RC,,OUTPATIENT,,,2050.75,820.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1640.6,OTHER,1538.06,2009.74,PERCENT OF CHARGES BASED ON HCPCS CODE
CT IAC/ORB/SELLA W/CONT (IACW),70481,CPT,350,RC,,OUTPATIENT,,,2050.75,820.3,MONUMENT,COMMERCIAL,,,,1640.6,,1538.06,2009.74,
CULTURE GENITAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT IAC/ORB/SELLA W/CONTRAST,70481QQ,CPT,350,RC,QQ,OUTPATIENT,,,2050.75,820.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1640.6,OTHER,1538.06,2009.74,PERCENT OF CHARGES BASED ON HCPCS CODE
CT IAC/ORB/SELLA W/CONTRAST,70481QQ,CPT,350,RC,QQ,OUTPATIENT,,,2050.75,820.3,MONUMENT,COMMERCIAL,,,,1640.6,,1538.06,2009.74,
CULTURE ANAEROBIC,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.38,180.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NEPHROSTOMY TUBE CHANGE,50435,CPT,361,RC,,OUTPATIENT,,,1839.5,735.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1471.6,OTHER,1379.63,1802.71,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NEPHROSTOMY TUBE CHANGE,50435,CPT,361,RC,,OUTPATIENT,,,1839.5,735.8,MONUMENT,COMMERCIAL,,,,1471.6,,1379.63,1802.71,
COMPREHENSIVE DIGESTIVE STOOL,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,138.38,180.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT IAC/ORB/SELLA W/WO CNT(IAWW,70482,CPT,350,RC,,OUTPATIENT,,,2516,1006.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2012.8,OTHER,1887,2465.68,PERCENT OF CHARGES BASED ON HCPCS CODE
CT IAC/ORB/SELLA W/WO CNT(IAWW,70482,CPT,350,RC,,OUTPATIENT,,,2516,1006.4,MONUMENT,COMMERCIAL,,,,2012.8,,1887,2465.68,
ANAEROBIC ISOLATE  ID,87076,CPT,306,RC,,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT IAC/ORB/SELLA W/WO CONTRAST,70482QQ,CPT,350,RC,QQ,OUTPATIENT,,,2516,1006.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2012.8,OTHER,1887,2465.68,PERCENT OF CHARGES BASED ON HCPCS CODE
CT IAC/ORB/SELLA W/WO CONTRAST,70482QQ,CPT,350,RC,QQ,OUTPATIENT,,,2516,1006.4,MONUMENT,COMMERCIAL,,,,2012.8,,1887,2465.68,
CULTURE ID BACTERIA,87077,CPT,306,RC,,OUTPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.38,55.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,BLUE CROSS ANTHEM,COMMERCIAL,,,,1572,OTHER,1473.75,1925.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,MONUMENT,COMMERCIAL,,,,1572,,1473.75,1925.7,
CULTURE STREP (THROAT),87081,CPT,306,RC,,OUTPATIENT,,,29.25,11.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.94,28.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT RENAL CORE BX (RNBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT RENAL CORE BX (RNBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
CULTURE GROUP B STREP,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1360.4,OTHER,1275.38,1666.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CT RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,MONUMENT,COMMERCIAL,,,,1360.4,,1275.38,1666.49,
CULTURE SCREEN,87081,CPT,306,RC,,OUTPATIENT,,,14.25,5.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,10.69,13.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
CLOTEST,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASPIRATION OF BLADDER,51102,CPT,350,RC,,OUTPATIENT,,,2759,1103.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2207.2,OTHER,2069.25,2703.82,PERCENT OF CHARGES BASED ON HCPCS CODE
ASPIRATION OF BLADDER,51102,CPT,350,RC,,OUTPATIENT,,,2759,1103.6,MONUMENT,COMMERCIAL,,,,2207.2,,2069.25,2703.82,
CULTURE SMEAR GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FNA W/IMAGE GUIDANCE,10009,CPT,350,RC,,OUTPATIENT,,,3220.25,1288.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2576.2,OTHER,2415.19,3155.85,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FNA W/IMAGE GUIDANCE,10009,CPT,350,RC,,OUTPATIENT,,,3220.25,1288.1,MONUMENT,COMMERCIAL,,,,2576.2,,2415.19,3155.85,
CULTURE GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,320.63,418.95,PERCENT OF CHARGES BASED ON HCPCS CODE
CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,342,,320.63,418.95,
MRSA NASAL SURVEILLANCE CULT,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ASPIRATION GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ASPIRATION GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
LEGIONELLA CULTURE,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO LWR EXTR W/O&W/DYE LT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,703.792,OTHER,659.8,862.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO LWR EXTR W/O&W/DYE LT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,MONUMENT,COMMERCIAL,,,,703.8,,659.8,862.1,
HELICOBACTER PYLORI CULT SENS,87081,CPT,306,RC,,OUTPATIENT,,,114,45.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.5,111.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO LWR EXTR W/O&W/DYE RT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,703.792,OTHER,659.8,862.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO LWR EXTR W/O&W/DYE RT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,MONUMENT,COMMERCIAL,,,,703.8,,659.8,862.1,
CULTURE URINE,87088,CPT,306,RC,,OUTPATIENT,,,130.5,52.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.88,127.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO LWR EXTR W/O&W/DYE BI,73706,CPT,,,,OUTPATIENT,,,1319.61,527.844,BLUE CROSS ANTHEM,COMMERCIAL,,,,1055.688,OTHER,989.7,1293.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO LWR EXTR W/O&W/DYE BI,73706,CPT,,,,OUTPATIENT,,,1319.61,527.844,MONUMENT,COMMERCIAL,,,,1055.7,,989.7,1293.2,
CULTURE FUNGAL,87101,CPT,306,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1074.8,OTHER,1007.63,1316.63,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,MONUMENT,COMMERCIAL,,,,1074.8,,1007.63,1316.63,
FUNGAL CULTURE ROUTINE,87102,CPT,306,RC,,OUTPATIENT,,,149.16,59.664,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,111.9,146.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2234.28,OTHER,1841.44,2406.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,MONUMENT,COMMERCIAL,,,,1964.2,,1841.44,2406.15,
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1841.44,,1841.44,2406.15,
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2234.28,OTHER,1841.44,2406.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,MONUMENT,COMMERCIAL,,,,1964.2,,1841.44,2406.15,
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1841.44,,1841.44,2406.15,
CT GUIDANCE FOR INJECTION,77012,CPT,350,RC,,OUTPATIENT,,,1062,424.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,849.6,OTHER,796.5,1040.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDANCE FOR INJECTION,77012,CPT,350,RC,,OUTPATIENT,,,1062,424.8,MONUMENT,COMMERCIAL,,,,849.6,,796.5,1040.76,
Z CULTURE BLOOD FUNGUS,87103,CPT,300,RC,,OUTPATIENT,,,127,50.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,95.25,124.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1526.4,OTHER,1431,1869.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,MONUMENT,COMMERCIAL,,,,1526.4,,1431,1869.84,
FUNGAL IDENTIFICATION(MAYO),87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO PARATHYROID W/WO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1526.4,OTHER,1431,1869.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO PARATHYROID W/WO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,MONUMENT,COMMERCIAL,,,,1526.4,,1431,1869.84,
YEAST ID PANEL,87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CERVICAL SPINE W/CONTRAST,72126,CPT,350,RC,,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CERVICAL SPINE W/CONTRAST,72126,CPT,350,RC,,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
FUNGAL IDENTIFICATION PANEL B,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.69,151.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE MARROW BIOPSY,38221,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1711.6,OTHER,1604.63,2096.71,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE MARROW BIOPSY,38221,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,MONUMENT,COMMERCIAL,,,,1711.6,,1604.63,2096.71,
FUNGAL IDENTIFICATION PANEL A,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.69,151.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BONE MARROW BX & ASP SAME SITE,38222,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1711.6,OTHER,1604.63,2096.71,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE MARROW BX & ASP SAME SITE,38222,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,MONUMENT,COMMERCIAL,,,,1711.6,,1604.63,2096.71,
MYCOPLASMA PHEUMONIAC CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,166.88,218.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CERVICAL SPINE W/O CNT(CSWO,72125,CPT,350,RC,,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CERVICAL SPINE W/O CNT(CSWO,72125,CPT,350,RC,,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
MYCOPLASMA HOMINIS CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,166.88,218.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CERVICAL SPINE W/O CONTRAST,72125QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CERVICAL SPINE W/O CONTRAST,72125QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
"MYCOBACTERIAL CULTURE, BLOOD",87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.5,170.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CERVICAL SPINE W/O & W/DYE,72127,CPT,352,RC,,OUTPATIENT,,,3099,1239.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2479.2,OTHER,2324.3,3037,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CERVICAL SPINE W/O & W/DYE,72127,CPT,352,RC,,OUTPATIENT,,,3099,1239.6,MONUMENT,COMMERCIAL,,,,2479.2,,2324.3,3037,
CULTURE AFB,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.5,170.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1868,747.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1494.4,OTHER,1401,1830.64,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1868,747.2,MONUMENT,COMMERCIAL,,,,1494.4,,1401,1830.64,
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.5,170.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT GUIDANCE NEEDLE PLMNT,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDANCE NEEDLE PLMNT,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.5,170.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NEEDLE CYST ASPIRATION,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NEEDLE CYST ASPIRATION,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
CULTURE AFB W/DEFINITIVE ID,87118,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132.38,172.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT NEEDLE BIOPSY (NDBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT NEEDLE BIOPSY (NDBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
E. COLI 0157,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.63,50.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT HEAD W/WO CONTRAST (HDWW),70470,CPT,350,RC,,OUTPATIENT,,,2113.75,845.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1691,OTHER,1585.31,2071.48,PERCENT OF CHARGES BASED ON HCPCS CODE
CT HEAD W/WO CONTRAST (HDWW),70470,CPT,350,RC,,OUTPATIENT,,,2113.75,845.5,MONUMENT,COMMERCIAL,,,,1691,,1585.31,2071.48,
LATEX TYPING FOR SALMONELLA,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.63,50.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT HEAD W/WO CONTRAST,70470QQ,CPT,350,RC,QQ,OUTPATIENT,,,2113.75,845.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1691,OTHER,1585.31,2071.48,PERCENT OF CHARGES BASED ON HCPCS CODE
CT HEAD W/WO CONTRAST,70470QQ,CPT,350,RC,QQ,OUTPATIENT,,,2113.75,845.5,MONUMENT,COMMERCIAL,,,,1691,,1585.31,2071.48,
INFECTIOUS AGENT ANTIGEN DETEC,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.63,50.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT HEAD W/CONTRAST (HDWC),70460,CPT,350,RC,,OUTPATIENT,,,1877.5,751,BLUE CROSS ANTHEM,COMMERCIAL,,,,1502,OTHER,1408.13,1839.95,PERCENT OF CHARGES BASED ON HCPCS CODE
CT HEAD W/CONTRAST (HDWC),70460,CPT,350,RC,,OUTPATIENT,,,1877.5,751,MONUMENT,COMMERCIAL,,,,1502,,1408.13,1839.95,
ID BY NUCLEIC ACID DIRECT PRBE,87149,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,127.88,167.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT HEAD W/CONTRAST,70460QQ,CPT,350,RC,QQ,OUTPATIENT,,,1877.5,751,BLUE CROSS ANTHEM,COMMERCIAL,,,,1502,OTHER,1408.13,1839.95,PERCENT OF CHARGES BASED ON HCPCS CODE
CT HEAD W/CONTRAST,70460QQ,CPT,350,RC,QQ,OUTPATIENT,,,1877.5,751,MONUMENT,COMMERCIAL,,,,1502,,1408.13,1839.95,
ID BY NUCLEIC ACID AMP PROBE,87150,CPT,300,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,945,378,BLUE CROSS ANTHEM,COMMERCIAL,,,,756,OTHER,708.75,926.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,945,378,MONUMENT,COMMERCIAL,,,,756,,708.75,926.1,
KPC PCR,87150,CPT,300,RC,,OUTPATIENT,,,185.5,74.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,139.13,181.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,1470,588,BLUE CROSS ANTHEM,COMMERCIAL,,,,1176,OTHER,1102.5,1440.6,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,1470,588,MONUMENT,COMMERCIAL,,,,1176,,1102.5,1440.6,
MYCOBACT IDENT BY SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,164.25,214.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT HEAD W/O CONTRAST (HDWO),70450,CPT,350,RC,,OUTPATIENT,,,1525,610,BLUE CROSS ANTHEM,COMMERCIAL,,,,1220,OTHER,1143.75,1494.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CT HEAD W/O CONTRAST (HDWO),70450,CPT,350,RC,,OUTPATIENT,,,1525,610,MONUMENT,COMMERCIAL,,,,1220,,1143.75,1494.5,
FUNGAL D2 SEQUENCING ID,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,164.25,214.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXT ANGIO RIGHT,73206RT,CPT,350,RC,RT,OUTPATIENT,,,2069.75,827.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1655.8,OTHER,1552.31,2028.36,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXT ANGIO RIGHT,73206RT,CPT,350,RC,RT,OUTPATIENT,,,2069.75,827.9,MONUMENT,COMMERCIAL,,,,1655.8,,1552.31,2028.36,
DNA RNA SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,361,144.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,270.75,353.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXT ANGIO LEFT,73206LT,CPT,350,RC,LT,OUTPATIENT,,,2069.75,827.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1655.8,OTHER,1552.31,2028.36,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXT ANGIO LEFT,73206LT,CPT,350,RC,LT,OUTPATIENT,,,2069.75,827.9,MONUMENT,COMMERCIAL,,,,1655.8,,1552.31,2028.36,
FLUORESCENT METHOD CULT TYPING,87158,CPT,300,RC,,OUTPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEPHROSTOMY TUBE CHANGE BIL,5043550,CPT,350,RC,50,OUTPATIENT,,,3200,1280,BLUE CROSS ANTHEM,COMMERCIAL,,,,2560,OTHER,2400,3136,PERCENT OF CHARGES BASED ON HCPCS CODE
NEPHROSTOMY TUBE CHANGE BIL,5043550,CPT,350,RC,50,OUTPATIENT,,,3200,1280,MONUMENT,COMMERCIAL,,,,2560,,2400,3136,
MACROSCOPIC ARTHROPOD EXAM,87168,CPT,300,RC,,OUTPATIENT,,,57,22.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.75,55.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXTREMITY W/CONT RT,73701,CPT,350,RC,,OUTPATIENT,,,2437.25,974.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1949.8,OTHER,1827.94,2388.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXTREMITY W/CONT RT,73701,CPT,350,RC,,OUTPATIENT,,,2437.25,974.9,MONUMENT,COMMERCIAL,,,,1949.8,,1827.94,2388.51,
MACROSCOPIC PARASITE EXAM,87169,CPT,300,RC,,OUTPATIENT,,,57,22.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.75,55.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXTREMITY W/CONT RT,73701QQ,CPT,350,RC,QQ,OUTPATIENT,,,2437.25,974.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1949.8,OTHER,1827.94,2388.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXTREMITY W/CONT RT,73701QQ,CPT,350,RC,QQ,OUTPATIENT,,,2437.25,974.9,MONUMENT,COMMERCIAL,,,,1949.8,,1827.94,2388.51,
PIN WORM EXAM,87172,CPT,306,RC,,OUTPATIENT,,,67.25,26.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.44,65.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1949.8,OTHER,1827.94,2388.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,MONUMENT,COMMERCIAL,,,,1949.8,,1827.94,2388.51,
TISSUE PROCESSING FOR CULTURE,87176,CPT,300,RC,,OUTPATIENT,,,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.5,72.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1949.8,OTHER,1827.94,2388.51,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,MONUMENT,COMMERCIAL,,,,1949.8,,1827.94,2388.51,
Z OVA PARASITES DIRECT SMEARS,87177,CPT,306,RC,,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXT BI,7370050,CPT,350,RC,50,OUTPATIENT,,,3125.75,1250.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2500.6,OTHER,2344.31,3063.24,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXT BI,7370050,CPT,350,RC,50,OUTPATIENT,,,3125.75,1250.3,MONUMENT,COMMERCIAL,,,,2500.6,,2344.31,3063.24,
ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,51.25,20.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,38.44,50.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXT W/O CONT RT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1270.2,OTHER,1475.81,1928.4,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXT W/O CONT RT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,MONUMENT,COMMERCIAL,,,,1574.2,,1475.81,1928.4,
Z ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXT W/O CONT RT,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1270.2,OTHER,1190.81,1556,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXT W/O CONT RT,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,MONUMENT,COMMERCIAL,,,,1270.2,,1190.81,1556,
CARBAPENEMASE TEST,87185,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,201.56,263.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LOWER EXT W/O CONT LT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1270.2,OTHER,1190.81,1556,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LOWER EXT W/O CONT LT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,MONUMENT,COMMERCIAL,,,,1270.2,,1190.81,1556,
ENZYME DETECTION PER ENZYME,87185,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/CONT RT,73201,CPT,350,RC,,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/CONT RT,73201,CPT,350,RC,,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
FUNGAL SENSITIVITY (MAYO),87186,CPT,306,RC,,OUTPATIENT,,,172,68.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/CONT RT,73201QQ,CPT,350,RC,QQ,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/CONT RT,73201QQ,CPT,350,RC,QQ,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
VORICONAZOLE,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/CONT LT,73201LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/CONT LT,73201LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
NOCARDIA SPECIES  MIC,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/CONT LT,73201LTQQ,CPT,350,RC,LTQQ,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/CONT LT,73201LTQQ,CPT,350,RC,LTQQ,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
SUSCEPTABILITY STUDIES,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LIVER NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LIVER NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
MICROSTREP PLUS 1,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PANCREAS CORE BX,48102,CPT,361,RC,,OUTPATIENT,,,2769,1107.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2215.2,OTHER,2076.75,2713.62,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PANCREAS CORE BX,48102,CPT,361,RC,,OUTPATIENT,,,2769,1107.6,MONUMENT,COMMERCIAL,,,,2215.2,,2076.75,2713.62,
Z MICRODILUTION MLC EACH PLATE,87187,CPT,300,RC,,OUTPATIENT,,,91,36.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.25,89.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PANCREAS FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3179.75,1271.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2543.8,OTHER,2384.81,3116.16,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PANCREAS FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3179.75,1271.9,MONUMENT,COMMERCIAL,,,,2543.8,,2384.81,3116.16,
Z MACROBROTH DILUTION EA AGENT,87188,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LUNG FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3360,1344,BLUE CROSS ANTHEM,COMMERCIAL,,,,2688,OTHER,2520,3292.8,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LUNG FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3360,1344,MONUMENT,COMMERCIAL,,,,2688,,2520,3292.8,
AFB (TUBERCLE BAC) EA DRUG,87190,CPT,306,RC,,OUTPATIENT,,,264.75,105.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,198.56,259.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION FOR HIP LT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,BLUE CROSS ANTHEM,COMMERCIAL,,,,548,OTHER,513.8,671.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION FOR HIP LT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,MONUMENT,COMMERCIAL,,,,548,,513.8,671.3,
SERUM KILLING LEVEL  PEAK,87197,CPT,300,RC,,OUTPATIENT,,,362,144.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,271.5,354.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION FOR HIP CT RIGHT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,BLUE CROSS ANTHEM,COMMERCIAL,,,,548,OTHER,513.8,671.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION FOR HIP CT RIGHT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,MONUMENT,COMMERCIAL,,,,548,,513.8,671.3,
SERUM KILLING LEVEL  TROUGH,87197,CPT,300,RC,,OUTPATIENT,,,240.5,96.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,180.38,235.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LUMBAR SPINE W/O CONT (LSWO,72131,CPT,350,RC,,OUTPATIENT,,,1769.25,707.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1415.4,OTHER,1326.94,1733.87,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LUMBAR SPINE W/O CONT (LSWO,72131,CPT,350,RC,,OUTPATIENT,,,1769.25,707.7,MONUMENT,COMMERCIAL,,,,1415.4,,1326.94,1733.87,
EOSINOPHILS URINE,87205,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.31,68.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LUMBAR SPINE W/O CONTRAST,72131QQ,CPT,350,RC,QQ,OUTPATIENT,,,1831.5,732.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1465.2,OTHER,1373.63,1794.87,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LUMBAR SPINE W/O CONTRAST,72131QQ,CPT,350,RC,QQ,OUTPATIENT,,,1831.5,732.6,MONUMENT,COMMERCIAL,,,,1465.2,,1373.63,1794.87,
METHYLENE BLUE,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MYELOGRAM,72131,CPT,350,RC,,OUTPATIENT,,,2626.5,1050.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2101.2,OTHER,1969.88,2573.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MYELOGRAM,72131,CPT,350,RC,,OUTPATIENT,,,2626.5,1050.6,MONUMENT,COMMERCIAL,,,,2101.2,,1969.88,2573.97,
GRAM STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SHOULDER DISLOCATION RT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,934.4,OTHER,876,1144.64,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SHOULDER DISLOCATION RT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,MONUMENT,COMMERCIAL,,,,934.4,,876,1144.64,
GIEMSA STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.38,71.05,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SHOULDER DISLOCATION LT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,934.4,OTHER,876,1144.64,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SHOULDER DISLOCATION LT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,MONUMENT,COMMERCIAL,,,,934.4,,876,1144.64,
AFB SMEAR,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MAXILLO FACIAL W/O CONT,70486,CPT,350,RC,,OUTPATIENT,,,1200,480,BLUE CROSS ANTHEM,COMMERCIAL,,,,960,OTHER,900,1176,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MAXILLO FACIAL W/O CONT,70486,CPT,350,RC,,OUTPATIENT,,,1200,480,MONUMENT,COMMERCIAL,,,,960,,900,1176,
AFB SPECIAL STAINS,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MAXILLO FACIAL W/O CONTRAST,70486QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MAXILLO FACIAL W/O CONTRAST,70486QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
SMEAR BLOOD-PARASITES,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.63,105.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAXILLOFACIAL W/WO,70488,CPT,350,RC,,OUTPATIENT,,,1300,520,BLUE CROSS ANTHEM,COMMERCIAL,,,,1040,OTHER,975,1274,PERCENT OF CHARGES BASED ON HCPCS CODE
MAXILLOFACIAL W/WO,70488,CPT,350,RC,,OUTPATIENT,,,1300,520,MONUMENT,COMMERCIAL,,,,1040,,975,1274,
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.63,105.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MAXILLO FACIAL W/CONT(MFWC),70487,CPT,350,RC,,OUTPATIENT,,,1250,500,BLUE CROSS ANTHEM,COMMERCIAL,,,,1000,OTHER,937.5,1225,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MAXILLO FACIAL W/CONT(MFWC),70487,CPT,350,RC,,OUTPATIENT,,,1250,500,MONUMENT,COMMERCIAL,,,,1000,,937.5,1225,
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.63,105.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MAXILLO FACIAL W/CONTRAST,70487QQ,CPT,350,RC,QQ,OUTPATIENT,,,2224.5,889.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1779.6,OTHER,1668.38,2180.01,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MAXILLO FACIAL W/CONTRAST,70487QQ,CPT,350,RC,QQ,OUTPATIENT,,,2224.5,889.8,MONUMENT,COMMERCIAL,,,,1779.6,,1668.38,2180.01,
MALARIAL THICK/THIN SMEAR,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.63,105.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SINUS (SINU),70486,CPT,350,RC,,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SINUS (SINU),70486,CPT,350,RC,,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
Z SMEAR COMPLEX STAIN,87209,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SINUS  W/O LIMITED,76380QQ,CPT,350,RC,QQ,OUTPATIENT,,,776.5,310.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,621.2,OTHER,582.38,760.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SINUS  W/O LIMITED,76380QQ,CPT,350,RC,QQ,OUTPATIENT,,,776.5,310.6,MONUMENT,COMMERCIAL,,,,621.2,,582.38,760.97,
INDIA INK,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SINUS LIMITED,76380,CPT,350,RC,,OUTPATIENT,,,776.5,310.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,621.2,OTHER,582.38,760.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SINUS LIMITED,76380,CPT,350,RC,,OUTPATIENT,,,776.5,310.6,MONUMENT,COMMERCIAL,,,,621.2,,582.38,760.97,
TRICHOMONAS,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT LUNG/MEDIASTINUM CORE BX,3500390,CDM,,,,INPATIENT,,,1198.25,479.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1090.41,OTHER,898.69,1174.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CT LUNG/MEDIASTINUM CORE BX,3500390,CDM,,,,INPATIENT,,,1198.25,479.3,MONUMENT,COMMERCIAL,,,,958.6,,898.69,1174.29,
CT LUNG/MEDIASTINUM CORE BX,3500390,CDM,,,,INPATIENT,,,1198.25,479.3,UNITED HEALTH,UNITED COMMERCIAL,,,,898.69,,898.69,1174.29,
CT LUNG/MEDIASTINUM NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT LUNG/MEDIASTINUM NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
WET PREP,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CORE LUNG/MEDIA NEEDLE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1224.8,OTHER,1148.25,1500.38,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CORE LUNG/MEDIA NEEDLE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,MONUMENT,COMMERCIAL,,,,1224.8,,1148.25,1500.38,
SMEAR WET MOUNT SALINE/INK,87210,CPT,300,RC,,OUTPATIENT,,,15,6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,11.3,14.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1198.4,OTHER,1123.5,1468.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,MONUMENT,COMMERCIAL,,,,1198.4,,1123.5,1468.04,
KOH PREP,87220,CPT,306,RC,,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,59.63,77.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1198.4,OTHER,1123.5,1468.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,MONUMENT,COMMERCIAL,,,,1198.4,,1123.5,1468.04,
CMV CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.06,226.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SOFT TISSUE NCK W/WO (NEWW),70492,CPT,350,RC,,OUTPATIENT,,,1908,763.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1526.4,OTHER,1431,1869.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SOFT TISSUE NCK W/WO (NEWW),70492,CPT,350,RC,,OUTPATIENT,,,1908,763.2,MONUMENT,COMMERCIAL,,,,1526.4,,1431,1869.84,
VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.06,226.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SOFT TISSUE NCK W/WO (NEWW),70492QQ,CPT,350,RC,QQ,OUTPATIENT,,,2228.5,891.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1782.8,OTHER,1671.38,2183.93,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SOFT TISSUE NCK W/WO (NEWW),70492QQ,CPT,350,RC,QQ,OUTPATIENT,,,2228.5,891.4,MONUMENT,COMMERCIAL,,,,1782.8,,1671.38,2183.93,
VIRUS ISO/TISS CUL/OBSV/ID(SO),87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.06,226.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SOFT TISSUE NECK W/CONT,70491,CPT,350,RC,,OUTPATIENT,,,1684.25,673.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1347.4,OTHER,1263.19,1650.57,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SOFT TISSUE NECK W/CONT,70491,CPT,350,RC,,OUTPATIENT,,,1684.25,673.7,MONUMENT,COMMERCIAL,,,,1347.4,,1263.19,1650.57,
CULTURE VIRUS NON RESPIRATORY,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.06,226.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SOFT TISSUE NECK W/CONTRAST,70491QQ,CPT,350,RC,QQ,OUTPATIENT,,,1684.25,673.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1347.4,OTHER,1263.19,1650.57,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SOFT TISSUE NECK W/CONTRAST,70491QQ,CPT,350,RC,QQ,OUTPATIENT,,,1684.25,673.7,MONUMENT,COMMERCIAL,,,,1347.4,,1263.19,1650.57,
MUMPS VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.06,226.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IMAGE CATH FLUID COLXN VISC CT,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,2274.912,OTHER,2132.7,2786.8,PERCENT OF CHARGES BASED ON HCPCS CODE
IMAGE CATH FLUID COLXN VISC CT,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,MONUMENT,COMMERCIAL,,,,2274.9,,2132.7,2786.8,
VIRUS EA ISO ID  TISS CUL  SO,87253,CPT,300,RC,,OUTPATIENT,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,56.25,73.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SOFT TISSUE NECK W/O (NEWO),70490,CPT,350,RC,,OUTPATIENT,,,1100.5,440.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,880.4,OTHER,825.38,1078.49,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SOFT TISSUE NECK W/O (NEWO),70490,CPT,350,RC,,OUTPATIENT,,,1100.5,440.2,MONUMENT,COMMERCIAL,,,,880.4,,825.38,1078.49,
TISSUE CULTURE ADD'L STUDY,87253,CPT,300,RC,,OUTPATIENT,,,442,176.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,331.5,433.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ANGIOGRAPH PELV W/O&W/DYE,72191,CPT,352,RC,,OUTPATIENT,,,879.74,351.896,BLUE CROSS ANTHEM,COMMERCIAL,,,,703.792,OTHER,659.8,862.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ANGIOGRAPH PELV W/O&W/DYE,72191,CPT,352,RC,,OUTPATIENT,,,879.74,351.896,MONUMENT,COMMERCIAL,,,,703.8,,659.8,862.1,
TISSUE CULTURE W/ID IMM STAIN,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/WO LT,73202LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/WO LT,73202LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
VIRAL SMEAR SHELL VIAL,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.38,98.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UPPER EXTREMITY W/WO RT,73202RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
UPPER EXTREMITY W/WO RT,73202RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
B PERTUSSIS SMEAR BY DFA,87265,CPT,306,RC,,OUTPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,74.25,97.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS W/WO CONTRAST (PELB),72194,CPT,350,RC,,OUTPATIENT,,,2135.75,854.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1708.6,OTHER,1601.81,2093.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS W/WO CONTRAST (PELB),72194,CPT,350,RC,,OUTPATIENT,,,2135.75,854.3,MONUMENT,COMMERCIAL,,,,1708.6,,1601.81,2093.04,
CHLAMYDIA TRACH AG DFA,87270,CPT,300,RC,,OUTPATIENT,,,107.25,42.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,80.44,105.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS W/WO CONTRAST,72194QQ,CPT,350,RC,QQ,OUTPATIENT,,,2135.75,854.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1708.6,OTHER,1601.81,2093.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS W/WO CONTRAST,72194QQ,CPT,350,RC,QQ,OUTPATIENT,,,2135.75,854.3,MONUMENT,COMMERCIAL,,,,1708.6,,1601.81,2093.04,
VARICELLA-ZOSTER VIRUS,87290,CPT,306,RC,,OUTPATIENT,,,119.5,47.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,89.63,117.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS W/CONTRAST (PELW),72193,CPT,350,RC,,OUTPATIENT,,,1871,748.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1496.8,OTHER,1403.25,1833.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS W/CONTRAST (PELW),72193,CPT,350,RC,,OUTPATIENT,,,1871,748.4,MONUMENT,COMMERCIAL,,,,1496.8,,1403.25,1833.58,
FRANCISELLA TULARENSIS DFA,87299,CPT,306,RC,,OUTPATIENT,,,273.75,109.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,205.31,268.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS W/CONTRAST,72193QQ,CPT,350,RC,QQ,OUTPATIENT,,,1871,748.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1496.8,OTHER,1403.25,1833.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS W/CONTRAST,72193QQ,CPT,350,RC,QQ,OUTPATIENT,,,1871,748.4,MONUMENT,COMMERCIAL,,,,1496.8,,1403.25,1833.58,
Z LEGIONELLA SMEAR,87300,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS W/O CONTRAST,72192,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1224.2,OTHER,1147.69,1499.65,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS W/O CONTRAST,72192,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,MONUMENT,COMMERCIAL,,,,1224.2,,1147.69,1499.65,
ADENOVIRUS AG EIA,87301,CPT,302,RC,,OUTPATIENT,,,130.5,52.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.88,127.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABSCESSOGRAM,76080,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1224.2,OTHER,1147.69,1499.65,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSCESSOGRAM,76080,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,MONUMENT,COMMERCIAL,,,,1224.2,,1147.69,1499.65,
ASPERGILLUS ANTIGEN,87305,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,104.06,135.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PELVIS/HIP FRACTURE,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1270.2,OTHER,1190.81,1556,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PELVIS/HIP FRACTURE,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,MONUMENT,COMMERCIAL,,,,1270.2,,1190.81,1556,
CLOSTRIDIUM DIFFICLE TOXIN,87324,CPT,306,RC,,OUTPATIENT,,,30.82,12.328,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,90.56,118.34,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASSESS CYST CONTRACT INJ,49424,CPT,350,RC,,OUTPATIENT,,,500,200,BLUE CROSS ANTHEM,COMMERCIAL,,,,400,OTHER,375,490,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSESS CYST CONTRACT INJ,49424,CPT,350,RC,,OUTPATIENT,,,500,200,MONUMENT,COMMERCIAL,,,,400,,375,490,
"CRYPTOCOCCUS AG SCREEN,SERUM",87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.75,138.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1534.8,OTHER,1438.88,1880.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,MONUMENT,COMMERCIAL,,,,1534.8,,1438.88,1880.13,
CRYPTOCOCCUS ANTIGEN CSF,87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.75,138.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1534.8,OTHER,1438.88,1880.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,MONUMENT,COMMERCIAL,,,,1534.8,,1438.88,1880.13,
CRYPTOCOCCAL AG,87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST W/O CONTRAST (THWO),71250,CPT,350,RC,,OUTPATIENT,,,1563.5,625.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1250.8,OTHER,1172.63,1532.23,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST W/O CONTRAST (THWO),71250,CPT,350,RC,,OUTPATIENT,,,1563.5,625.4,MONUMENT,COMMERCIAL,,,,1250.8,,1172.63,1532.23,
CRYPTOSPORIDIUM,87328,CPT,306,RC,,OUTPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.81,42.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2697,1078.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2157.6,OTHER,2022.75,2643.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2697,1078.8,MONUMENT,COMMERCIAL,,,,2157.6,,2022.75,2643.06,
"CRYPTOSPORIDIUM ANTIGEN, FECES",87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.19,102.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2458.75,983.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1967,OTHER,1844.06,2409.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2458.75,983.5,MONUMENT,COMMERCIAL,,,,1967,,1844.06,2409.58,
GIARDIA,87329,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.19,43.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MPR/3D RECONSTRUCTION (MPRS,76377,CPT,350,RC,,OUTPATIENT,,,534,213.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.2,OTHER,400.5,523.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MPR/3D RECONSTRUCTION (MPRS,76377,CPT,350,RC,,OUTPATIENT,,,534,213.6,MONUMENT,COMMERCIAL,,,,427.2,,400.5,523.32,
ENTAMOEBA HISTOLYTICA,87337,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLAVICLE BILATERAL,7300050,CPT,320,RC,50,OUTPATIENT,,,520.75,208.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.6,OTHER,390.56,510.34,PERCENT OF CHARGES BASED ON HCPCS CODE
CLAVICLE BILATERAL,7300050,CPT,320,RC,50,OUTPATIENT,,,520.75,208.3,MONUMENT,COMMERCIAL,,,,416.6,,390.56,510.34,
HELICOBACTER PYLORI ANTIGEN,87338,CPT,306,RC,,OUTPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,167.06,218.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACIC SPINE W/CONT (TSWC,72129,CPT,350,RC,,OUTPATIENT,,,2478.5,991.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1982.8,OTHER,1858.88,2428.93,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACIC SPINE W/CONT (TSWC,72129,CPT,350,RC,,OUTPATIENT,,,2478.5,991.4,MONUMENT,COMMERCIAL,,,,1982.8,,1858.88,2428.93,
Z HBS ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACIC SPINE W/CONTRAST,72129QQ,CPT,350,RC,QQ,OUTPATIENT,,,2478.5,991.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1982.8,OTHER,1858.88,2428.93,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACIC SPINE W/CONTRAST,72129QQ,CPT,350,RC,QQ,OUTPATIENT,,,2478.5,991.4,MONUMENT,COMMERCIAL,,,,1982.8,,1858.88,2428.93,
Z EH HEP B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACIC SPINE W/O (TSWO),72128,CPT,350,RC,,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACIC SPINE W/O (TSWO),72128,CPT,350,RC,,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
HEPATITIS B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACIC SPINE W/O CONTRAST,72128QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1698.4,OTHER,1592.25,2080.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACIC SPINE W/O CONTRAST,72128QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,MONUMENT,COMMERCIAL,,,,1698.4,,1592.25,2080.54,
HEPITITIS B ANTIGEN CONFIRMATN,87341,CPT,300,RC,,OUTPATIENT,,,102.5,41,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.88,100.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST SPINE W/O & W/DYE,72130,CPT,352,RC,,OUTPATIENT,,,2951.14,1180.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,2360.912,OTHER,2213.4,2892.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST SPINE W/O & W/DYE,72130,CPT,352,RC,,OUTPATIENT,,,2951.14,1180.456,MONUMENT,COMMERCIAL,,,,2360.9,,2213.4,2892.1,
HEPATITIS BE ANTIGEN,87350,CPT,306,RC,,OUTPATIENT,,,84,33.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT RENAL CYST/PELVIS ASPIRATE,50390,CPT,361,RC,,OUTPATIENT,,,3053,1221.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2442.4,OTHER,2289.75,2991.94,PERCENT OF CHARGES BASED ON HCPCS CODE
CT RENAL CYST/PELVIS ASPIRATE,50390,CPT,361,RC,,OUTPATIENT,,,3053,1221.2,MONUMENT,COMMERCIAL,,,,2442.4,,2289.75,2991.94,
HEPATITIS D ANTIGEN,87380,CPT,300,RC,,OUTPATIENT,,,321.75,128.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,241.31,315.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MUSCLE NEEDLE BX (MSBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MUSCLE NEEDLE BX (MSBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
HISTOPLASMA ANTIGEN URINE,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,186.75,244.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT JOINT INJECTION 2 SITE,64494,CPT,350,RC,,OUTPATIENT,,,772.5,309,BLUE CROSS ANTHEM,COMMERCIAL,,,,618,OTHER,579.38,757.05,PERCENT OF CHARGES BASED ON HCPCS CODE
CT JOINT INJECTION 2 SITE,64494,CPT,350,RC,,OUTPATIENT,,,772.5,309,MONUMENT,COMMERCIAL,,,,618,,579.38,757.05,
HISTOPLASMA ANTIGEN SERUM,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,186.75,244.02,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THORACENTESIS (BNSP),32555,CPT,361,RC,,OUTPATIENT,,,1965,786,BLUE CROSS ANTHEM,COMMERCIAL,,,,1572,OTHER,1473.75,1925.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THORACENTESIS (BNSP),32555,CPT,361,RC,,OUTPATIENT,,,1965,786,MONUMENT,COMMERCIAL,,,,1572,,1473.75,1925.7,
HIV-1 P24 ANTIGEN,87390,CPT,306,RC,,OUTPATIENT,,,153.25,61.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.94,150.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
ROTAVIRUS,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.88,147.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THYROID BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THYROID BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
ROTAVIRUS AG  EIA,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.88,147.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT THYROID CORE BX,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,631.88,825.65,PERCENT OF CHARGES BASED ON HCPCS CODE
CT THYROID CORE BX,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,674,,631.88,825.65,
SHIGA TOXIN 1,87427,CPT,300,RC,,OUTPATIENT,,,41.5,16.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.13,40.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/O CONT RT,73200RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/O CONT RT,73200RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
NORWALK LIKE VIRUS (NOROVIRUS),87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,104.06,135.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/O RT,73200RTQQ,CPT,350,RC,RTQQ,OUTPATIENT,,,1934.25,773.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1547.4,OTHER,1450.69,1895.57,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/O RT,73200RTQQ,CPT,350,RC,RTQQ,OUTPATIENT,,,1934.25,773.7,MONUMENT,COMMERCIAL,,,,1547.4,,1450.69,1895.57,
B-D GLUCAN,87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,104.06,135.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY W/O LT,73200LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1099.2,OTHER,1030.5,1346.52,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY W/O LT,73200LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,MONUMENT,COMMERCIAL,,,,1099.2,,1030.5,1346.52,
FUNGITELL CSF,87449,CPT,300,RC,,OUTPATIENT,,,204,81.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,153,199.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT UPPER EXTREMITY BIL,7320050,CPT,350,RC,50,OUTPATIENT,,,2400,960,BLUE CROSS ANTHEM,COMMERCIAL,,,,1920,OTHER,1800,2352,PERCENT OF CHARGES BASED ON HCPCS CODE
CT UPPER EXTREMITY BIL,7320050,CPT,350,RC,50,OUTPATIENT,,,2400,960,MONUMENT,COMMERCIAL,,,,1920,,1800,2352,
LYME DISEASE BY PCR,87476,CPT,300,RC,,OUTPATIENT,,,509,203.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,381.75,498.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT COLONOSCOPY SCREENING,74263,CPT,350,RC,,OUTPATIENT,,,1719.75,687.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1375.8,OTHER,1289.81,1685.36,PERCENT OF CHARGES BASED ON HCPCS CODE
CT COLONOSCOPY SCREENING,74263,CPT,350,RC,,OUTPATIENT,,,1719.75,687.9,MONUMENT,COMMERCIAL,,,,1375.8,,1289.81,1685.36,
ZLYME DIS DNA AMP PROBE,87476,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.6,68.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT INJ 1 LEV PARAVRT F JNT L/S,6449350,CPT,350,RC,50,OUTPATIENT,,,2665,1066,BLUE CROSS ANTHEM,COMMERCIAL,,,,2132,OTHER,1998.75,2611.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CT INJ 1 LEV PARAVRT F JNT L/S,6449350,CPT,350,RC,50,OUTPATIENT,,,2665,1066,MONUMENT,COMMERCIAL,,,,2132,,1998.75,2611.7,
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,2316,926.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1737,2269.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT INJ 2 LEV PARAVRT F JNT L/S,6449450,CPT,350,RC,50,OUTPATIENT,,,639,255.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.2,OTHER,479.25,626.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CT INJ 2 LEV PARAVRT F JNT L/S,6449450,CPT,350,RC,50,OUTPATIENT,,,639,255.6,MONUMENT,COMMERCIAL,,,,511.2,,479.25,626.22,
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,833.56,333.424,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,625.2,816.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT INJ 3 LEV PARAVRT F JNT L/S,6449550,CPT,350,RC,50,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
CT INJ 3 LEV PARAVRT F JNT L/S,6449550,CPT,350,RC,50,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
CHLAMYDIA TRACH BY DNA PROBE,87490,CPT,300,RC,,OUTPATIENT,,,96.25,38.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.19,94.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GUIDED GASTROSTOMY TUBE PLC,49450,CPT,350,RC,,OUTPATIENT,,,2507.5,1003,BLUE CROSS ANTHEM,COMMERCIAL,,,,2006,OTHER,1880.63,2457.35,PERCENT OF CHARGES BASED ON HCPCS CODE
GUIDED GASTROSTOMY TUBE PLC,49450,CPT,350,RC,,OUTPATIENT,,,2507.5,1003,MONUMENT,COMMERCIAL,,,,2006,,1880.63,2457.35,
CHLAMYDIA TRACH DNA AMP PROBE,87491,CPT,306,RC,,OUTPATIENT,,,96.25,38.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.19,94.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT GUIDED GASTROSTOMY TUBE PLC,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDED GASTROSTOMY TUBE PLC,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
CLOSTRIDIUM DIFFICLE TOXIN PCR,87493,CPT,300,RC,,OUTPATIENT,,,266,106.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,199.5,260.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT MUSCLE NEEDLE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,998.4,OTHER,936,1223.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CT MUSCLE NEEDLE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,MONUMENT,COMMERCIAL,,,,998.4,,936,1223.04,
CYTOMEGALOVIRUS QUAL BY PCR,87496,CPT,300,RC,,OUTPATIENT,,,204.5,81.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,153.38,200.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FACET INJ 1 LEVEL,64493,CPT,350,RC,,OUTPATIENT,,,1777,710.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1421.6,OTHER,1332.75,1741.46,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FACET INJ 1 LEVEL,64493,CPT,350,RC,,OUTPATIENT,,,1777,710.8,MONUMENT,COMMERCIAL,,,,1421.6,,1332.75,1741.46,
CMV DNA QUANTITATIVE BY PCR,87497,CPT,300,RC,,OUTPATIENT,,,408.5,163.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,306.38,400.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FACET INJ 2 LEVELS,64494,CPT,350,RC,,OUTPATIENT,,,426,170.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,340.8,OTHER,319.5,417.48,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FACET INJ 2 LEVELS,64494,CPT,350,RC,,OUTPATIENT,,,426,170.4,MONUMENT,COMMERCIAL,,,,340.8,,319.5,417.48,
ENTEROVIRUS DETECTION RT-PCR,87498,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132.38,172.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT FACET INJ 3 LEVELS,64495,CPT,350,RC,,OUTPATIENT,,,399.75,159.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,319.8,OTHER,299.81,391.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CT FACET INJ 3 LEVELS,64495,CPT,350,RC,,OUTPATIENT,,,399.75,159.9,MONUMENT,COMMERCIAL,,,,319.8,,299.81,391.76,
INFLUENZA A/B PCR,87502,CPT,306,RC,,OUTPATIENT,,,191.6,76.64,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,91.5,119.56,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ TENDON SHEATH LIGAMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,504.8,OTHER,473.25,618.38,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ TENDON SHEATH LIGAMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,MONUMENT,COMMERCIAL,,,,504.8,,473.25,618.38,
INFLUENZA A H1N1 BY PCR,87502,CPT,306,RC,,OUTPATIENT,,,592,236.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,444,580.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SCAN FOR NEEDLE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SCAN FOR NEEDLE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
INFLUENZA DNA AMP PROBE,87502,CPT,306,RC,,OUTPATIENT,,,117,46.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,87.8,114.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EPIDURAL INJECTION,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,894,1168.16,PERCENT OF CHARGES BASED ON HCPCS CODE
EPIDURAL INJECTION,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,953.6,,894,1168.16,
GI PATHOGEN 6-11 TARGETS,87506,CPT,300,RC,,OUTPATIENT,,,525.98,210.392,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,375,490,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABDOMEN/PELVIS ANGIO,74174,CPT,350,RC,,OUTPATIENT,,,2016,806.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1612.8,OTHER,1512,1975.68,PERCENT OF CHARGES BASED ON HCPCS CODE
ABDOMEN/PELVIS ANGIO,74174,CPT,350,RC,,OUTPATIENT,,,2016,806.4,MONUMENT,COMMERCIAL,,,,1612.8,,1512,1975.68,
GASTROINTESTINAL PATHOGENS,87507,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,521.06,680.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT BONE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT BONE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
HEPATITIS B DNA QUALITATIVE,87516,CPT,306,RC,,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT EXTREMITY ANGIO,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2801.2,OTHER,2626.13,3431.47,PERCENT OF CHARGES BASED ON HCPCS CODE
CT EXTREMITY ANGIO,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,MONUMENT,COMMERCIAL,,,,2801.2,,2626.13,3431.47,
HEPATITIS B VIRAL DNA  QUANT,87517,CPT,300,RC,,OUTPATIENT,,,442.5,177,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,331.88,433.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SHOULDER ARTHROGRAM RIGHT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1815.4,OTHER,1701.9,2223.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SHOULDER ARTHROGRAM RIGHT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,MONUMENT,COMMERCIAL,,,,1815.4,,1701.9,2223.9,
HEPATITIS C AMPLIFIED PROBE,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,244.69,319.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT SHOULDER ARTHROGRAM LEFT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1815.4,OTHER,1701.9,2223.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CT SHOULDER ARTHROGRAM LEFT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,MONUMENT,COMMERCIAL,,,,1815.4,,1701.9,2223.9,
HEPATITIS C VIRUS RNA QUAL PCR,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,244.69,319.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CAROTID ANGIO (CAAN),70498QQ,CPT,350,RC,QQ,OUTPATIENT,,,1908,763.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1526.4,OTHER,1431,1869.84,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CAROTID ANGIO (CAAN),70498QQ,CPT,350,RC,QQ,OUTPATIENT,,,1908,763.2,MONUMENT,COMMERCIAL,,,,1526.4,,1431,1869.84,
HEPATITIS C RNA AMP PROBE,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,348,454.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"CT CHEST ANGIO(PE,AORTA)(CTAC)",71275,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1512.38,1976.17,PERCENT OF CHARGES BASED ON HCPCS CODE
"CT CHEST ANGIO(PE,AORTA)(CTAC)",71275,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,MONUMENT,COMMERCIAL,,,,1613.2,,1512.38,1976.17,
HEPATITIS C VIRUS RNA QUANT,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,348,454.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT CHEST ANGIO,71275QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1512.38,1976.17,PERCENT OF CHARGES BASED ON HCPCS CODE
CT CHEST ANGIO,71275QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,MONUMENT,COMMERCIAL,,,,1613.2,,1512.38,1976.17,
HERPES SIMPLEX VIRUS BY PCR,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.75,102.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD ANGIO (CTAA),74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1512.38,1976.17,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD ANGIO (CTAA),74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,MONUMENT,COMMERCIAL,,,,1613.2,,1512.38,1976.17,
HERPES SIMPLEX AMPLIFIED PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.75,102.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT ABD ANGIO (CTAA),74175QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1613.2,OTHER,1512.38,1976.17,PERCENT OF CHARGES BASED ON HCPCS CODE
CT ABD ANGIO (CTAA),74175QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,MONUMENT,COMMERCIAL,,,,1613.2,,1512.38,1976.17,
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.8,102.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT PANCREAS CORE BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1898.4,OTHER,1779.75,2325.54,PERCENT OF CHARGES BASED ON HCPCS CODE
CT PANCREAS CORE BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,MONUMENT,COMMERCIAL,,,,1898.4,,1779.75,2325.54,
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,78.8,102.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CT GUIDED PARACENTESIS,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,1210.2,1581.4,PERCENT OF CHARGES BASED ON HCPCS CODE
CT GUIDED PARACENTESIS,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,1290.9,,1210.2,1581.4,
HIV RNA QUANT BY PCR,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,336.19,439.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LITHOTRIPSY (ESWL),3600010,CDM,,,,INPATIENT,,,17451.5,6980.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,15880.87,OTHER,13088.63,17102.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LITHOTRIPSY (ESWL),3600010,CDM,,,,INPATIENT,,,17451.5,6980.6,MONUMENT,COMMERCIAL,,,,13961.2,,13088.63,17102.47,
LITHOTRIPSY (ESWL),3600010,CDM,,,,INPATIENT,,,17451.5,6980.6,UNITED HEALTH,UNITED COMMERCIAL,,,,13088.63,,13088.63,17102.47,
LITHOTRIPSY (LASER),3600012,CDM,,,,INPATIENT,,,7544.75,3017.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,6865.72,OTHER,5658.56,7393.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LITHOTRIPSY (LASER),3600012,CDM,,,,INPATIENT,,,7544.75,3017.9,MONUMENT,COMMERCIAL,,,,6035.8,,5658.56,7393.86,
LITHOTRIPSY (LASER),3600012,CDM,,,,INPATIENT,,,7544.75,3017.9,UNITED HEALTH,UNITED COMMERCIAL,,,,5658.56,,5658.56,7393.86,
OR INPT LEVEL1,3600102,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR INPT LEVEL1,3600102,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
OR INPT LEVEL1,3600102,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
OR INPT LEVEL2,3600202,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR INPT LEVEL2,3600202,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
OR INPT LEVEL2,3600202,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
INJ FOR SACROILIAC JT ANESTH,G0260,HCPCS,350,RC,,INPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1151,OTHER,948.6,1239.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INJ FOR SACROILIAC JT ANESTH,G0260,HCPCS,350,RC,,INPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
INJ FOR SACROILIAC JT ANESTH,G0260,HCPCS,350,RC,,INPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,948.6,,948.6,1239.5,
IVC FILTER PLACEMENT,37191,CPT,361,RC,,OUTPATIENT,,,6206.5,2482.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,4965.2,OTHER,4654.88,6082.37,PERCENT OF CHARGES BASED ON HCPCS CODE
IVC FILTER PLACEMENT,37191,CPT,361,RC,,OUTPATIENT,,,6206.5,2482.6,MONUMENT,COMMERCIAL,,,,4965.2,,4654.88,6082.37,
HIV ULTRA SENSITIVE RNA QNT,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,336.19,439.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OR INPT LEVEL3,3600302,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR INPT LEVEL3,3600302,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
OR INPT LEVEL3,3600302,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
OR INPT LEVEL4,3600402,CDM,,,,INPATIENT,,,4778,1911.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4347.98,OTHER,3583.5,4682.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR INPT LEVEL4,3600402,CDM,,,,INPATIENT,,,4778,1911.2,MONUMENT,COMMERCIAL,,,,3822.4,,3583.5,4682.44,
OR INPT LEVEL4,3600402,CDM,,,,INPATIENT,,,4778,1911.2,UNITED HEALTH,UNITED COMMERCIAL,,,,3583.5,,3583.5,4682.44,
OR/IP LEVEL 1 EA ADD'L 15 MIN,3600500,CDM,,,,INPATIENT,,,277.75,111.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,252.75,OTHER,208.31,272.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR/IP LEVEL 1 EA ADD'L 15 MIN,3600500,CDM,,,,INPATIENT,,,277.75,111.1,MONUMENT,COMMERCIAL,,,,222.2,,208.31,272.2,
OR/IP LEVEL 1 EA ADD'L 15 MIN,3600500,CDM,,,,INPATIENT,,,277.75,111.1,UNITED HEALTH,UNITED COMMERCIAL,,,,208.31,,208.31,272.2,
OR/IP LEVEL 2 EA ADD'L 15 MIN,3600502,CDM,,,,INPATIENT,,,306.25,122.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,278.69,OTHER,229.69,300.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR/IP LEVEL 2 EA ADD'L 15 MIN,3600502,CDM,,,,INPATIENT,,,306.25,122.5,MONUMENT,COMMERCIAL,,,,245,,229.69,300.13,
OR/IP LEVEL 2 EA ADD'L 15 MIN,3600502,CDM,,,,INPATIENT,,,306.25,122.5,UNITED HEALTH,UNITED COMMERCIAL,,,,229.69,,229.69,300.13,
OR/IP LEVEL 3 EA ADD'L 15 MIN,3600504,CDM,,,,INPATIENT,,,334.25,133.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.17,OTHER,250.69,327.57,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR/IP LEVEL 3 EA ADD'L 15 MIN,3600504,CDM,,,,INPATIENT,,,334.25,133.7,MONUMENT,COMMERCIAL,,,,267.4,,250.69,327.57,
OR/IP LEVEL 3 EA ADD'L 15 MIN,3600504,CDM,,,,INPATIENT,,,334.25,133.7,UNITED HEALTH,UNITED COMMERCIAL,,,,250.69,,250.69,327.57,
OR/IP LEVEL 4 EA ADD'L 15 MIN,3600506,CDM,,,,INPATIENT,,,365,146,BLUE CROSS ANTHEM,COMMERCIAL,,,,332.15,OTHER,273.75,357.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OR/IP LEVEL 4 EA ADD'L 15 MIN,3600506,CDM,,,,INPATIENT,,,365,146,MONUMENT,COMMERCIAL,,,,292,,273.75,357.7,
OR/IP LEVEL 4 EA ADD'L 15 MIN,3600506,CDM,,,,INPATIENT,,,365,146,UNITED HEALTH,UNITED COMMERCIAL,,,,273.75,,273.75,357.7,
MINOR EXCISION LEVEL 1,3600510,CDM,,,,INPATIENT,,,343.75,137.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,312.81,OTHER,257.81,336.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINOR EXCISION LEVEL 1,3600510,CDM,,,,INPATIENT,,,343.75,137.5,MONUMENT,COMMERCIAL,,,,275,,257.81,336.88,
MINOR EXCISION LEVEL 1,3600510,CDM,,,,INPATIENT,,,343.75,137.5,UNITED HEALTH,UNITED COMMERCIAL,,,,257.81,,257.81,336.88,
MINOR EXCISION LEVEL 2,3600512,CDM,,,,INPATIENT,,,514.25,205.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,467.97,OTHER,385.69,503.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINOR EXCISION LEVEL 2,3600512,CDM,,,,INPATIENT,,,514.25,205.7,MONUMENT,COMMERCIAL,,,,411.4,,385.69,503.97,
MINOR EXCISION LEVEL 2,3600512,CDM,,,,INPATIENT,,,514.25,205.7,UNITED HEALTH,UNITED COMMERCIAL,,,,385.69,,385.69,503.97,
GI TUBE PLACEMENT,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,987.56,1290.42,PERCENT OF CHARGES BASED ON HCPCS CODE
GI TUBE PLACEMENT,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,1053.4,,987.56,1290.42,
MYCOBACTERIUM TB AMPLIFIED,87556,CPT,306,RC,,OUTPATIENT,,,529.75,211.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,397.31,519.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ADENOIDECTOMY               II,3601002,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADENOIDECTOMY               II,3601002,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ADENOIDECTOMY               II,3601002,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ADENOIDECTOMY/MYRING        II,3601003,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADENOIDECTOMY/MYRING        II,3601003,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ADENOIDECTOMY/MYRING        II,3601003,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
AMPUTATE STUMP REVIS        II,3601004,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMPUTATE STUMP REVIS        II,3601004,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
AMPUTATE STUMP REVIS        II,3601004,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
AMPUTATE TOES/FINGER       I,3601005,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMPUTATE TOES/FINGER       I,3601005,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
AMPUTATE TOES/FINGER       I,3601005,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
AMPUTATE STUMP DEBRIDE      II,3601006,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMPUTATE STUMP DEBRIDE      II,3601006,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
AMPUTATE STUMP DEBRIDE      II,3601006,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ART/SHAVE/LIG/REPAIR       III,3601009,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ART/SHAVE/LIG/REPAIR       III,3601009,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
ART/SHAVE/LIG/REPAIR       III,3601009,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
ARTHROSCOPY                III,3601011,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ARTHROSCOPY                III,3601011,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
ARTHROSCOPY                III,3601011,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
ARTHROSCOPY/SHAVING        III,3601013,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ARTHROSCOPY/SHAVING        III,3601013,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
ARTHROSCOPY/SHAVING        III,3601013,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
BX ABD/RETROPERITONEAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1210.4,OTHER,1134.75,1482.74,PERCENT OF CHARGES BASED ON HCPCS CODE
BX ABD/RETROPERITONEAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,MONUMENT,COMMERCIAL,,,,1210.4,,1134.75,1482.74,
MYCOPLASMA GENITALIUM TMA,87563,CPT,306,RC,,OUTPATIENT,,,136,54.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,102,133.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BIOPSY OF PAROTID           II,3601016,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOPSY OF PAROTID           II,3601016,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
BIOPSY OF PAROTID           II,3601016,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
BUNIONECTOMY UNI/SIM        II,3601017,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BUNIONECTOMY UNI/SIM        II,3601017,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
BUNIONECTOMY UNI/SIM        II,3601017,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
BURSA OLECRANON REM II,3601018,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BURSA OLECRANON REM II,3601018,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
BURSA OLECRANON REM II,3601018,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CARPAL TUNNEL RELEASE       II,3601025,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPAL TUNNEL RELEASE       II,3601025,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CARPAL TUNNEL RELEASE       II,3601025,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CARPAL TUNNEL DEQUERVAINS   II,3601026,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPAL TUNNEL DEQUERVAINS   II,3601026,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CARPAL TUNNEL DEQUERVAINS   II,3601026,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CATARACT EXTRACTION         II,3601027,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATARACT EXTRACTION         II,3601027,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CATARACT EXTRACTION         II,3601027,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CERVICAL CONE W/ D&C         I,3601028,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CERVICAL CONE W/ D&C         I,3601028,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
CERVICAL CONE W/ D&C         I,3601028,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
CIRCUMCISION ADULT II,3601029,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCUMCISION ADULT II,3601029,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CIRCUMCISION ADULT II,3601029,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CIRCUMCISION PED II,3601030,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CIRCUMCISION PED II,3601030,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CIRCUMCISION PED II,3601030,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CLSD REDUCT W/ CAST          I,3601031,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CLSD REDUCT W/ CAST          I,3601031,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
CLSD REDUCT W/ CAST          I,3601031,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
CONTIGEN INJECTION         III,3601033,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CONTIGEN INJECTION         III,3601033,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
CONTIGEN INJECTION         III,3601033,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
CYSTO/BLADDER BIOPSY       III,3601035,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTO/BLADDER BIOPSY       III,3601035,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
CYSTO/BLADDER BIOPSY       III,3601035,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
CYSTO/BLADDER EXTRAC        II,3601036,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTO/BLADDER EXTRAC        II,3601036,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CYSTO/BLADDER EXTRAC        II,3601036,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CYSTO/RETROGRADE PYE        II,3601037,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTO/RETROGRADE PYE        II,3601037,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CYSTO/RETROGRADE PYE        II,3601037,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CYSTO/URETER/LITHO         III,3601038,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTO/URETER/LITHO         III,3601038,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
CYSTO/URETER/LITHO         III,3601038,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
CYSTO/URETERAL EXTRA        II,3601039,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYSTO/URETERAL EXTRA        II,3601039,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CYSTO/URETERAL EXTRA        II,3601039,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CYTOSCOPY                   II,3601040,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CYTOSCOPY                   II,3601040,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
CYTOSCOPY                   II,3601040,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
D&C                          I,3601041,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
D&C                          I,3601041,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
D&C                          I,3601041,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
DEBRIDEMENT WOUND           II,3601042,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DEBRIDEMENT WOUND           II,3601042,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
DEBRIDEMENT WOUND           II,3601042,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
DUPUYTRENS CONTRACT         II,3601043,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DUPUYTRENS CONTRACT         II,3601043,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
DUPUYTRENS CONTRACT         II,3601043,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ECCE W/ IOL                 II,3601044,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ECCE W/ IOL                 II,3601044,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ECCE W/ IOL                 II,3601044,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ENDOSCOPIC SINUS            II,3601045,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ENDOSCOPIC SINUS            II,3601045,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ENDOSCOPIC SINUS            II,3601045,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
EXC BREAST MASS UNIL         I,3601046,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXC BREAST MASS UNIL         I,3601046,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
EXC BREAST MASS UNIL         I,3601046,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
EXCISION LIPOMA             II,3601047,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXCISION LIPOMA             II,3601047,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
EXCISION LIPOMA             II,3601047,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
EXCISION MISC/MINOR          I,3601048,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXCISION MISC/MINOR          I,3601048,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
EXCISION MISC/MINOR          I,3601048,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
EXCISION TOENAIL             I,3601049,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXCISION TOENAIL             I,3601049,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
EXCISION TOENAIL             I,3601049,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
EXOSTOSIS EXCISION          II,3601050,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXOSTOSIS EXCISION          II,3601050,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
EXOSTOSIS EXCISION          II,3601050,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
EXP. JNT SOFT TISSUE        II,3601051,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXP. JNT SOFT TISSUE        II,3601051,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
EXP. JNT SOFT TISSUE        II,3601051,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
FRENULECTOMY                 I,3601054,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FRENULECTOMY                 I,3601054,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
FRENULECTOMY                 I,3601054,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
GANGLIONECTOMY              II,3601055,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GANGLIONECTOMY              II,3601055,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
GANGLIONECTOMY              II,3601055,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
HAMMER TOES EX BILA II,3601056,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HAMMER TOES EX BILA II,3601056,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
HAMMER TOES EX BILA II,3601056,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
HAMMER TOES EX UNI II,3601057,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HAMMER TOES EX UNI II,3601057,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
HAMMER TOES EX UNI II,3601057,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
HARDWARE REMOVAL MAJOR      II,3601058,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HARDWARE REMOVAL MAJOR      II,3601058,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
HARDWARE REMOVAL MAJOR      II,3601058,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
HARDWARE REMOVAL MINOR       I,3601059,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HARDWARE REMOVAL MINOR       I,3601059,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
HARDWARE REMOVAL MINOR       I,3601059,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
HEMORRHOIDECTOMY            II,3601060,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEMORRHOIDECTOMY            II,3601060,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
HEMORRHOIDECTOMY            II,3601060,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
HYDROCELECTOMY               I,3601061,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HYDROCELECTOMY               I,3601061,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
HYDROCELECTOMY               I,3601061,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
INCIS HERNIA REPAIR         II,3601062,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INCIS HERNIA REPAIR         II,3601062,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
INCIS HERNIA REPAIR         II,3601062,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
INGUINAL HERNIA UNIL         I,3601063,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INGUINAL HERNIA UNIL         I,3601063,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
INGUINAL HERNIA UNIL         I,3601063,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
INGUINAL HERNIA BIL         II,3601064,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INGUINAL HERNIA BIL         II,3601064,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
INGUINAL HERNIA BIL         II,3601064,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
INSERT/REMOVE HICKMAN CATH  II,3601065,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INSERT/REMOVE HICKMAN CATH  II,3601065,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
INSERT/REMOVE HICKMAN CATH  II,3601065,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
LAPAROSCOPY                 II,3601066,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LAPAROSCOPY                 II,3601066,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
LAPAROSCOPY                 II,3601066,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
LAP CHOLECYSTECTOMY  III,3601067,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LAP CHOLECYSTECTOMY  III,3601067,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
LAP CHOLECYSTECTOMY  III,3601067,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
LIG/HAND/FOOT REPAIR        II,3601068,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LIG/HAND/FOOT REPAIR        II,3601068,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
LIG/HAND/FOOT REPAIR        II,3601068,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
MEATOTOMY                    I,3601069,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MEATOTOMY                    I,3601069,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
MEATOTOMY                    I,3601069,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
MICROLARYNGOSCOPY           II,3601070,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MICROLARYNGOSCOPY           II,3601070,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
MICROLARYNGOSCOPY           II,3601070,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
MINI LAP TUBAL/PPTL         II,3601071,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINI LAP TUBAL/PPTL         II,3601071,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
MINI LAP TUBAL/PPTL         II,3601071,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
MISC OP SURG LEVEL 1,3601072,CDM,,,,INPATIENT,,,1400,560,BLUE CROSS ANTHEM,COMMERCIAL,,,,1274,OTHER,1050,1372,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MISC OP SURG LEVEL 1,3601072,CDM,,,,INPATIENT,,,1400,560,MONUMENT,COMMERCIAL,,,,1120,,1050,1372,
MISC OP SURG LEVEL 1,3601072,CDM,,,,INPATIENT,,,1400,560,UNITED HEALTH,UNITED COMMERCIAL,,,,1050,,1050,1372,
MISC OP SURG LEVEL 2,3601073,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MISC OP SURG LEVEL 2,3601073,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
MISC OP SURG LEVEL 2,3601073,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
MISC OP SURG LEVEL 3,3601074,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MISC OP SURG LEVEL 3,3601074,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
MISC OP SURG LEVEL 3,3601074,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
MISC OP SURG LEVEL 4,3601075,CDM,,,,INPATIENT,,,4778,1911.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4347.98,OTHER,3583.5,4682.44,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MISC OP SURG LEVEL 4,3601075,CDM,,,,INPATIENT,,,4778,1911.2,MONUMENT,COMMERCIAL,,,,3822.4,,3583.5,4682.44,
MISC OP SURG LEVEL 4,3601075,CDM,,,,INPATIENT,,,4778,1911.2,UNITED HEALTH,UNITED COMMERCIAL,,,,3583.5,,3583.5,4682.44,
MYRINGOTOMY W/WO TUBES       I,3601076,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MYRINGOTOMY W/WO TUBES       I,3601076,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
MYRINGOTOMY W/WO TUBES       I,3601076,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
NODE BIOPSY                 II,3601077,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NODE BIOPSY                 II,3601077,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
NODE BIOPSY                 II,3601077,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
MORTONS NEUROMA II,3601078,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MORTONS NEUROMA II,3601078,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
MORTONS NEUROMA II,3601078,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
O R I F FINGERS/TOES        II,3601079,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
O R I F FINGERS/TOES        II,3601079,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
O R I F FINGERS/TOES        II,3601079,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
O R I F RADIUS/ULNA         II,3601080,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
O R I F RADIUS/ULNA         II,3601080,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
O R I F RADIUS/ULNA         II,3601080,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
O R I F ARM                 II,3601081,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
O R I F ARM                 II,3601081,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
O R I F ARM                 II,3601081,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
OPEN REDUCT NASAL FX        II,3601082,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OPEN REDUCT NASAL FX        II,3601082,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
OPEN REDUCT NASAL FX        II,3601082,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ORCHIECTOMY                 II,3601083,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORCHIECTOMY                 II,3601083,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ORCHIECTOMY                 II,3601083,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
ORCHIOPEXY                  II,3601084,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ORCHIOPEXY                  II,3601084,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ORCHIOPEXY                  II,3601084,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
O R I F ANKLE               II,3601085,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
O R I F ANKLE               II,3601085,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
O R I F ANKLE               II,3601085,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
PARS PLANA VITRECTOMY      III,3601087,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PARS PLANA VITRECTOMY      III,3601087,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
PARS PLANA VITRECTOMY      III,3601087,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
PILONIDAL CYSTECTOMY        II,3601089,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PILONIDAL CYSTECTOMY        II,3601089,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
PILONIDAL CYSTECTOMY        II,3601089,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
POLYPECTOMY NASAL           II,3601090,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
POLYPECTOMY NASAL           II,3601090,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
POLYPECTOMY NASAL           II,3601090,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
PTOSIS REPAIR               II,3601092,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PTOSIS REPAIR               II,3601092,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
PTOSIS REPAIR               II,3601092,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
SECONDARY LENS IMPLANT      II,3601094,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SECONDARY LENS IMPLANT      II,3601094,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SECONDARY LENS IMPLANT      II,3601094,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
SEPTO W/TURBINECTOMY        II,3601095,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEPTO W/TURBINECTOMY        II,3601095,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SEPTO W/TURBINECTOMY        II,3601095,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
SEPTOPLASTY                 II,3601096,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SEPTOPLASTY                 II,3601096,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SEPTOPLASTY                 II,3601096,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
SILASTIC IMPT HD & FT       II,3601097,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SILASTIC IMPT HD & FT       II,3601097,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SILASTIC IMPT HD & FT       II,3601097,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CARPAL TUNNEL SIMPLE         I,3601098,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPAL TUNNEL SIMPLE         I,3601098,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
CARPAL TUNNEL SIMPLE         I,3601098,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
TENDON REPAIR SIMPLE I,3601099,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TENDON REPAIR SIMPLE I,3601099,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
TENDON REPAIR SIMPLE I,3601099,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
SKIN GRAFTING MINOR         II,3602002,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SKIN GRAFTING MINOR         II,3602002,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SKIN GRAFTING MINOR         II,3602002,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
SPERMATOCELECTOMY           II,3602003,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SPERMATOCELECTOMY           II,3602003,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
SPERMATOCELECTOMY           II,3602003,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
STRABISMUS                  II,3602004,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STRABISMUS                  II,3602004,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
STRABISMUS                  II,3602004,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
T & A TUBES                 II,3602007,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
T & A TUBES                 II,3602007,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
T & A TUBES                 II,3602007,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TND/TRAN FINER/O R I F      II,3602008,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TND/TRAN FINER/O R I F      II,3602008,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TND/TRAN FINER/O R I F      II,3602008,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TONSIL/ADENOIDECTOMY        II,3602009,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TONSIL/ADENOIDECTOMY        II,3602009,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TONSIL/ADENOIDECTOMY        II,3602009,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TONSILLECTOMY               II,3602010,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TONSILLECTOMY               II,3602010,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TONSILLECTOMY               II,3602010,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TRABECULECTOMY              II,3602011,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRABECULECTOMY              II,3602011,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TRABECULECTOMY              II,3602011,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TRIGGER FINGER RELEASE      II,3602012,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRIGGER FINGER RELEASE      II,3602012,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TRIGGER FINGER RELEASE      II,3602012,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TRIPPLE ENDOSCOPY           II,3602013,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRIPPLE ENDOSCOPY           II,3602013,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TRIPPLE ENDOSCOPY           II,3602013,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TURP                        II,3602014,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TURP                        II,3602014,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
TURP                        II,3602014,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
TYMPANOPLASTY              III,3602015,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TYMPANOPLASTY              III,3602015,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
TYMPANOPLASTY              III,3602015,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
ULNAR NERVE TRANSFER        II,3602016,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ULNAR NERVE TRANSFER        II,3602016,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
ULNAR NERVE TRANSFER        II,3602016,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
UMBILICAL HERNIA             I,3602017,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
UMBILICAL HERNIA             I,3602017,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
UMBILICAL HERNIA             I,3602017,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
URETHRAL DILATATION          I,3602018,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
URETHRAL DILATATION          I,3602018,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
URETHRAL DILATATION          I,3602018,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
VARICOSE VEIN STRIP         II,3602019,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VARICOSE VEIN STRIP         II,3602019,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
VARICOSE VEIN STRIP         II,3602019,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
VASOVASOSTOMY               II,3602020,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VASOVASOSTOMY               II,3602020,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
VASOVASOSTOMY               II,3602020,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
Z-PLASTY HD OR FT            I,3602021,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
Z-PLASTY HD OR FT            I,3602021,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
Z-PLASTY HD OR FT            I,3602021,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
OP SURGERY 15 MIN,3602022,CDM,,,,INPATIENT,,,271,108.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,246.61,OTHER,203.25,265.58,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OP SURGERY 15 MIN,3602022,CDM,,,,INPATIENT,,,271,108.4,MONUMENT,COMMERCIAL,,,,216.8,,203.25,265.58,
OP SURGERY 15 MIN,3602022,CDM,,,,INPATIENT,,,271,108.4,UNITED HEALTH,UNITED COMMERCIAL,,,,203.25,,203.25,265.58,
APPENDECTOMY                II,3602023,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
APPENDECTOMY                II,3602023,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
APPENDECTOMY                II,3602023,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
CARPAL TUNNEL ENDOSCOPIC   III,3602024,CDM,,,,INPATIENT,,,3588,1435.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,3265.08,OTHER,2691,3516.24,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARPAL TUNNEL ENDOSCOPIC   III,3602024,CDM,,,,INPATIENT,,,3588,1435.2,MONUMENT,COMMERCIAL,,,,2870.4,,2691,3516.24,
CARPAL TUNNEL ENDOSCOPIC   III,3602024,CDM,,,,INPATIENT,,,3588,1435.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2691,,2691,3516.24,
HYSTEROSCOPY                II,3602025,CDM,,,,INPATIENT,,,2689.25,1075.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2447.22,OTHER,2016.94,2635.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HYSTEROSCOPY                II,3602025,CDM,,,,INPATIENT,,,2689.25,1075.7,MONUMENT,COMMERCIAL,,,,2151.4,,2016.94,2635.47,
HYSTEROSCOPY                II,3602025,CDM,,,,INPATIENT,,,2689.25,1075.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2016.94,,2016.94,2635.47,
INSERT/REMOVE GROSHONG CATH  I,3602026,CDM,,,,INPATIENT,,,1402.25,560.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1276.05,OTHER,1051.69,1374.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INSERT/REMOVE GROSHONG CATH  I,3602026,CDM,,,,INPATIENT,,,1402.25,560.9,MONUMENT,COMMERCIAL,,,,1121.8,,1051.69,1374.21,
INSERT/REMOVE GROSHONG CATH  I,3602026,CDM,,,,INPATIENT,,,1402.25,560.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1051.69,,1051.69,1374.21,
LUMBAR PUNCTURE INJ FOR NM,3602030,CDM,361,RC,,INPATIENT,,,1369.75,547.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1246.47,OTHER,1027.31,1342.36,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LUMBAR PUNCTURE INJ FOR NM,3602030,CDM,361,RC,,INPATIENT,,,1369.75,547.9,MONUMENT,COMMERCIAL,,,,1095.8,,1027.31,1342.36,
LUMBAR PUNCTURE INJ FOR NM,3602030,CDM,361,RC,,INPATIENT,,,1369.75,547.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1027.31,,1027.31,1342.36,
LUMBAR PUNCTURE (SPINAL TAP),3602032,CDM,,,,INPATIENT,,,303.25,121.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,275.96,OTHER,227.44,297.19,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LUMBAR PUNCTURE (SPINAL TAP),3602032,CDM,,,,INPATIENT,,,303.25,121.3,MONUMENT,COMMERCIAL,,,,242.6,,227.44,297.19,
LUMBAR PUNCTURE (SPINAL TAP),3602032,CDM,,,,INPATIENT,,,303.25,121.3,UNITED HEALTH,UNITED COMMERCIAL,,,,227.44,,227.44,297.19,
TURP GREEN LIGHT,52648,CPT,360,RC,,INPATIENT,,,11506.75,4602.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,10471.14,OTHER,8630.06,11276.62,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TURP GREEN LIGHT,52648,CPT,360,RC,,INPATIENT,,,11506.75,4602.7,MONUMENT,COMMERCIAL,,,,9205.4,,8630.06,11276.62,
TURP GREEN LIGHT,52648,CPT,360,RC,,INPATIENT,,,11506.75,4602.7,UNITED HEALTH,UNITED COMMERCIAL,,,,8630.06,,8630.06,11276.62,
TURP W/LASER,52648,CPT,360,RC,,INPATIENT,,,8082.75,3233.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,7355.3,OTHER,6062.06,7921.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TURP W/LASER,52648,CPT,360,RC,,INPATIENT,,,8082.75,3233.1,MONUMENT,COMMERCIAL,,,,6466.2,,6062.06,7921.1,
TURP W/LASER,52648,CPT,360,RC,,INPATIENT,,,8082.75,3233.1,UNITED HEALTH,UNITED COMMERCIAL,,,,6062.06,,6062.06,7921.1,
PX SMALL INTESTINE,44799,CPT,360,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,977.06,1276.7,PERCENT OF CHARGES BASED ON HCPCS CODE
PX SMALL INTESTINE,44799,CPT,360,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,1042.2,,977.06,1276.7,
NEISSERIA GONORRHEA DNA PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.63,89.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTRO TUBE REPLACEMENT,49450,CPT,350,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,570,744.8,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTRO TUBE REPLACEMENT,49450,CPT,350,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,608,,570,744.8,
GONORRHEA DNA AMP PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.63,89.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ERCP,43260,CPT,361,RC,,INPATIENT,,,6622,2648.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,6026.02,OTHER,4966.5,6489.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ERCP,43260,CPT,361,RC,,INPATIENT,,,6622,2648.8,MONUMENT,COMMERCIAL,,,,5297.6,,4966.5,6489.56,
ERCP,43260,CPT,361,RC,,INPATIENT,,,6622,2648.8,UNITED HEALTH,UNITED COMMERCIAL,,,,4966.5,,4966.5,6489.56,
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,INPATIENT,,,2927.25,1170.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2663.8,OTHER,2195.44,2868.71,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,INPATIENT,,,2927.25,1170.9,MONUMENT,COMMERCIAL,,,,2341.8,,2195.44,2868.71,
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,INPATIENT,,,2927.25,1170.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2195.44,,2195.44,2868.71,
AUTOLOGOUS W/PLASMA SEQUEST,3605010,CDM,,,,INPATIENT,,,3543.25,1417.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3224.36,OTHER,2657.44,3472.39,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AUTOLOGOUS W/PLASMA SEQUEST,3605010,CDM,,,,INPATIENT,,,3543.25,1417.3,MONUMENT,COMMERCIAL,,,,2834.6,,2657.44,3472.39,
AUTOLOGOUS W/PLASMA SEQUEST,3605010,CDM,,,,INPATIENT,,,3543.25,1417.3,UNITED HEALTH,UNITED COMMERCIAL,,,,2657.44,,2657.44,3472.39,
HYSTEROSALPINGOGRAM,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,415.8,OTHER,389.81,509.36,PERCENT OF CHARGES BASED ON HCPCS CODE
HYSTEROSALPINGOGRAM,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,MONUMENT,COMMERCIAL,,,,415.8,,389.81,509.36,
URINE NEISSERIA GONORRHEA DNA,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,68.63,89.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,OUTPATIENT,,,543,217.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,434.4,OTHER,407.25,532.14,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,OUTPATIENT,,,543,217.2,MONUMENT,COMMERCIAL,,,,434.4,,407.25,532.14,
MONKEYPOX PCR,87593,CPT,306,RC,,OUTPATIENT,,,120,48,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,90,117.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FNA ADDITIONAL LESION,10006,CPT,402,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
FNA ADDITIONAL LESION,10006,CPT,402,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
HUMAN PAPILLOMAVIRUS HIGH RISK,87624,CPT,300,RC,,OUTPATIENT,,,256.5,102.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,192.38,251.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S LEV 1,64493,CPT,350,RC,,OUTPATIENT,,,1763.58,705.432,BLUE CROSS ANTHEM,COMMERCIAL,,,,1410.864,OTHER,1322.7,1728.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S LEV 1,64493,CPT,350,RC,,OUTPATIENT,,,1763.58,705.432,MONUMENT,COMMERCIAL,,,,1410.9,,1322.7,1728.3,
RESPIRATORY VIRUS PCR,87631,CPT,300,RC,,OUTPATIENT,,,557.5,223,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,418.13,546.35,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S LEV 2,64494,CPT,350,RC,,OUTPATIENT,,,2730.94,1092.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,2184.752,OTHER,2048.2,2676.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S LEV 2,64494,CPT,350,RC,,OUTPATIENT,,,2730.94,1092.376,MONUMENT,COMMERCIAL,,,,2184.8,,2048.2,2676.3,
OUT-PT/OBS RESPIRATORY PANEL,87631,CPT,300,RC,,OUTPATIENT,,,285.26,114.104,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,213.9,279.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S LEV 3,64495,CPT,350,RC,,OUTPATIENT,,,2490,996,BLUE CROSS ANTHEM,COMMERCIAL,,,,1992,OTHER,1867.5,2440.2,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S LEV 3,64495,CPT,350,RC,,OUTPATIENT,,,2490,996,MONUMENT,COMMERCIAL,,,,1992,,1867.5,2440.2,
RESPIRATORY PANEL PCR,87633,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,496.13,648.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIOVERSION (PACU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1348.17,OTHER,1111.13,1451.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARDIOVERSION (PACU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,MONUMENT,COMMERCIAL,,,,1185.2,,1111.13,1451.87,
CARDIOVERSION (PACU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1111.13,,1111.13,1451.87,
TTL COLONSCOPY BIOPSY/SNARE,3610050,CDM,,,,INPATIENT,,,2691.25,1076.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2449.04,OTHER,2018.44,2637.43,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TTL COLONSCOPY BIOPSY/SNARE,3610050,CDM,,,,INPATIENT,,,2691.25,1076.5,MONUMENT,COMMERCIAL,,,,2153,,2018.44,2637.43,
TTL COLONSCOPY BIOPSY/SNARE,3610050,CDM,,,,INPATIENT,,,2691.25,1076.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2018.44,,2018.44,2637.43,
COLONOSCOPY TOTAL,3610070,CDM,,,,INPATIENT,,,1992.75,797.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1813.4,OTHER,1494.56,1952.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COLONOSCOPY TOTAL,3610070,CDM,,,,INPATIENT,,,1992.75,797.1,MONUMENT,COMMERCIAL,,,,1594.2,,1494.56,1952.9,
COLONOSCOPY TOTAL,3610070,CDM,,,,INPATIENT,,,1992.75,797.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1494.56,,1494.56,1952.9,
SIGMOIDOSCOPY LOW LEVEL,3610074,CDM,,,,INPATIENT,,,1000,400,BLUE CROSS ANTHEM,COMMERCIAL,,,,910,OTHER,750,980,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SIGMOIDOSCOPY LOW LEVEL,3610074,CDM,,,,INPATIENT,,,1000,400,MONUMENT,COMMERCIAL,,,,800,,750,980,
SIGMOIDOSCOPY LOW LEVEL,3610074,CDM,,,,INPATIENT,,,1000,400,UNITED HEALTH,UNITED COMMERCIAL,,,,750,,750,980,
BIOPSY W/PROCEDURE,3610076,CDM,,,,INPATIENT,,,698.5,279.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,635.64,OTHER,523.88,684.53,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BIOPSY W/PROCEDURE,3610076,CDM,,,,INPATIENT,,,698.5,279.4,MONUMENT,COMMERCIAL,,,,558.8,,523.88,684.53,
BIOPSY W/PROCEDURE,3610076,CDM,,,,INPATIENT,,,698.5,279.4,UNITED HEALTH,UNITED COMMERCIAL,,,,523.88,,523.88,684.53,
EGD,3610080,CDM,,,,INPATIENT,,,2537,1014.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2308.67,OTHER,1902.75,2486.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EGD,3610080,CDM,,,,INPATIENT,,,2537,1014.8,MONUMENT,COMMERCIAL,,,,2029.6,,1902.75,2486.26,
EGD,3610080,CDM,,,,INPATIENT,,,2537,1014.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1902.75,,1902.75,2486.26,
EGD WITH COLONOSCOPY,3610090,CDM,,,,INPATIENT,,,656.25,262.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,597.19,OTHER,492.19,643.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EGD WITH COLONOSCOPY,3610090,CDM,,,,INPATIENT,,,656.25,262.5,MONUMENT,COMMERCIAL,,,,525,,492.19,643.13,
EGD WITH COLONOSCOPY,3610090,CDM,,,,INPATIENT,,,656.25,262.5,UNITED HEALTH,UNITED COMMERCIAL,,,,492.19,,492.19,643.13,
EGD WITH PEG INCISION,3610100,CDM,,,,INPATIENT,,,2537,1014.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2308.67,OTHER,1902.75,2486.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EGD WITH PEG INCISION,3610100,CDM,,,,INPATIENT,,,2537,1014.8,MONUMENT,COMMERCIAL,,,,2029.6,,1902.75,2486.26,
EGD WITH PEG INCISION,3610100,CDM,,,,INPATIENT,,,2537,1014.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1902.75,,1902.75,2486.26,
EGD W/BIOPSY,3610110,CDM,,,,INPATIENT,,,2630.25,1052.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2393.53,OTHER,1972.69,2577.65,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EGD W/BIOPSY,3610110,CDM,,,,INPATIENT,,,2630.25,1052.1,MONUMENT,COMMERCIAL,,,,2104.2,,1972.69,2577.65,
EGD W/BIOPSY,3610110,CDM,,,,INPATIENT,,,2630.25,1052.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1972.69,,1972.69,2577.65,
EGD W/FOREIGN BODY REMOVAL,3610112,CDM,361,RC,,INPATIENT,,,2537,1014.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2308.67,OTHER,1902.75,2486.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EGD W/FOREIGN BODY REMOVAL,3610112,CDM,361,RC,,INPATIENT,,,2537,1014.8,MONUMENT,COMMERCIAL,,,,2029.6,,1902.75,2486.26,
EGD W/FOREIGN BODY REMOVAL,3610112,CDM,361,RC,,INPATIENT,,,2537,1014.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1902.75,,1902.75,2486.26,
FLUSHING IMPLANTABLE PORT,96523,CPT,260,RC,,OUTPATIENT,,,282.25,112.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.8,OTHER,211.69,276.61,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUSHING IMPLANTABLE PORT,96523,CPT,260,RC,,OUTPATIENT,,,282.25,112.9,MONUMENT,COMMERCIAL,,,,225.8,,211.69,276.61,
RSV AMPLIFIED PROBE TECHNIQUE,87634,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.5,99.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COLLECT BLOOD PICC LINE LVL I,36592,CPT,761,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,132.94,173.71,PERCENT OF CHARGES BASED ON HCPCS CODE
COLLECT BLOOD PICC LINE LVL I,36592,CPT,761,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,141.8,,132.94,173.71,
RSV DNA/RNA AMP PROBE,87634,CPT,300,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.8,95.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DECLOTTING AGENT OF IMPLT,36593,CPT,761,RC,,OUTPATIENT,,,804,321.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,643.2,OTHER,603,787.92,PERCENT OF CHARGES BASED ON HCPCS CODE
DECLOTTING AGENT OF IMPLT,36593,CPT,761,RC,,OUTPATIENT,,,804,321.6,MONUMENT,COMMERCIAL,,,,643.2,,603,787.92,
COVID-19 POC RAPID,87635,CPT,300,RC,,OUTPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60,78.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COLLECT BLOOD PICC LINE LVL II,36592,CPT,761,RC,,OUTPATIENT,,,232,92.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.6,OTHER,174,227.36,PERCENT OF CHARGES BASED ON HCPCS CODE
COLLECT BLOOD PICC LINE LVL II,36592,CPT,761,RC,,OUTPATIENT,,,232,92.8,MONUMENT,COMMERCIAL,,,,185.6,,174,227.36,
COVID19 SARS2 RNA QUAL RT PCR,87635,CPT,300,RC,,OUTPATIENT,,,100.2,40.08,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,75.2,98.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD DRAW FROM IMPLNT PORT,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,BLUE CROSS ANTHEM,COMMERCIAL,,,,230,OTHER,215.63,281.75,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD DRAW FROM IMPLNT PORT,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,MONUMENT,COMMERCIAL,,,,230,,215.63,281.75,
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.44,54.15,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HEMORRDOID BANDING,3610140,CDM,,,,INPATIENT,,,722.25,288.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,657.25,OTHER,541.69,707.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HEMORRDOID BANDING,3610140,CDM,,,,INPATIENT,,,722.25,288.9,MONUMENT,COMMERCIAL,,,,577.8,,541.69,707.81,
HEMORRDOID BANDING,3610140,CDM,,,,INPATIENT,,,722.25,288.9,UNITED HEALTH,UNITED COMMERCIAL,,,,541.69,,541.69,707.81,
PARACENTESIS,49080,CPT,361,RC,,OUTPATIENT,,,582.5,233,BLUE CROSS ANTHEM,COMMERCIAL,,,,466,OTHER,436.88,570.85,PERCENT OF CHARGES BASED ON HCPCS CODE
PARACENTESIS,49080,CPT,361,RC,,OUTPATIENT,,,582.5,233,MONUMENT,COMMERCIAL,,,,466,,436.88,570.85,
STREP GRP A AMP PROBE TECH,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.56,55.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIGMOIDOSCOPY,3610170,CDM,361,RC,,INPATIENT,,,1891,756.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1720.81,OTHER,1418.25,1853.18,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SIGMOIDOSCOPY,3610170,CDM,361,RC,,INPATIENT,,,1891,756.4,MONUMENT,COMMERCIAL,,,,1512.8,,1418.25,1853.18,
SIGMOIDOSCOPY,3610170,CDM,361,RC,,INPATIENT,,,1891,756.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1418.25,,1418.25,1853.18,
ANOSCOPY DIAGNOSTIC,3610225,CDM,,,,INPATIENT,,,206.5,82.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,187.92,OTHER,154.88,202.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANOSCOPY DIAGNOSTIC,3610225,CDM,,,,INPATIENT,,,206.5,82.6,MONUMENT,COMMERCIAL,,,,165.2,,154.88,202.37,
ANOSCOPY DIAGNOSTIC,3610225,CDM,,,,INPATIENT,,,206.5,82.6,UNITED HEALTH,UNITED COMMERCIAL,,,,154.88,,154.88,202.37,
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.448,OTHER,390.4,510.1,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,MONUMENT,COMMERCIAL,,,,416.4,,390.4,510.1,
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,54,21.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECT TRIGGER POINTS 3/>,20553,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.448,OTHER,390.4,510.1,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECT TRIGGER POINTS 3/>,20553,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,MONUMENT,COMMERCIAL,,,,416.4,,390.4,510.1,
STREP B DNA AMP PROBE,87653,CPT,300,RC,,OUTPATIENT,,,252.75,101.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,189.56,247.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,528.02,211.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,422.416,OTHER,396,517.5,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,528.02,211.208,MONUMENT,COMMERCIAL,,,,422.4,,396,517.5,
TRICHOMONAS VAGINALIS AMP RNA,87661,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,182.63,238.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN/INJ JOINT/BURSA W/O US,20610,CPT,320,RC,,OUTPATIENT,,,520.56,208.224,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.448,OTHER,390.4,510.1,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN/INJ JOINT/BURSA W/O US,20610,CPT,320,RC,,OUTPATIENT,,,520.56,208.224,MONUMENT,COMMERCIAL,,,,416.4,,390.4,510.1,
Z TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.6,68.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRN/INJ JNT/BURSA W/O US BILA,20610,CPT,320,RC,,OUTPATIENT,,,1041.12,416.448,BLUE CROSS ANTHEM,COMMERCIAL,,,,832.896,OTHER,780.8,1020.3,PERCENT OF CHARGES BASED ON HCPCS CODE
DRN/INJ JNT/BURSA W/O US BILA,20610,CPT,320,RC,,OUTPATIENT,,,1041.12,416.448,MONUMENT,COMMERCIAL,,,,832.9,,780.8,1020.3,
ENTEROVIRUS RNA QUAL RT PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN SPINAL CORD CYST,62268,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,BLUE CROSS ANTHEM,COMMERCIAL,,,,1330.96,OTHER,1247.8,1630.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN SPINAL CORD CYST,62268,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,MONUMENT,COMMERCIAL,,,,1331,,1247.8,1630.4,
EPSTEIN-BARR VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
WEST NILE VIRUS  RNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,395,158,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
PHEUMOCYSTIS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
BK VIRUS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX INTERLAMINAR LMBR/SAC,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX INTERLAMINAR LMBR/SAC,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
BK VIRUS PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,320,RC,,OUTPATIENT,,,1283.34,513.336,BLUE CROSS ANTHEM,COMMERCIAL,,,,1026.672,OTHER,962.5,1257.7,PERCENT OF CHARGES BASED ON HCPCS CODE
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,320,RC,,OUTPATIENT,,,1283.34,513.336,MONUMENT,COMMERCIAL,,,,1026.7,,962.5,1257.7,
MALARIA MODLECULAR DETECT PCR,87798,CPT,306,RC,,OUTPATIENT,,,255.75,102.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,191.81,250.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD GR OCPL NRV,64405,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,BLUE CROSS ANTHEM,COMMERCIAL,,,,416.448,OTHER,390.4,510.1,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD GR OCPL NRV,64405,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,MONUMENT,COMMERCIAL,,,,416.4,,390.4,510.1,
AMPLIFIED PROBE TECHE EA ORGNS,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD BRACH PLEXUS,64415,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,BLUE CROSS ANTHEM,COMMERCIAL,,,,1311.44,OTHER,1229.5,1606.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD BRACH PLEXUS,64415,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,MONUMENT,COMMERCIAL,,,,1311.4,,1229.5,1606.5,
EBV BY PCR QUALITATIVE,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD AXILLARY NRV,64417,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,BLUE CROSS ANTHEM,COMMERCIAL,,,,1311.44,OTHER,1229.5,1606.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD AXILLARY NRV,64417,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,MONUMENT,COMMERCIAL,,,,1311.4,,1229.5,1606.5,
Q FEVER PCR,87798,CPT,306,RC,,OUTPATIENT,,,603.75,241.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,452.81,591.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
PARVOVIRUS B-19 PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
LEGIONELLA SPECIES BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
VARICELLA-ZOSTER VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
Z INFLUENZA A H1N1 BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
MUMPS PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,506.3,661.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,OUTPATIENT,,,1283.34,513.336,BLUE CROSS ANTHEM,COMMERCIAL,,,,1026.672,OTHER,962.5,1257.7,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,OUTPATIENT,,,1283.34,513.336,MONUMENT,COMMERCIAL,,,,1026.7,,962.5,1257.7,
MEASLES PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,506.3,661.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PVB THORACIC SINGLE INJ SITE,64461,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
PVB THORACIC SINGLE INJ SITE,64461,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
MYCOPLASMA HOMINIS PCR,87798,CPT,306,RC,,OUTPATIENT,,,195,78,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.3,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T 1 LT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T 1 LT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63.8,83.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T LT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2119.2,OTHER,1986.8,2596,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T LT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,MONUMENT,COMMERCIAL,,,,2119.2,,1986.8,2596,
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63.8,83.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI L/S 1,64483,CPT,361,RC,,OUTPATIENT,,,1693.3,677.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,1354.64,OTHER,1270,1659.4,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI L/S 1,64483,CPT,361,RC,,OUTPATIENT,,,1693.3,677.32,MONUMENT,COMMERCIAL,,,,1354.6,,1270,1659.4,
TOXOPLASMA GONDII PCR BLD,87798,CPT,306,RC,,OUTPATIENT,,,513.75,205.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,385.3,503.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI L/S EA,64484,CPT,361,RC,,OUTPATIENT,,,1270.87,508.348,BLUE CROSS ANTHEM,COMMERCIAL,,,,1016.696,OTHER,953.2,1245.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI L/S EA,64484,CPT,361,RC,,OUTPATIENT,,,1270.87,508.348,MONUMENT,COMMERCIAL,,,,1016.7,,953.2,1245.5,
RICKETTSIA SPECIEIS DNA PCR,87798,CPT,306,RC,,OUTPATIENT,,,406.66,162.664,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,305,398.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TAP BLOCK BI INJECTION,64488,CPT,361,RC,,OUTPATIENT,,,7130,2852,BLUE CROSS ANTHEM,COMMERCIAL,,,,5704,OTHER,5347.5,6987.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TAP BLOCK BI INJECTION,64488,CPT,361,RC,,OUTPATIENT,,,7130,2852,MONUMENT,COMMERCIAL,,,,5704,,5347.5,6987.4,
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 1 LEV L,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,BLUE CROSS ANTHEM,COMMERCIAL,,,,1311.44,OTHER,1229.5,1606.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 1 LEV L,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,MONUMENT,COMMERCIAL,,,,1311.4,,1229.5,1606.5,
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.3,34.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.34,942.136,BLUE CROSS ANTHEM,COMMERCIAL,,,,1884.272,OTHER,1766.5,2308.2,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.34,942.136,MONUMENT,COMMERCIAL,,,,1884.3,,1766.5,2308.2,
Z DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,70.18,28.072,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.6,68.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,350,RC,,OUTPATIENT,,,2287.66,915.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,1830.128,OTHER,1715.7,2241.9,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,350,RC,,OUTPATIENT,,,2287.66,915.064,MONUMENT,COMMERCIAL,,,,1830.1,,1715.7,2241.9,
INFECT AGT NUCLEIC ACID QUANT,87799,CPT,300,RC,,OUTPATIENT,,,228,91.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,171,223.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S 1 LEV,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,BLUE CROSS ANTHEM,COMMERCIAL,,,,1358.64,OTHER,1273.7,1664.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S 1 LEV,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,MONUMENT,COMMERCIAL,,,,1358.6,,1273.7,1664.3,
JC VIRUS,87799,CPT,300,RC,,OUTPATIENT,,,543,217.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,407.25,532.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S 2 LEV,64494,CPT,350,RC,,OUTPATIENT,,,826,330.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,660.8,OTHER,619.5,809.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S 2 LEV,64494,CPT,350,RC,,OUTPATIENT,,,826,330.4,MONUMENT,COMMERCIAL,,,,660.8,,619.5,809.5,
EBV DNA DETECTION BY PCR,87799,CPT,300,RC,,OUTPATIENT,,,270.25,108.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,202.69,264.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S 3 LEV,64495,CPT,350,RC,,OUTPATIENT,,,1186,474.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,948.8,OTHER,889.5,1162.3,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S 3 LEV,64495,CPT,350,RC,,OUTPATIENT,,,1186,474.4,MONUMENT,COMMERCIAL,,,,948.8,,889.5,1162.3,
INFECTIOUS AGENT DETECTION APT,87801,CPT,300,RC,,OUTPATIENT,,,231,92.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.25,226.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEMODENERV MUSC MIGRAINE,64615,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,422.416,OTHER,396,517.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMODENERV MUSC MIGRAINE,64615,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,MONUMENT,COMMERCIAL,,,,422.4,,396,517.5,
Z DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.3,137.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,OUTPATIENT,,,3548.74,1419.496,BLUE CROSS ANTHEM,COMMERCIAL,,,,2838.992,OTHER,2661.6,3477.8,PERCENT OF CHARGES BASED ON HCPCS CODE
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,OUTPATIENT,,,3548.74,1419.496,MONUMENT,COMMERCIAL,,,,2839,,2661.6,3477.8,
VISBY SEXUAL HEALTH TEST,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,105.3,137.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DESTROY C/T FACET JNT,64633,CPT,361,RC,,OUTPATIENT,,,3469.78,1387.912,BLUE CROSS ANTHEM,COMMERCIAL,,,,2775.824,OTHER,2602.3,3400.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DESTROY C/T FACET JNT,64633,CPT,361,RC,,OUTPATIENT,,,3469.78,1387.912,MONUMENT,COMMERCIAL,,,,2775.8,,2602.3,3400.4,
DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,98,39.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.5,96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DESTROY C/T FACET JNT ADDL,64634,CPT,361,RC,,OUTPATIENT,,,3512,1404.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2809.6,OTHER,2634,3441.8,PERCENT OF CHARGES BASED ON HCPCS CODE
DESTROY C/T FACET JNT ADDL,64634,CPT,361,RC,,OUTPATIENT,,,3512,1404.8,MONUMENT,COMMERCIAL,,,,2809.6,,2634,3441.8,
"INFCT ANTIGEN, INFLUENZA",87804,CPT,300,RC,,OUTPATIENT,,,41,16.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.75,40.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,OUTPATIENT,,,3496.78,1398.712,BLUE CROSS ANTHEM,COMMERCIAL,,,,2797.424,OTHER,2622.6,3426.8,PERCENT OF CHARGES BASED ON HCPCS CODE
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,OUTPATIENT,,,3496.78,1398.712,MONUMENT,COMMERCIAL,,,,2797.4,,2622.6,3426.8,
RSV ANTIGEN,87807,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,150.38,196.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DESTROY L/S FACET JNT ADDL,64636,CPT,361,RC,,OUTPATIENT,,,4010,1604,BLUE CROSS ANTHEM,COMMERCIAL,,,,3208,OTHER,3007.5,3929.8,PERCENT OF CHARGES BASED ON HCPCS CODE
DESTROY L/S FACET JNT ADDL,64636,CPT,361,RC,,OUTPATIENT,,,4010,1604,MONUMENT,COMMERCIAL,,,,3208,,3007.5,3929.8,
STREP A ANTIGEN,87880,CPT,300,RC,,OUTPATIENT,,,38.75,15.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.06,37.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,BLUE CROSS ANTHEM,COMMERCIAL,,,,1330.96,OTHER,1247.8,1630.4,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,MONUMENT,COMMERCIAL,,,,1331,,1247.8,1630.4,
"INFCTS ANTIGN, STREPTOCOCCUS A",87880,CPT,300,RC,,OUTPATIENT,,,47,18.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.25,46.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NERVOUS SYSTEM SURGERY UNLISTE,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,422.416,OTHER,396,517.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NERVOUS SYSTEM SURGERY UNLISTE,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,MONUMENT,COMMERCIAL,,,,422.4,,396,517.5,
LEGIONELLA PNEUMO AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99,129.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T 1 RT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T 1 RT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
STREP PHEUMONIAE AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99,129.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T RT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2119.2,OTHER,1986.8,2596,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T RT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,MONUMENT,COMMERCIAL,,,,2119.2,,1986.8,2596,
STREPTOCOCCUS PNEUMO AG CSF,87899,CPT,300,RC,,OUTPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159,207.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 1 LEV R,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,BLUE CROSS ANTHEM,COMMERCIAL,,,,1311.44,OTHER,1229.5,1606.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 1 LEV R,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,MONUMENT,COMMERCIAL,,,,1311.4,,1229.5,1606.5,
"CRYPTOCOCCUS AG TITER,LFA,CSF",87899,CPT,300,RC,,OUTPATIENT,,,87.66,35.064,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,65.7,85.9,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.54,942.216,BLUE CROSS ANTHEM,COMMERCIAL,,,,1884.432,OTHER,1766.7,2308.4,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.54,942.216,MONUMENT,COMMERCIAL,,,,1884.4,,1766.7,2308.4,
HIV-1 PHENOTYPIC RESIST PRE,87900,CPT,300,RC,,OUTPATIENT,,,673.5,269.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,505.13,660.03,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THER/PROPH/DIAG IV INF INIT,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,380.6,OTHER,356.8,466.2,PERCENT OF CHARGES BASED ON HCPCS CODE
THER/PROPH/DIAG IV INF INIT,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,MONUMENT,COMMERCIAL,,,,380.6,,356.8,466.2,
HIV-1 GENOTYPE REFLEX TO PHENO,87901,CPT,300,RC,,OUTPATIENT,,,1378.75,551.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1034.06,1351.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THER/PROPH/DIAG IV INF ADDON,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.6,OTHER,73.7,96.3,PERCENT OF CHARGES BASED ON HCPCS CODE
THER/PROPH/DIAG IV INF ADDON,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.7,96.3,
HEPATITIS C GENOTYPE,87902,CPT,300,RC,,OUTPATIENT,,,678.75,271.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,509.06,665.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ FOR SACROILIAC JT ANESTH B,G0260,HCPCS,350,RC,,INPATIENT,,,2529.68,1011.872,BLUE CROSS ANTHEM,COMMERCIAL,,,,2302.01,OTHER,1897.3,2479.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INJ FOR SACROILIAC JT ANESTH B,G0260,HCPCS,350,RC,,INPATIENT,,,2529.68,1011.872,MONUMENT,COMMERCIAL,,,,2023.7,,1897.3,2479.1,
INJ FOR SACROILIAC JT ANESTH B,G0260,HCPCS,350,RC,,INPATIENT,,,2529.68,1011.872,UNITED HEALTH,UNITED COMMERCIAL,,,,1897.3,,1897.3,2479.1,
ANESTHESIA LOCAL ADDT'L 15,3700600,CDM,,,,INPATIENT,,,49.75,19.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,45.27,OTHER,37.31,48.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA LOCAL ADDT'L 15,3700600,CDM,,,,INPATIENT,,,49.75,19.9,MONUMENT,COMMERCIAL,,,,39.8,,37.31,48.76,
ANESTHESIA LOCAL ADDT'L 15,3700600,CDM,,,,INPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,,37.31,,37.31,48.76,
ANESTHESIA LOCAL,3700602,CDM,,,,INPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,202.7,OTHER,167.06,218.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA LOCAL,3700602,CDM,,,,INPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
ANESTHESIA LOCAL,3700602,CDM,,,,INPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,167.06,,167.06,218.3,
ANESTHESIA REGIONAL ADDT'L 15,3700700,CDM,,,,INPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.35,OTHER,59.63,77.91,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA REGIONAL ADDT'L 15,3700700,CDM,,,,INPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
ANESTHESIA REGIONAL ADDT'L 15,3700700,CDM,,,,INPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,,59.63,,59.63,77.91,
ANESTHESIA REGIONAL SUPPLIES,3700703,CDM,,,,INPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,523.25,OTHER,431.25,563.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA REGIONAL SUPPLIES,3700703,CDM,,,,INPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
ANESTHESIA REGIONAL SUPPLIES,3700703,CDM,,,,INPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,431.25,,431.25,563.5,
ANESTHESIA GENERAL ADDT'L 15,3700800,CDM,,,,INPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.46,OTHER,79.5,103.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA GENERAL ADDT'L 15,3700800,CDM,,,,INPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
ANESTHESIA GENERAL ADDT'L 15,3700800,CDM,,,,INPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,79.5,,79.5,103.88,
ANESTHESIA GENERAL,3700803,CDM,,,,INPATIENT,,,941.5,376.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,856.77,OTHER,706.13,922.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ANESTHESIA GENERAL,3700803,CDM,,,,INPATIENT,,,941.5,376.6,MONUMENT,COMMERCIAL,,,,753.2,,706.13,922.67,
ANESTHESIA GENERAL,3700803,CDM,,,,INPATIENT,,,941.5,376.6,UNITED HEALTH,UNITED COMMERCIAL,,,,706.13,,706.13,922.67,
EPIDURAL INJECTION ANESTHESIA,3701112,CDM,,,,INPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EPIDURAL INJECTION ANESTHESIA,3701112,CDM,,,,INPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
EPIDURAL INJECTION ANESTHESIA,3701112,CDM,,,,INPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
NJX AA&/STRD NRV NRVTG SI JT B,64451,CPT,361,RC,,OUTPATIENT,,,2529.68,1011.872,BLUE CROSS ANTHEM,COMMERCIAL,,,,2023.744,OTHER,1897.3,2479.1,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD NRV NRVTG SI JT B,64451,CPT,361,RC,,OUTPATIENT,,,2529.68,1011.872,MONUMENT,COMMERCIAL,,,,2023.7,,1897.3,2479.1,
HEP C RNA NSC DRUG RESISTANCE,87902,CPT,300,RC,,OUTPATIENT,,,1007.25,402.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,755.44,987.11,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T 1 BI,64479,CPT,,,,OUTPATIENT,,,2529.68,1011.872,BLUE CROSS ANTHEM,COMMERCIAL,,,,2023.744,OTHER,1897.3,2479.1,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T 1 BI,64479,CPT,,,,OUTPATIENT,,,2529.68,1011.872,MONUMENT,COMMERCIAL,,,,2023.7,,1897.3,2479.1,
CHCV GENTYPE RESOLUTION,87902,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,386.2,504.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI C/T BIL,64480,CPT,,,,OUTPATIENT,,,5298,2119.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4238.4,OTHER,3973.5,5192,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI C/T BIL,64480,CPT,,,,OUTPATIENT,,,5298,2119.2,MONUMENT,COMMERCIAL,,,,4238.4,,3973.5,5192,
HEPATITIS B GENOTYPE,87912,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,372.19,486.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD TFRM EPI L/S 1 BI,64483,CPT,361,RC,,OUTPATIENT,,,3278.6,1311.44,BLUE CROSS ANTHEM,COMMERCIAL,,,,2622.88,OTHER,2459,3213,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD TFRM EPI L/S 1 BI,64483,CPT,361,RC,,OUTPATIENT,,,3278.6,1311.44,MONUMENT,COMMERCIAL,,,,2622.9,,2459,3213,
FLUCONAZOLE (DIFLUCAN) SENS,87999,CPT,306,RC,,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,375,490,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 1 LEV B,64490,CPT,350,RC,,OUTPATIENT,,,2458.95,983.58,BLUE CROSS ANTHEM,COMMERCIAL,,,,1967.16,OTHER,1844.2,2409.8,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 1 LEV B,64490,CPT,350,RC,,OUTPATIENT,,,2458.95,983.58,MONUMENT,COMMERCIAL,,,,1967.2,,1844.2,2409.8,
CYTOPATHLOGY FLUIDS WASH/BRUSH,88104,CPT,310,RC,,OUTPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,72.75,95.06,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT C/T 2 LEV B,64491,CPT,350,RC,,OUTPATIENT,,,4710.68,1884.272,BLUE CROSS ANTHEM,COMMERCIAL,,,,3768.544,OTHER,3533,4616.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT C/T 2 LEV B,64491,CPT,350,RC,,OUTPATIENT,,,4710.68,1884.272,MONUMENT,COMMERCIAL,,,,3768.5,,3533,4616.5,
CYTOPATHOLOGY NON-GYN,88106,CPT,300,RC,,OUTPATIENT,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,65.25,85.26,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S 1 LEV B,64493,CPT,350,RC,,OUTPATIENT,,,3396.6,1358.64,BLUE CROSS ANTHEM,COMMERCIAL,,,,2717.28,OTHER,2547.5,3328.7,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S 1 LEV B,64493,CPT,350,RC,,OUTPATIENT,,,3396.6,1358.64,MONUMENT,COMMERCIAL,,,,2717.3,,2547.5,3328.7,
CYTOPATH SMEAR,88108,CPT,311,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ PARAVERT F JNT L/S 2 LEV B,64494,CPT,350,RC,,OUTPATIENT,,,1652,660.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1321.6,OTHER,1239,1619,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ PARAVERT F JNT L/S 2 LEV B,64494,CPT,350,RC,,OUTPATIENT,,,1652,660.8,MONUMENT,COMMERCIAL,,,,1321.6,,1239,1619,
CYTOPATHOLOGY SMEARS INTREPRET,88108,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.19,106.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION TRTMNT OF NERVE BILA,64640,CPT,361,RC,,OUTPATIENT,,,3327.4,1330.96,BLUE CROSS ANTHEM,COMMERCIAL,,,,2661.92,OTHER,2495.6,3260.9,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION TRTMNT OF NERVE BILA,64640,CPT,361,RC,,OUTPATIENT,,,3327.4,1330.96,MONUMENT,COMMERCIAL,,,,2661.9,,2495.6,3260.9,
CYTOLOGY SPUTUM/FLUIDS,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RHO(D) IMMUNE GLOBULIN RHIGIV,90386,CPT,636,RC,,OUTPATIENT,,,386,154.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.8,OTHER,289.5,378.28,PERCENT OF CHARGES BASED ON HCPCS CODE
RHO(D) IMMUNE GLOBULIN RHIGIV,90386,CPT,636,RC,,OUTPATIENT,,,386,154.4,MONUMENT,COMMERCIAL,,,,308.8,,289.5,378.28,
CYTOLOGY URINE,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RHO(D) IMMUNE GLOBULIN (RHIG),90384,CPT,636,RC,,OUTPATIENT,,,386,154.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.8,OTHER,289.5,378.28,PERCENT OF CHARGES BASED ON HCPCS CODE
RHO(D) IMMUNE GLOBULIN (RHIG),90384,CPT,636,RC,,OUTPATIENT,,,386,154.4,MONUMENT,COMMERCIAL,,,,308.8,,289.5,378.28,
CYTOPATH LIQUID BASED NON GYN,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,66.19,86.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,INPATIENT,,,402.25,160.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.05,OTHER,301.69,394.21,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,INPATIENT,,,402.25,160.9,MONUMENT,COMMERCIAL,,,,321.8,,301.69,394.21,
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,INPATIENT,,,402.25,160.9,UNITED HEALTH,UNITED COMMERCIAL,,,,301.69,,301.69,394.21,
BLOOD TRANS BLD OR COMP,36430,CPT,391,RC,,OUTPATIENT,,,1003.75,401.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,803,OTHER,752.81,983.68,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANS BLD OR COMP,36430,CPT,391,RC,,OUTPATIENT,,,1003.75,401.5,MONUMENT,COMMERCIAL,,,,803,,752.81,983.68,
UROVYSION FISH,88120,CPT,311,RC,,OUTPATIENT,,,414.75,165.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,311.06,406.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLATELET PHERESIS LEU IRR,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1567.7,OTHER,1292.06,1688.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLATELET PHERESIS LEU IRR,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,MONUMENT,COMMERCIAL,,,,1378.2,,1292.06,1688.3,
PLATELET PHERESIS LEU IRR,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1292.06,,1292.06,1688.3,
PLATELET EACH - LR,P9032,HCPCS,390,RC,,INPATIENT,,,394.75,157.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.22,OTHER,296.06,386.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLATELET EACH - LR,P9032,HCPCS,390,RC,,INPATIENT,,,394.75,157.9,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
PLATELET EACH - LR,P9032,HCPCS,390,RC,,INPATIENT,,,394.75,157.9,UNITED HEALTH,UNITED COMMERCIAL,,,,296.06,,296.06,386.86,
ABO (BLOOD TYPING),86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,24,31.36,PERCENT OF CHARGES BASED ON HCPCS CODE
ABO (BLOOD TYPING),86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,25.6,,24,31.36,
BARR BODIES (SEX CHROMATIN ID),88130,CPT,311,RC,,OUTPATIENT,,,155.75,62.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,116.81,152.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABO BLOOD TYPING,86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
ABO BLOOD TYPING,86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
THINPREP SCREEN  W/O PHYS INTR,88142,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.19,106.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIBODY SCREENING (RBC),86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.344,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIBODY SCREENING (RBC),86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
THINPREP PAP RESCREEN,88143,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.19,106.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIGEN TYPING (UNIT),86902,CPT,300,RC,,OUTPATIENT,,,295,118,BLUE CROSS ANTHEM,COMMERCIAL,,,,236,OTHER,20.44,26.71,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIGEN TYPING (UNIT),86902,CPT,300,RC,,OUTPATIENT,,,295,118,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
PAP SMEAR  TECHNICAL FEE,88150,CPT,311,RC,,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIGEN TYPING (PATIENT),86905,CPT,300,RC,,OUTPATIENT,,,295,118,BLUE CROSS ANTHEM,COMMERCIAL,,,,236,OTHER,20.44,26.71,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIGEN TYPING (PATIENT),86905,CPT,300,RC,,OUTPATIENT,,,295,118,MONUMENT,COMMERCIAL,,,,21.8,,20.44,26.71,
SMEAR CYTOPATHOLOGY,88161,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,70.69,92.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,32,12.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.6,OTHER,24,31.36,PERCENT OF CHARGES BASED ON HCPCS CODE
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,32,12.8,MONUMENT,COMMERCIAL,,,,25.6,,24,31.36,
CYTOPATHOLOGY BODY FLUIDS MULT,88162,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,75.4,OTHER,70.69,92.37,PERCENT OF CHARGES BASED ON HCPCS CODE
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,MONUMENT,COMMERCIAL,,,,75.4,,70.69,92.37,
CYTOPATH TBS  C/V  MANUAL,88164,CPT,311,RC,,OUTPATIENT,,,43.75,17.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.81,42.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FETAL SCREEN,85461,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,36.2,OTHER,33.94,44.35,PERCENT OF CHARGES BASED ON HCPCS CODE
FETAL SCREEN,85461,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,MONUMENT,COMMERCIAL,,,,36.2,,33.94,44.35,
PAP W/MATURATION INDEX,88165,CPT,311,RC,,OUTPATIENT,,,84.44,33.776,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.5,52.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIBODY IDENTIFICATION,86870,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,BLUE CROSS ANTHEM,COMMERCIAL,,,,464.424,OTHER,269.81,352.56,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIBODY IDENTIFICATION,86870,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,MONUMENT,COMMERCIAL,,,,287.8,,269.81,352.56,
EVALUATION OF FINE NEEDLE BX,88172,CPT,311,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,96.94,126.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIBODY TITER,86886,CPT,390,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,151.31,197.72,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIBODY TITER,86886,CPT,390,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
FINE NEEDLE BIOPSY INTRP&RPT,88173,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,63,82.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z PROGEST RECEPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z PROGEST RECEPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
LIQUID BASED PREPARATION,88174,CPT,300,RC,,OUTPATIENT,,,240,96,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,180,235.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
Z ESTROGEN RECPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,194.06,253.58,PERCENT OF CHARGES BASED ON HCPCS CODE
Z ESTROGEN RECPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,207,,194.06,253.58,
EVAL FINE NEEDLE ASP ADDL SPEC,88177,CPT,300,RC,,OUTPATIENT,,,66.25,26.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.69,64.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOSURE PUNCTURE DEVICE,3900883,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CLOSURE PUNCTURE DEVICE,3900883,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
CLOSURE PUNCTURE DEVICE,3900883,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
PRBC LR EA UNIT,P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,496.18,OTHER,408.94,534.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PRBC LR EA UNIT,P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,MONUMENT,COMMERCIAL,,,,436.2,,408.94,534.35,
PRBC LR EA UNIT,P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,UNITED HEALTH,UNITED COMMERCIAL,,,,408.94,,408.94,534.35,
PLATELET APHERESIS LR/UNIT,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1567.7,OTHER,1292.06,1688.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLATELET APHERESIS LR/UNIT,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,MONUMENT,COMMERCIAL,,,,1378.2,,1292.06,1688.3,
PLATELET APHERESIS LR/UNIT,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1292.06,,1292.06,1688.3,
PLT  EA UNIT,P9019,HCPCS,390,RC,,INPATIENT,,,272,108.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,247.52,OTHER,204,266.56,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLT  EA UNIT,P9019,HCPCS,390,RC,,INPATIENT,,,272,108.8,MONUMENT,COMMERCIAL,,,,217.6,,204,266.56,
PLT  EA UNIT,P9019,HCPCS,390,RC,,INPATIENT,,,272,108.8,UNITED HEALTH,UNITED COMMERCIAL,,,,204,,204,266.56,
CROSSMATCH LEUKO REDUCED,86920,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,88.13,115.15,PERCENT OF CHARGES BASED ON HCPCS CODE
CROSSMATCH LEUKO REDUCED,86920,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
FLOW CYTOMETRY  RBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BLOOD LEUKO REDUCED,IRRADIATED",P9040,HCPCS,390,RC,,INPATIENT,,,929.25,371.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,845.62,OTHER,696.94,910.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"BLOOD LEUKO REDUCED,IRRADIATED",P9040,HCPCS,390,RC,,INPATIENT,,,929.25,371.7,MONUMENT,COMMERCIAL,,,,743.4,,696.94,910.67,
"BLOOD LEUKO REDUCED,IRRADIATED",P9040,HCPCS,390,RC,,INPATIENT,,,929.25,371.7,UNITED HEALTH,UNITED COMMERCIAL,,,,696.94,,696.94,910.67,
IRRADIATION OF BLOOD PROD (EA),86945,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,293.2,OTHER,274.88,359.17,PERCENT OF CHARGES BASED ON HCPCS CODE
IRRADIATION OF BLOOD PROD (EA),86945,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,MONUMENT,COMMERCIAL,,,,293.2,,274.88,359.17,
Z FLOW CYTOMETRY WBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PLTPH LR    IRR     APHERESIS,P9037,HCPCS,390,RC,,INPATIENT,,,1875.5,750.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1706.71,OTHER,1406.63,1837.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLTPH LR    IRR     APHERESIS,P9037,HCPCS,390,RC,,INPATIENT,,,1875.5,750.2,MONUMENT,COMMERCIAL,,,,1500.4,,1406.63,1837.99,
PLTPH LR    IRR     APHERESIS,P9037,HCPCS,390,RC,,INPATIENT,,,1875.5,750.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1406.63,,1406.63,1837.99,
SPLITTING OF BLD OR BLD PRODTS,86985,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.84,OTHER,89.63,117.11,PERCENT OF CHARGES BASED ON HCPCS CODE
SPLITTING OF BLD OR BLD PRODTS,86985,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,MONUMENT,COMMERCIAL,,,,95.6,,89.63,117.11,
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,450,588,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANTIGEN SCREENING,86906,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
ANTIGEN SCREENING,86906,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
FETOMATERNAL BLEED FLOW CYTO,88184,CPT,300,RC,,OUTPATIENT,,,851.25,340.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,638.44,834.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"PRBC TRANSFUSED,LEUKO REDUCED",P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,496.18,OTHER,408.94,534.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"PRBC TRANSFUSED,LEUKO REDUCED",P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,MONUMENT,COMMERCIAL,,,,436.2,,408.94,534.35,
"PRBC TRANSFUSED,LEUKO REDUCED",P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,UNITED HEALTH,UNITED COMMERCIAL,,,,408.94,,408.94,534.35,
PLASMA  FRESH FROZEN SD,P9017,HCPCS,390,RC,,INPATIENT,,,225.5,90.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,205.21,OTHER,169.13,220.99,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PLASMA  FRESH FROZEN SD,P9017,HCPCS,390,RC,,INPATIENT,,,225.5,90.2,MONUMENT,COMMERCIAL,,,,180.4,,169.13,220.99,
PLASMA  FRESH FROZEN SD,P9017,HCPCS,390,RC,,INPATIENT,,,225.5,90.2,UNITED HEALTH,UNITED COMMERCIAL,,,,169.13,,169.13,220.99,
AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,BLUE CROSS ANTHEM,COMMERCIAL,,,,1046.248,OTHER,97.88,127.89,PERCENT OF CHARGES BASED ON HCPCS CODE
AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,MONUMENT,COMMERCIAL,,,,104.4,,97.88,127.89,
FLOW CYTO CELL SURF 1ST MRK,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD ADM ONC (0-1HRS),36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.8,OTHER,787.3,1028.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD ADM ONC (0-1HRS),36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,MONUMENT,COMMERCIAL,,,,839.8,,787.3,1028.8,
BAND 3 FLUORESCENCE STAIN RBC,88184,CPT,300,RC,,OUTPATIENT,,,837.25,334.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,627.94,820.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD ADM ONC (1-2HRS),36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,919.8,OTHER,862.3,1126.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD ADM ONC (1-2HRS),36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,MONUMENT,COMMERCIAL,,,,919.8,,862.3,1126.8,
FLOW CYTOMETRY CELL SURFACE,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD ADM ONC (2-4HRS),36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,999.8,OTHER,937.3,1224.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD ADM ONC (2-4HRS),36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,MONUMENT,COMMERCIAL,,,,999.8,,937.3,1224.8,
Z FLOW CYTOMETRY CYTOPLASMIC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD ADM ONC (4-8HRS),36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1159.8,OTHER,1087.3,1420.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD ADM ONC (4-8HRS),36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,MONUMENT,COMMERCIAL,,,,1159.8,,1087.3,1420.8,
Z FLOW CYTOMETRY 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,114.19,149.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMM DUCTOGRAM SGL LT,77053LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.6,OTHER,564.94,738.19,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMM DUCTOGRAM SGL LT,77053LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,MONUMENT,COMMERCIAL,,,,602.6,,564.94,738.19,
Z FLOW CYTOMETRY EA ADD'L WBC,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMM DUCTOGRAM MULT LT,77054LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.6,OTHER,564.94,738.19,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMM DUCTOGRAM MULT LT,77054LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,MONUMENT,COMMERCIAL,,,,602.6,,564.94,738.19,
R LEUKEMIA IMMUNOTYPING,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 3RD RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 3RD RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
FLOW CYTO EA ADD'L MARKER,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 4TH RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 4TH RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
C FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,70,28,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.5,68.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO CORE BX RT,19081RT,CPT,401,RC,RT,OUTPATIENT,,,2904.5,1161.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2323.6,OTHER,2178.38,2846.41,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO CORE BX RT,19081RT,CPT,401,RC,RT,OUTPATIENT,,,2904.5,1161.8,MONUMENT,COMMERCIAL,,,,2323.6,,2178.38,2846.41,
Z FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC RT,77031RT,CPT,320,RC,RT,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC RT,77031RT,CPT,320,RC,RT,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
Z FLOW CYTOMETRY EA ADD'L MRKR,88185,CPT,310,RC,,OUTPATIENT,,,271.75,108.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,203.81,266.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC CORE BX GUIDANCE,77031,CPT,320,RC,,OUTPATIENT,,,1744.75,697.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1395.8,OTHER,1308.56,1709.86,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC CORE BX GUIDANCE,77031,CPT,320,RC,,OUTPATIENT,,,1744.75,697.9,MONUMENT,COMMERCIAL,,,,1395.8,,1308.56,1709.86,
FLOW CYTOMETRY EA ADD'L MRKER,88185,CPT,310,RC,,OUTPATIENT,,,432.75,173.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,324.56,424.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STERO 3RD LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
STERO 3RD LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
Z FLOW CYTOMETRY ADD ON,88185,CPT,310,RC,,OUTPATIENT,,,52.25,20.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.19,51.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STERO 2ND LESION LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
STERO 2ND LESION LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
FLOW CYTOMETRY INTRP 2-8 MRUS,88187,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMMOTOME BIOPSY LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMMOTOME BIOPSY LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
FLOW CYTOMETRY INTRP 9-15 MRKS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMMOTOME BIOPSY RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMMOTOME BIOPSY RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
R FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
Z FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
FLOW CYTOMETRY INTRO 16+MRUS,88189,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,110.06,143.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMMOTOME BIOPSY 2ND LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMMOTOME BIOPSY 2ND LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
Z TISSUE CULUTRE  LYMPHOCYTE,88230,CPT,310,RC,,OUTPATIENT,,,553,221.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,199.31,260.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC RT,19290RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1005.6,OTHER,942.75,1231.86,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC RT,19290RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,MONUMENT,COMMERCIAL,,,,1005.6,,942.75,1231.86,
CHROMOSOME ANLY TISSUE CULT,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,499.31,652.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO 2ND LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO 2ND LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
SKIN OR OTH SOLID TISSUE BPSY,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,499.31,652.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC RT 2ND,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC RT 2ND,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
CHROME ANALY CLT PROC FEE (AF),88235,CPT,311,RC,,OUTPATIENT,,,569.75,227.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,427.31,558.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO 3RD LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO 3RD LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
TISSUE CULTURE,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,403.88,527.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC RT 3RD,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC RT 3RD,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
Z TISSUE CULTURE NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,616.75,246.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,462.56,604.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC LT,19290LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1005.6,OTHER,942.75,1231.86,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC LT,19290LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,MONUMENT,COMMERCIAL,,,,1005.6,,942.75,1231.86,
TISSUE CULTURE FOR NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,403.88,527.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO 2ND LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO 2ND LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
CHROMOSOME ANALYSIS FRAGILE X,88248,CPT,310,RC,,OUTPATIENT,,,1778.75,711.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1334.06,1743.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC (LT) 2ND,77031LT59,CPT,320,RC,LT59,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC (LT) 2ND,77031LT59,CPT,320,RC,LT59,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
CHROM ANALY CT 5 CELLS 1 KARY,88261,CPT,300,RC,,OUTPATIENT,,,1072.75,429.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,804.56,1051.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO 3RD LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO 3RD LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
CHROMOSOME PERIPHERAL BLOOD,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,723,944.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC (LT) 3RD,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC (LT) 3RD,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
Z CHROMOSOME 15-20  CELLS,88262,CPT,310,RC,,OUTPATIENT,,,1042,416.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,781.5,1021.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMM SPECIMEN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,BLUE CROSS ANTHEM,COMMERCIAL,,,,769.984,OTHER,466.31,609.32,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMM SPECIMEN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,MONUMENT,COMMERCIAL,,,,497.4,,466.31,609.32,
Z CHROMOSOME ANALYSIS 15-20,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,723,944.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMMOGRAPHY GUIDANCE,77032,CPT,320,RC,,OUTPATIENT,,,419,167.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,335.2,OTHER,314.25,410.62,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMMOGRAPHY GUIDANCE,77032,CPT,320,RC,,OUTPATIENT,,,419,167.6,MONUMENT,COMMERCIAL,,,,335.2,,314.25,410.62,
CHROMOSOME ANALYSIS 15-20 CELL,88262,CPT,310,RC,,OUTPATIENT,,,351.25,140.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,263.44,344.23,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1005.6,OTHER,942.75,1231.86,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,MONUMENT,COMMERCIAL,,,,1005.6,,942.75,1231.86,
ANALYZE 20-25 CELLS,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,700.13,914.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 2ND LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 2ND LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
CHROMOSOME ANALYSIS 20-25 CELL,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,700.13,914.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 4TH LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 4TH LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
CHROMOSOME ANALYSIS,88269,CPT,311,RC,,OUTPATIENT,,,894.75,357.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,671.06,876.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION STRTCTC,19081,CPT,401,RC,,OUTPATIENT,,,2904.5,1161.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2323.6,OTHER,2178.38,2846.41,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION STRTCTC,19081,CPT,401,RC,,OUTPATIENT,,,2904.5,1161.8,MONUMENT,COMMERCIAL,,,,2323.6,,2178.38,2846.41,
Z MOLECULAR CYTOGENETICS DNA,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION STRTCTC,19082,CPT,401,RC,,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION STRTCTC,19082,CPT,401,RC,,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US MAM UNILATERAL LT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
US MAM UNILATERAL LT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US MAM UNILATERAL RT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
US MAM UNILATERAL RT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAMM BILATERAL DIAG,77066,CPT,401,RC,,OUTPATIENT,,,244.58,97.832,BLUE CROSS ANTHEM,COMMERCIAL,,,,195.664,OTHER,176.63,230.79,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAMM BILATERAL DIAG,77066,CPT,401,RC,,OUTPATIENT,,,244.58,97.832,MONUMENT,COMMERCIAL,,,,188.4,,176.63,230.79,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAM UNI SCREEN CAD,7706752,CPT,,,52,OUTPATIENT,,,20.75,8.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,16.6,OTHER,15.56,20.34,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM UNI SCREEN CAD,7706752,CPT,,,52,OUTPATIENT,,,20.75,8.3,MONUMENT,COMMERCIAL,,,,16.6,,15.56,20.34,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAM BILAT SCREENING,77067,CPT,403,RC,,OUTPATIENT,,,217.5,87,BLUE CROSS ANTHEM,COMMERCIAL,,,,174,OTHER,163.13,213.15,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM BILAT SCREENING,77067,CPT,403,RC,,OUTPATIENT,,,217.5,87,MONUMENT,COMMERCIAL,,,,174,,163.13,213.15,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAM SCREENING CAD,77067,CPT,403,RC,,OUTPATIENT,,,20.75,8.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,16.6,OTHER,15.56,20.34,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM SCREENING CAD,77067,CPT,403,RC,,OUTPATIENT,,,20.75,8.3,MONUMENT,COMMERCIAL,,,,16.6,,15.56,20.34,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAMM UNILAT RT DIAG,77065RT,CPT,401,RC,RT,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAMM UNILAT RT DIAG,77065RT,CPT,401,RC,RT,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAMM UNILAT LT DIAG,77065LT,CPT,401,RC,LT,OUTPATIENT,,,193,77.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,154.4,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAMM UNILAT LT DIAG,77065LT,CPT,401,RC,LT,OUTPATIENT,,,193,77.2,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAM UNI RT SCREEN,77067RT52,CPT,403,RC,RT52,OUTPATIENT,,,202.2,80.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.76,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM UNI RT SCREEN,77067RT52,CPT,403,RC,RT52,OUTPATIENT,,,202.2,80.88,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIGITAL MAM UNI LT SCREEN,77067LT52,CPT,403,RC,LT52,OUTPATIENT,,,202.2,80.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.76,OTHER,144.75,189.14,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM UNI LT SCREEN,77067LT52,CPT,403,RC,LT52,OUTPATIENT,,,202.2,80.88,MONUMENT,COMMERCIAL,,,,154.4,,144.75,189.14,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEV BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2846.75,1138.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2277.4,OTHER,2135.06,2789.82,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEV BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2846.75,1138.7,MONUMENT,COMMERCIAL,,,,2277.4,,2135.06,2789.82,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25,32.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEV BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2846.75,1138.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2277.4,OTHER,2135.06,2789.82,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEV BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2846.75,1138.7,MONUMENT,COMMERCIAL,,,,2277.4,,2135.06,2789.82,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION STEREO RT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2259,OTHER,2117.81,2767.28,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION STEREO RT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,MONUMENT,COMMERCIAL,,,,2259,,2117.81,2767.28,
CYTOGENETICS - DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION STEREO LT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2259,OTHER,2117.81,2767.28,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION STEREO LT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,MONUMENT,COMMERCIAL,,,,2259,,2117.81,2767.28,
FISH TESTING,88271,CPT,300,RC,,OUTPATIENT,,,320,128,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,240,313.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION STEREO RT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1647.2,OTHER,1544.25,2017.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION STEREO RT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,MONUMENT,COMMERCIAL,,,,1647.2,,1544.25,2017.82,
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION STEREO LT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1647.2,OTHER,1544.25,2017.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION STEREO LT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,MONUMENT,COMMERCIAL,,,,1647.2,,1544.25,2017.82,
CHROMOSOMONAL IN SITU HYBRID,88272,CPT,310,RC,,OUTPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,119.63,156.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJECTION FOR BREAST XRAY,19030,CPT,401,RC,,OUTPATIENT,,,396.25,158.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,317,OTHER,297.19,388.33,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION FOR BREAST XRAY,19030,CPT,401,RC,,OUTPATIENT,,,396.25,158.5,MONUMENT,COMMERCIAL,,,,317,,297.19,388.33,
CYTOGENECTICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,255.38,333.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST EA IMAGE RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST EA IMAGE RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
Z CYTOGENETICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,255.38,333.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST EA IMAGE LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST EA IMAGE LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
CYTOGENETIC TESTING,88274,CPT,311,RC,,OUTPATIENT,,,40,16,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30,39.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION STEREO BI,1908350,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION STEREO BI,1908350,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION STEREO BI,1908450,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION STEREO BI,1908450,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST 1ST BI,1928150,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST 1ST BI,1928150,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEVICE BREAST EA IMAGE,1928250,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1880.2,OTHER,1762.69,2303.25,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEVICE BREAST EA IMAGE,1928250,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,MONUMENT,COMMERCIAL,,,,1880.2,,1762.69,2303.25,
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.7,104.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERQ DEV BREAST 1ST BI,1928350,CPT,401,RC,50,OUTPATIENT,,,2846.75,1138.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2277.4,OTHER,2135.06,2789.82,PERCENT OF CHARGES BASED ON HCPCS CODE
PERQ DEV BREAST 1ST BI,1928350,CPT,401,RC,50,OUTPATIENT,,,2846.75,1138.7,MONUMENT,COMMERCIAL,,,,2277.4,,2135.06,2789.82,
Z CYTOGENETICS ANALYSIS,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,233.63,305.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION STEREO BI,1908150,CPT,401,RC,50,OUTPATIENT,,,5808.75,2323.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,4647,OTHER,4356.56,5692.58,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION STEREO BI,1908150,CPT,401,RC,50,OUTPATIENT,,,5808.75,2323.5,MONUMENT,COMMERCIAL,,,,4647,,4356.56,5692.58,
CYTOGENETICS ANALY 100-300,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,233.63,305.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION STEREO BI,1908250,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2055.2,OTHER,1926.75,2517.62,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION STEREO BI,1908250,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,MONUMENT,COMMERCIAL,,,,2055.2,,1926.75,2517.62,
CHROMO ANALY ADD'L KARYOTYPES,88280,CPT,310,RC,,OUTPATIENT,,,77,30.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.75,75.46,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIAG DIGI BREAST TOMO UNI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.17,OTHER,65.25,85.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DIAG DIGI BREAST TOMO UNI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
DIAG DIGI BREAST TOMO UNI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,,65.25,,65.25,85.26,
DIGITAL MAM SCREENING CAD,77065,CPT,,,,OUTPATIENT,,,20.75,8.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,16.6,OTHER,15.56,20.34,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL MAM SCREENING CAD,77065,CPT,,,,OUTPATIENT,,,20.75,8.3,MONUMENT,COMMERCIAL,,,,16.6,,15.56,20.34,
CYTOGENETICS MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,158,63.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST TOMOSYNTHESIS BI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,79.17,OTHER,65.25,85.26,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BREAST TOMOSYNTHESIS BI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
BREAST TOMOSYNTHESIS BI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,,65.25,,65.25,85.26,
NEEDLE PLACEMENT 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1005.6,OTHER,942.75,1231.86,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,MONUMENT,COMMERCIAL,,,,1005.6,,942.75,1231.86,
CYTOGENETICS/MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NEEDLE PLACEMENT 2ND RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE PLACEMENT 2ND RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.06,57.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMM DUCTOGRAM SGL RT,77053RT,CPT,320,RC,RT,OUTPATIENT,,,753.25,301.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.6,OTHER,564.94,738.19,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMM DUCTOGRAM SGL RT,77053RT,CPT,320,RC,RT,OUTPATIENT,,,753.25,301.3,MONUMENT,COMMERCIAL,,,,602.6,,564.94,738.19,
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.06,57.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MAMM DUCTOGRAM MULT RT,77054RT,CPT,401,RC,RT,OUTPATIENT,,,753.25,301.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,602.6,OTHER,564.94,738.19,PERCENT OF CHARGES BASED ON HCPCS CODE
MAMM DUCTOGRAM MULT RT,77054RT,CPT,401,RC,RT,OUTPATIENT,,,753.25,301.3,MONUMENT,COMMERCIAL,,,,602.6,,564.94,738.19,
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,73.25,29.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.94,71.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREO CORE BX LT,19081LT,CPT,401,RC,LT,OUTPATIENT,,,2904.5,1161.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2323.6,OTHER,2178.38,2846.41,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREO CORE BX LT,19081LT,CPT,401,RC,LT,OUTPATIENT,,,2904.5,1161.8,MONUMENT,COMMERCIAL,,,,2323.6,,2178.38,2846.41,
SURGICAL MACRO I,88300,CPT,312,RC,,OUTPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.13,64.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STEREOTACTIC NDLE LOC LT,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1387,OTHER,1300.31,1699.08,PERCENT OF CHARGES BASED ON HCPCS CODE
STEREOTACTIC NDLE LOC LT,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,MONUMENT,COMMERCIAL,,,,1387,,1300.31,1699.08,
SURGICAL MACRO MICRO I,88302,CPT,312,RC,,OUTPATIENT,,,188.75,75.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,141.56,184.98,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST BILATERAL 1EA,4020004,CDM,,,,INPATIENT,,,4117.5,1647,BLUE CROSS ANTHEM,COMMERCIAL,,,,3746.93,OTHER,3088.13,4035.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
US BIOPSY BREAST BILATERAL 1EA,4020004,CDM,,,,INPATIENT,,,4117.5,1647,MONUMENT,COMMERCIAL,,,,3294,,3088.13,4035.15,
US BIOPSY BREAST BILATERAL 1EA,4020004,CDM,,,,INPATIENT,,,4117.5,1647,UNITED HEALTH,UNITED COMMERCIAL,,,,3088.13,,3088.13,4035.15,
US BIOPSY BREAST BI 1ST LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST BI 1ST LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
TISSUE 1 COMPLEX TECHNICAL,88304,CPT,312,RC,,OUTPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93.19,121.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST BI 2ND LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST BI 2ND LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
BONE MARROW ANALYSIS,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDED 2ND NEEDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED 2ND NEEDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
TISSUE 2 COMPLEX  TECHNICAL,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,109.5,143.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST LT 1ST LESION,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST LT 1ST LESION,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
TISSUE 3 COMPLEX--TECHNICAL,88307,CPT,312,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,296.06,386.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDED NEEDLE PLACEMENT LT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1286.8,OTHER,1206.38,1576.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED NEEDLE PLACEMENT LT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,MONUMENT,COMMERCIAL,,,,1286.8,,1206.38,1576.33,
TISSUE 4 COMPLEX--TECHNICAL,88309,CPT,312,RC,,OUTPATIENT,,,1307.81,523.124,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,296.06,386.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDED NEEDLE PLACEMENT BI,7694250,CPT,402,RC,50,OUTPATIENT,,,1608.5,643.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1286.8,OTHER,1206.38,1576.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED NEEDLE PLACEMENT BI,7694250,CPT,402,RC,50,OUTPATIENT,,,1608.5,643.4,MONUMENT,COMMERCIAL,,,,1286.8,,1206.38,1576.33,
DECALCIFICATION-TECHNICAL,88311,CPT,312,RC,,OUTPATIENT,,,33.75,13.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,25.31,33.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST LT 2 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST LT 2 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
SPEC GROUP STAIN I TECHNICAL,88312,CPT,312,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.13,134.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST LT 3 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST LT 3 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
SPECIAL STAINS GROUP II,88313,CPT,300,RC,,OUTPATIENT,,,145,58,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,108.75,142.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY LIVER,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1411.2,OTHER,1323,1728.72,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY LIVER,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,MONUMENT,COMMERCIAL,,,,1411.2,,1323,1728.72,
CONSULT AND REPORT SLIDES,88321,CPT,312,RC,,OUTPATIENT,,,567,226.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,425.25,555.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDANCE BI NEEDLE 2ND PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE BI NEEDLE 2ND PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
PATHOLOGY CONSULATION,88323,CPT,310,RC,,OUTPATIENT,,,279,111.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,209.25,273.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US THYROID FNA,10005,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1478.2,OTHER,1385.81,1810.8,PERCENT OF CHARGES BASED ON HCPCS CODE
US THYROID FNA,10005,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,MONUMENT,COMMERCIAL,,,,1478.2,,1385.81,1810.8,
CONSULTATION COMPREHENSIVE,88325,CPT,310,RC,,OUTPATIENT,,,567,226.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,425.25,555.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US OB AFI/PLACENTA/HR/POS/E.G.,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB AFI/PLACENTA/HR/POS/E.G.,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
PATHOLOGY CONSULT DURING SURG,88329,CPT,310,RC,,OUTPATIENT,,,199.5,79.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,149.63,195.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST RT 1 LESION,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST RT 1 LESION,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
OR CONSULT W/FROZ SECTION SING,88331,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159.38,208.25,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST RT 2 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST RT 2 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
OR CONS FRZ SEC ADDL TECHNICAL,88332,CPT,312,RC,,OUTPATIENT,,,49.75,19.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,37.31,48.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST RT 3 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST RT 3 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
EVALUATION OF TOUCH PREP,88333,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
IMMUNOHISTOCHEMISTRY ADD'L,88341,CPT,312,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US OB VERSION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB VERSION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
IMMUNOHISTOCHEMISTRY INITIAL,88342,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US OB CERVIX LENGTH,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB CERVIX LENGTH,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,312,RC,,OUTPATIENT,,,322,128.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,241.5,315.6,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDANCE BI NEEDLE 3RD PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE BI NEEDLE 3RD PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,173.81,227.12,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY BREAST BI 3RD LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1086.4,OTHER,1018.5,1330.84,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST BI 3RD LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,MONUMENT,COMMERCIAL,,,,1086.4,,1018.5,1330.84,
Z IMMUNOFLUORESCENT STUDY,88347,CPT,310,RC,,OUTPATIENT,,,315.75,126.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,236.81,309.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY MUSCLE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY MUSCLE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,310,RC,,OUTPATIENT,,,174,69.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,130.5,170.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US ABCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,595.2,OTHER,558,729.12,PERCENT OF CHARGES BASED ON HCPCS CODE
US ABCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,MONUMENT,COMMERCIAL,,,,595.2,,558,729.12,
MORPHOMETRIC ANALYUSIS TMR IMM,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.06,253.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABCESS DRAINAGE - ABDOMEN,49406,CPT,361,RC,,OUTPATIENT,,,3982,1592.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3185.6,OTHER,2986.5,3902.36,PERCENT OF CHARGES BASED ON HCPCS CODE
ABCESS DRAINAGE - ABDOMEN,49406,CPT,361,RC,,OUTPATIENT,,,3982,1592.8,MONUMENT,COMMERCIAL,,,,3185.6,,2986.5,3902.36,
Z PROGEST RECEPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.06,253.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BREAST ASPIRATION LT2 SITES,19001LT,CPT,361,RC,LT,OUTPATIENT,,,768,307.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,614.4,OTHER,576,752.64,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST ASPIRATION LT2 SITES,19001LT,CPT,361,RC,LT,OUTPATIENT,,,768,307.2,MONUMENT,COMMERCIAL,,,,614.4,,576,752.64,
Z ESTROGEN RECPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,194.06,253.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY RENAL,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1411.2,OTHER,1323,1728.72,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY RENAL,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,MONUMENT,COMMERCIAL,,,,1411.2,,1323,1728.72,
TUMOR IMMUNOHISTOCHEM,88361,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,112.5,147,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1360.4,OTHER,1275.38,1666.49,PERCENT OF CHARGES BASED ON HCPCS CODE
US RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,MONUMENT,COMMERCIAL,,,,1360.4,,1275.38,1666.49,
EA ADD'L SINGLE PROBE STAIN,88364,CPT,300,RC,,OUTPATIENT,,,547.5,219,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,410.63,536.55,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US RENAL FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1411.2,OTHER,1323,1728.72,PERCENT OF CHARGES BASED ON HCPCS CODE
US RENAL FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,MONUMENT,COMMERCIAL,,,,1411.2,,1323,1728.72,
IN SITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,189,246.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LEVEL II,20206,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1478.2,OTHER,1385.81,1810.8,PERCENT OF CHARGES BASED ON HCPCS CODE
LEVEL II,20206,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,MONUMENT,COMMERCIAL,,,,1478.2,,1385.81,1810.8,
INSITU HYBRIDIZATION AUTO,88367,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,320.06,418.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY PELVIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY PELVIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
Z UROVYSION DETECTION BLAD CA,88368,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.25,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US LUNG/MEDIASTINUM CORE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1224.8,OTHER,1148.25,1500.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US LUNG/MEDIASTINUM CORE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,MONUMENT,COMMERCIAL,,,,1224.8,,1148.25,1500.38,
MORPHOMETRIC ANALYSIS MANUAL,88368,CPT,310,RC,,OUTPATIENT,,,622.75,249.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,467.06,610.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US LUNG/MEDIASTINUM FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,2680.75,1072.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2144.6,OTHER,2010.56,2627.14,PERCENT OF CHARGES BASED ON HCPCS CODE
US LUNG/MEDIASTINUM FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,2680.75,1072.3,MONUMENT,COMMERCIAL,,,,2144.6,,2010.56,2627.14,
MICRO GEN ANA OF TISSUE ADD'L,88369,CPT,310,RC,,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.6,223,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,426.5,170.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,341.2,OTHER,319.88,417.97,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,426.5,170.6,MONUMENT,COMMERCIAL,,,,341.2,,319.88,417.97,
M/PHMTRC ALYS ISHQUANT/SEMIQ,88373,CPT,310,RC,,OUTPATIENT,,,228.69,91.476,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,171.5,224.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST LIMITED LT,76642LT,CPT,402,RC,LT,OUTPATIENT,,,196.25,78.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,157,OTHER,147.19,192.33,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST LIMITED LT,76642LT,CPT,402,RC,LT,OUTPATIENT,,,196.25,78.5,MONUMENT,COMMERCIAL,,,,157,,147.19,192.33,
MULTIPLEX PROBE STAIN EA,88374,CPT,300,RC,,OUTPATIENT,,,426,170.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,319.5,417.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST LIMITED RT,76642RT,CPT,402,RC,RT,OUTPATIENT,,,196.25,78.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,157,OTHER,147.19,192.33,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST LIMITED RT,76642RT,CPT,402,RC,RT,OUTPATIENT,,,196.25,78.5,MONUMENT,COMMERCIAL,,,,157,,147.19,192.33,
MULTIPLER PROBE STAIN PROC,88377,CPT,300,RC,,OUTPATIENT,,,622.75,249.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,467.06,610.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST LIMITED BILATERAL,7664250,CPT,402,RC,50,OUTPATIENT,,,392,156.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,313.6,OTHER,294,384.16,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST LIMITED BILATERAL,7664250,CPT,402,RC,50,OUTPATIENT,,,392,156.8,MONUMENT,COMMERCIAL,,,,313.6,,294,384.16,
MICRODISSECTION - MANUAL,88381,CPT,312,RC,,OUTPATIENT,,,180.5,72.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,135.38,176.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST COMPLETE LT,76641LT,CPT,402,RC,LT,OUTPATIENT,,,293.5,117.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,234.8,OTHER,220.13,287.63,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST COMPLETE LT,76641LT,CPT,402,RC,LT,OUTPATIENT,,,293.5,117.4,MONUMENT,COMMERCIAL,,,,234.8,,220.13,287.63,
Z ARRAY BASED EVAL MULT PROBES,88386,CPT,310,RC,,OUTPATIENT,,,735,294,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,551.25,720.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST COMPLETE RT,76641RT,CPT,402,RC,RT,OUTPATIENT,,,293.5,117.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,234.8,OTHER,220.13,287.63,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST COMPLETE RT,76641RT,CPT,402,RC,RT,OUTPATIENT,,,293.5,117.4,MONUMENT,COMMERCIAL,,,,234.8,,220.13,287.63,
Z SLIDE REVIEW MOLECULAR GENE,88387,CPT,310,RC,,OUTPATIENT,,,195,78,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.25,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST COMPLETE BILATERAL,7664150,CPT,402,RC,50,OUTPATIENT,,,586.5,234.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,469.2,OTHER,439.88,574.77,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST COMPLETE BILATERAL,7664150,CPT,402,RC,50,OUTPATIENT,,,586.5,234.6,MONUMENT,COMMERCIAL,,,,469.2,,439.88,574.77,
TRANSCUTANEOUS BILIRUBIN,88720,CPT,300,RC,,OUTPATIENT,,,28.75,11.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.56,28.18,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BIOPSY THYROID,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY THYROID,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
CSF CELL CT W/DIFF,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US THYROID,76536,CPT,402,RC,,OUTPATIENT,,,795,318,BLUE CROSS ANTHEM,COMMERCIAL,,,,636,OTHER,596.25,779.1,PERCENT OF CHARGES BASED ON HCPCS CODE
US THYROID,76536,CPT,402,RC,,OUTPATIENT,,,795,318,MONUMENT,COMMERCIAL,,,,636,,596.25,779.1,
CELL CT/DIFF BODY FLUID,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,93,121.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US CORE BIOPSY OF THYROID,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,631.88,825.65,PERCENT OF CHARGES BASED ON HCPCS CODE
US CORE BIOPSY OF THYROID,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,674,,631.88,825.65,
FECAL WBC STAIN,89055,CPT,300,RC,,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.75,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MID LINE PLACEMENT W/US GUIDAN,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,390.4,OTHER,366,478.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MID LINE PLACEMENT W/US GUIDAN,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,MONUMENT,COMMERCIAL,,,,390.4,,366,478.2,
FLUID CRYSTALS EXAM,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.5,84.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,BLUE CROSS ANTHEM,COMMERCIAL,,,,1572,OTHER,1473.75,1925.7,PERCENT OF CHARGES BASED ON HCPCS CODE
US THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,MONUMENT,COMMERCIAL,,,,1572,,1473.75,1925.7,
FERN TEST,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.5,84.28,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US THORACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US THORACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
FATS URINE STAIN,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.19,66.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FNA BX W/US GDN 1ST LES OTHER,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1411.2,OTHER,1323,1728.7,PERCENT OF CHARGES BASED ON HCPCS CODE
FNA BX W/US GDN 1ST LES OTHER,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,MONUMENT,COMMERCIAL,,,,1411.2,,1323,1728.7,
FATS URINE QUALITATIVE,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,51.19,66.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US THORACENTESIS,32421,CPT,361,RC,,OUTPATIENT,,,1049,419.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.2,OTHER,786.75,1028.02,PERCENT OF CHARGES BASED ON HCPCS CODE
US THORACENTESIS,32421,CPT,361,RC,,OUTPATIENT,,,1049,419.6,MONUMENT,COMMERCIAL,,,,839.2,,786.75,1028.02,
FECES EXAM (MEAT FIBERS),89160,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,57.56,75.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US ABDOMINAL COMPLETE,76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,484.4,OTHER,454.13,593.39,PERCENT OF CHARGES BASED ON HCPCS CODE
US ABDOMINAL COMPLETE,76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,MONUMENT,COMMERCIAL,,,,484.4,,454.13,593.39,
NASAL EOSINOPHIL SMEAR,89190,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,40.69,53.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PARACENTESIS W/IMAGE GUIDANCE,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,710.63,928.55,PERCENT OF CHARGES BASED ON HCPCS CODE
PARACENTESIS W/IMAGE GUIDANCE,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,758,,710.63,928.55,
SEMEN ANALYSIS COMPLETE,89320,CPT,309,RC,,OUTPATIENT,,,202.5,81,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,151.88,198.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDANCE FOR AMNIOCENTESIS,76946,CPT,402,RC,,OUTPATIENT,,,1081.25,432.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,865,OTHER,810.94,1059.63,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE FOR AMNIOCENTESIS,76946,CPT,402,RC,,OUTPATIENT,,,1081.25,432.5,MONUMENT,COMMERCIAL,,,,865,,810.94,1059.63,
SEMEN ANALYSIS  POST VAS,89321,CPT,300,RC,,OUTPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,49.13,64.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US AMNIOCENTESIS,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,BLUE CROSS ANTHEM,COMMERCIAL,,,,1009.992,OTHER,446.25,583.1,PERCENT OF CHARGES BASED ON HCPCS CODE
US AMNIOCENTESIS,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,MONUMENT,COMMERCIAL,,,,476,,446.25,583.1,
SPERM ANTIBODY,89325,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,137.06,179.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BREAST ASPIRATION LT 1 SITE,19000LT,CPT,361,RC,LT,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,487.5,637,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST ASPIRATION LT 1 SITE,19000LT,CPT,361,RC,LT,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,520,,487.5,637,
RHO(D) IMMUNE GLOBULIN (RHIG),90384,CPT,636,RC,,OUTPATIENT,,,386,154.4,UNITED HEALTH,UNITED COMMERCIAL,,,,328.1,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 1 SITE,19000RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,487.5,637,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST ASPIRATION RT 1 SITE,19000RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,520,,487.5,637,
RHO(D) IMMUNE GLOBULIN RHIGIV,90386,CPT,636,RC,,OUTPATIENT,,,386,154.4,UNITED HEALTH,UNITED COMMERCIAL,,,,328.1,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT RT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1286.8,OTHER,1206.38,1576.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED NEEDLE PLACEMENT RT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,MONUMENT,COMMERCIAL,,,,1286.8,,1206.38,1576.33,
IM VACCINATION <18 YRS OLD,90460,CPT,761,RC,,OUTPATIENT,,,137,54.8,UNITED HEALTH,UNITED COMMERCIAL,,,,116.45,OTHER,102.75,134.26,PERCENT OF TOTAL BILLED CHARGES
US GUIDED 2ND NEEDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED 2ND NEEDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
IMMUNIZATION ADMIN,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,122.4,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 2 SITES,19001RT,CPT,361,RC,RT,OUTPATIENT,,,768,307.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,614.4,OTHER,576,752.64,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST ASPIRATION RT 2 SITES,19001RT,CPT,361,RC,RT,OUTPATIENT,,,768,307.2,MONUMENT,COMMERCIAL,,,,614.4,,576,752.64,
IM/SQ VACCINATION 1ST,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,122.4,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
US BREAST/BILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,494.4,OTHER,463.5,605.64,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST/BILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,MONUMENT,COMMERCIAL,,,,494.4,,463.5,605.64,
"IMMUN ADMIN 1 VAC, SNGL/COMBO",90471,CPT,761,RC,,OUTPATIENT,,,123.52,49.408,UNITED HEALTH,UNITED COMMERCIAL,,,,104.992,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 1 SITE,1900050,CPT,402,RC,50,OUTPATIENT,,,1299.75,519.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1039.8,OTHER,974.81,1273.76,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST ASPIRATION BIL 1 SITE,1900050,CPT,402,RC,50,OUTPATIENT,,,1299.75,519.9,MONUMENT,COMMERCIAL,,,,1039.8,,974.81,1273.76,
OB IM/SQ VACCINE,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,122.4,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 2 SITES,1900150,CPT,402,RC,50,OUTPATIENT,,,1535.5,614.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1228.4,OTHER,1151.63,1504.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST ASPIRATION BIL 2 SITES,1900150,CPT,402,RC,50,OUTPATIENT,,,1535.5,614.2,MONUMENT,COMMERCIAL,,,,1228.4,,1151.63,1504.79,
IMMUNIZATION ADMIN EACH ADD,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,UNITED HEALTH,UNITED COMMERCIAL,,,,77.9875,OTHER,68.8,89.9,PERCENT OF TOTAL BILLED CHARGES
US BREAST/UNILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,494.4,OTHER,463.5,605.64,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST/UNILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,MONUMENT,COMMERCIAL,,,,494.4,,463.5,605.64,
IM/SQ VACCINATION EA ADD'L,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,UNITED HEALTH,UNITED COMMERCIAL,,,,77.9875,OTHER,68.81,89.92,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2173.25,869.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1738.6,OTHER,1629.94,2129.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST NEEDLE LOC LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2173.25,869.3,MONUMENT,COMMERCIAL,,,,1738.6,,1629.94,2129.79,
TD VACCINE NO PRSRV 7/> IM,90714,CPT,516,RC,,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,,45.05,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST NEEDLE LOC LT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
TDAP IMMUNIZATION,90715,CPT,516,RC,,OUTPATIENT,,,79,31.6,UNITED HEALTH,UNITED COMMERCIAL,,,,67.15,OTHER,59.25,77.42,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2173.25,869.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1738.6,OTHER,1629.94,2129.79,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST NEEDLE LOC RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2173.25,869.3,MONUMENT,COMMERCIAL,,,,1738.6,,1629.94,2129.79,
CENTRAL LINE FLUSH/DRAW,90784,CPT,361,RC,,OUTPATIENT,,,110.25,44.1,UNITED HEALTH,UNITED COMMERCIAL,,,,93.7125,OTHER,82.69,108.05,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST NEEDLE LOC RT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
OPHTHALMOLOGICAL EXAM AND EVAL,92002,CPT,450,RC,,OUTPATIENT,,,270,108,UNITED HEALTH,UNITED COMMERCIAL,,,,229.5,OTHER,202.5,264.6,PERCENT OF TOTAL BILLED CHARGES
US CHEST BSCAN INC MEDIASTINUM,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,318.8,OTHER,298.88,390.53,PERCENT OF CHARGES BASED ON HCPCS CODE
US CHEST BSCAN INC MEDIASTINUM,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,MONUMENT,COMMERCIAL,,,,318.8,,298.88,390.53,
DIAGNOSTIC NASOPHARYNGOSCOPY,92511,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UNITED HEALTH,UNITED COMMERCIAL,,,,671.2875,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US CYST ASPIRATION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
HEARING SCREEN,92586,CPT,470,RC,,OUTPATIENT,,,289.75,115.9,UNITED HEALTH,UNITED COMMERCIAL,,,,246.2875,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,320.63,418.95,PERCENT OF CHARGES BASED ON HCPCS CODE
US CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,342,,320.63,418.95,
EVALUATE SWALLOWING FUNCTION,92610,CPT,430,RC,,OUTPATIENT,,,436.5,174.6,UNITED HEALTH,UNITED COMMERCIAL,,,,371.025,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
US SKIN LESION BIOPSY,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,345,OTHER,323.44,422.63,PERCENT OF CHARGES BASED ON HCPCS CODE
US SKIN LESION BIOPSY,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,MONUMENT,COMMERCIAL,,,,345,,323.44,422.63,
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,,,,OUTPATIENT,,,534,213.6,UNITED HEALTH,UNITED COMMERCIAL,,,,453.9,OTHER,400.5,523.3,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR,76881,CPT,402,RC,,OUTPATIENT,,,798.75,319.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,639,OTHER,599.06,782.78,PERCENT OF CHARGES BASED ON HCPCS CODE
EXTREMITY NON VASCULAR,76881,CPT,402,RC,,OUTPATIENT,,,798.75,319.5,MONUMENT,COMMERCIAL,,,,639,,599.06,782.78,
ENDOSCOPY SWALLOW (FEES) VID,92612,CPT,444,RC,,OUTPATIENT,,,531,212.4,UNITED HEALTH,UNITED COMMERCIAL,,,,451.35,OTHER,398.3,520.4,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR LIMITED,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
EXTREMITY NON VASCULAR LIMITED,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
DEFIBRILLATION,92950,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1259.275,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
AXILLA ULTRASOUND,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
AXILLA ULTRASOUND,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
CARDIAC ARREST CPR,92950,CPT,450,RC,,OUTPATIENT,,,998,399.2,UNITED HEALTH,UNITED COMMERCIAL,,,,848.3,OTHER,748.5,978.04,PERCENT OF TOTAL BILLED CHARGES
FOLLOW UP (NOT FOR OB),76970,CPT,402,RC,,OUTPATIENT,,,264.5,105.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,211.6,OTHER,198.38,259.21,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLLOW UP (NOT FOR OB),76970,CPT,402,RC,,OUTPATIENT,,,264.5,105.8,MONUMENT,COMMERCIAL,,,,211.6,,198.38,259.21,
CARDIOPULMONARY RESUSCITATION,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,UNITED HEALTH,UNITED COMMERCIAL,,,,847.875,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
US SURGICAL SPECIMAN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,BLUE CROSS ANTHEM,COMMERCIAL,,,,769.984,OTHER,466.31,609.32,PERCENT OF CHARGES BASED ON HCPCS CODE
US SURGICAL SPECIMAN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,MONUMENT,COMMERCIAL,,,,497.4,,466.31,609.32,
VENTILATION RESCUE BREATHING,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,UNITED HEALTH,UNITED COMMERCIAL,,,,847.875,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
VASCULAR STUDY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.944,OTHER,344,449.5,PERCENT OF CHARGES BASED ON HCPCS CODE
VASCULAR STUDY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,MONUMENT,COMMERCIAL,,,,366.9,,344,449.5,
TC PACING,92953,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1146.225,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
US TESTICULAR,76870,CPT,402,RC,,OUTPATIENT,,,732,292.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,585.6,OTHER,549,717.36,PERCENT OF CHARGES BASED ON HCPCS CODE
US TESTICULAR,76870,CPT,402,RC,,OUTPATIENT,,,732,292.8,MONUMENT,COMMERCIAL,,,,585.6,,549,717.36,
CARDIOVERSION ELECTIVE,92960,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1259.275,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
US HEAD/NECK SOFT TISSUE,76536,CPT,402,RC,,OUTPATIENT,,,795,318,BLUE CROSS ANTHEM,COMMERCIAL,,,,636,OTHER,457.69,598.05,PERCENT OF CHARGES BASED ON HCPCS CODE
US HEAD/NECK SOFT TISSUE,76536,CPT,402,RC,,OUTPATIENT,,,795,318,MONUMENT,COMMERCIAL,,,,488.2,,457.69,598.05,
CORONARY THROMBOLYSIS,92977,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,UNITED HEALTH,UNITED COMMERCIAL,,,,1146.225,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
US SONOHYSTOGRAPHY,76831,CPT,402,RC,,OUTPATIENT,,,1027.25,410.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,821.8,OTHER,770.44,1006.71,PERCENT OF CHARGES BASED ON HCPCS CODE
US SONOHYSTOGRAPHY,76831,CPT,402,RC,,OUTPATIENT,,,1027.25,410.9,MONUMENT,COMMERCIAL,,,,821.8,,770.44,1006.71,
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,OUTPATIENT,,,22,8.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.7,OTHER,16.5,21.6,PERCENT OF TOTAL BILLED CHARGES
US HIPS INFANT,76885,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.2,OTHER,285.19,372.65,PERCENT OF CHARGES BASED ON HCPCS CODE
US HIPS INFANT,76885,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,MONUMENT,COMMERCIAL,,,,304.2,,285.19,372.65,
EKG,93005,CPT,730,RC,,OUTPATIENT,,,362.25,144.9,UNITED HEALTH,UNITED COMMERCIAL,,,,307.9125,OTHER,271.69,355.01,PERCENT OF TOTAL BILLED CHARGES
US GUIDED BIOPSY,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDED BIOPSY,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
GRADED EXERCISE BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UNITED HEALTH,UNITED COMMERCIAL,,,,987.0625,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
US MARKING FOR NEEDLE PLACEMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US MARKING FOR NEEDLE PLACEMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
GRADED EXERCISE TEST,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UNITED HEALTH,UNITED COMMERCIAL,,,,987.0625,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE NEEDLE PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,545.5,218.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,436.4,OTHER,409.13,534.59,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE NEEDLE PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,545.5,218.2,MONUMENT,COMMERCIAL,,,,436.4,,409.13,534.59,
GXT STD THREADMILL WALKING,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UNITED HEALTH,UNITED COMMERCIAL,,,,987.0625,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE 3RD NDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
PHARM STRESS TEST BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UNITED HEALTH,UNITED COMMERCIAL,,,,987.0625,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE 3RD NDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
RHYTHM STRIP,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,,94.299,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 1ST PLCM,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1286.8,OTHER,1206.38,1576.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE BI NEEDLE 1ST PLCM,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,MONUMENT,COMMERCIAL,,,,1286.8,,1206.38,1576.33,
RHYTHM STRIP TRACING ONLY,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,,94.299,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
US HEAD NEONATAL,76506,CPT,402,RC,,OUTPATIENT,,,525.5,210.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,420.4,OTHER,394.13,514.99,PERCENT OF CHARGES BASED ON HCPCS CODE
US HEAD NEONATAL,76506,CPT,402,RC,,OUTPATIENT,,,525.5,210.2,MONUMENT,COMMERCIAL,,,,420.4,,394.13,514.99,
HOLTER MONITOR RECORDING/SETUP,93225,CPT,731,RC,,OUTPATIENT,,,327.75,131.1,UNITED HEALTH,UNITED COMMERCIAL,,,,278.5875,OTHER,245.81,321.2,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB>14 WKS DETAILED,76805,CPT,402,RC,,OUTPATIENT,,,770.75,308.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,616.6,OTHER,578.06,755.34,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB TRAB>14 WKS DETAILED,76805,CPT,402,RC,,OUTPATIENT,,,770.75,308.3,MONUMENT,COMMERCIAL,,,,616.6,,578.06,755.34,
CARDIAC EVENT MONITER SETUP,93270,CPT,480,RC,,OUTPATIENT,,,412,164.8,UNITED HEALTH,UNITED COMMERCIAL,,,,350.2,OTHER,309,403.76,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB 14-20 WKS EA GEST,76810,CPT,402,RC,,OUTPATIENT,,,328.25,131.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,262.6,OTHER,246.19,321.69,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB TRAB 14-20 WKS EA GEST,76810,CPT,402,RC,,OUTPATIENT,,,328.25,131.3,MONUMENT,COMMERCIAL,,,,262.6,,246.19,321.69,
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2206.175,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
US OB AFI/PLACENTA/HR/POSITION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB AFI/PLACENTA/HR/POSITION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2206.175,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL OB,76817,CPT,402,RC,,OUTPATIENT,,,616.25,246.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,493,OTHER,462.19,603.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US TRANSVAGINAL OB,76817,CPT,402,RC,,OUTPATIENT,,,616.25,246.5,MONUMENT,COMMERCIAL,,,,493,,462.19,603.93,
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1530.6375,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS,76801,CPT,402,RC,,OUTPATIENT,,,682.25,272.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,545.8,OTHER,511.69,668.61,PERCENT OF CHARGES BASED ON HCPCS CODE
US TRANSABD OB <14 WKS,76801,CPT,402,RC,,OUTPATIENT,,,682.25,272.9,MONUMENT,COMMERCIAL,,,,545.8,,511.69,668.61,
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1530.6375,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS E/GEST,76802,CPT,402,RC,,OUTPATIENT,,,274.75,109.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,219.8,OTHER,206.06,269.26,PERCENT OF CHARGES BASED ON HCPCS CODE
US TRANSABD OB <14 WKS E/GEST,76802,CPT,402,RC,,OUTPATIENT,,,274.75,109.9,MONUMENT,COMMERCIAL,,,,219.8,,206.06,269.26,
"TRANSTHORACIC ECHO, LIMITED",93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UNITED HEALTH,UNITED COMMERCIAL,,,,409.275,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
US PELVIC,76856,CPT,402,RC,,OUTPATIENT,,,854,341.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,683.2,OTHER,640.5,836.92,PERCENT OF CHARGES BASED ON HCPCS CODE
US PELVIC,76856,CPT,402,RC,,OUTPATIENT,,,854,341.6,MONUMENT,COMMERCIAL,,,,683.2,,640.5,836.92,
ECHO 2D/M MODE LIMITED,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UNITED HEALTH,UNITED COMMERCIAL,,,,409.275,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
PELVIS LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.4,OTHER,479.44,626.47,PERCENT OF CHARGES BASED ON HCPCS CODE
PELVIS LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,MONUMENT,COMMERCIAL,,,,511.4,,479.44,626.47,
ECHO 2D/M MODE LIMITED STUDY,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UNITED HEALTH,UNITED COMMERCIAL,,,,409.275,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
OB FOLLOW UP,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
STRESS ECHO TECHNICAL,93350,CPT,480,RC,,OUTPATIENT,,,1572.25,628.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1336.4125,OTHER,1179.19,1540.81,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
OB LIMITED,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
SUPERVISED EXERCISE THERAPY,93668,CPT,943,RC,,OUTPATIENT,,,192,76.8,UNITED HEALTH,UNITED COMMERCIAL,,,,163.2,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
AMB BP MONITOR RECORDING,93786,CPT,920,RC,,OUTPATIENT,,,224.25,89.7,UNITED HEALTH,UNITED COMMERCIAL,,,,190.6125,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
US RENAL,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,748.6,OTHER,701.81,917.04,PERCENT OF CHARGES BASED ON HCPCS CODE
US RENAL,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,MONUMENT,COMMERCIAL,,,,748.6,,701.81,917.04,
AMB BP 24 HRS SCAN ANALYSIS,93788,CPT,480,RC,,OUTPATIENT,,,475.5,190.2,UNITED HEALTH,UNITED COMMERCIAL,,,,404.175,OTHER,356.63,465.99,PERCENT OF TOTAL BILLED CHARGES
US AORTA,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.8,OTHER,418.88,547.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US AORTA,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,MONUMENT,COMMERCIAL,,,,446.8,,418.88,547.33,
CARDIAC REHAB W/MONITOR,93798,CPT,948,RC,,OUTPATIENT,,,231.33,92.532,UNITED HEALTH,UNITED COMMERCIAL,,,,196.6305,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
US AAA SCREENING,76706,CPT,402,RC,,OUTPATIENT,,,344.25,137.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,275.4,OTHER,258.19,337.37,PERCENT OF CHARGES BASED ON HCPCS CODE
US AAA SCREENING,76706,CPT,402,RC,,OUTPATIENT,,,344.25,137.7,MONUMENT,COMMERCIAL,,,,275.4,,258.19,337.37,
US CAROTID DUPLEX,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1012.31,1322.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
US HEAD DUP EXTRACRANIAL ARTER,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1012.31,1322.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US RENAL TRANSPLANT,76776,CPT,402,RC,,OUTPATIENT,,,484.75,193.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,387.8,OTHER,363.56,475.06,PERCENT OF CHARGES BASED ON HCPCS CODE
US RENAL TRANSPLANT,76776,CPT,402,RC,,OUTPATIENT,,,484.75,193.9,MONUMENT,COMMERCIAL,,,,387.8,,363.56,475.06,
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,402,RC,,OUTPATIENT,,,233.98,93.592,UNITED HEALTH,UNITED COMMERCIAL,,,,198.883,OTHER,175.5,229.3,PERCENT OF TOTAL BILLED CHARGES
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,OUTPATIENT,,,489.75,195.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,391.8,OTHER,367.31,479.96,PERCENT OF CHARGES BASED ON HCPCS CODE
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,OUTPATIENT,,,489.75,195.9,MONUMENT,COMMERCIAL,,,,391.8,,367.31,479.96,
US DUPLEX V/A FLOW BIL,93925,CPT,402,RC,,OUTPATIENT,,,959.25,383.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,719.44,940.07,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OB US LIMITED FETUS(S),76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
OB US LIMITED FETUS(S),76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
US LE ART;UNILAT OR LIMITED,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,402.38,525.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US RETROPERITONEAL LIMITED,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.8,OTHER,418.88,547.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US RETROPERITONEAL LIMITED,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,MONUMENT,COMMERCIAL,,,,446.8,,418.88,547.33,
DUPLEX V/A FLOW UNILATERAL,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,UNITED HEALTH,UNITED COMMERCIAL,,,,456.025,OTHER,402.38,525.77,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL,76830,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.2,OTHER,285.19,372.65,PERCENT OF CHARGES BASED ON HCPCS CODE
US TRANSVAGINAL,76830,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,MONUMENT,COMMERCIAL,,,,304.2,,285.19,372.65,
US VEN DOPPLER BILATERAL,93970,CPT,921,RC,,OUTPATIENT,,,1293.25,517.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,969.94,1267.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US CHEST LIMITED,76604,CPT,402,RC,,OUTPATIENT,,,217.19,86.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.752,OTHER,141.75,185.22,PERCENT OF CHARGES BASED ON HCPCS CODE
US CHEST LIMITED,76604,CPT,402,RC,,OUTPATIENT,,,217.19,86.876,MONUMENT,COMMERCIAL,,,,151.2,,141.75,185.22,
US VENOUS LIMITED - BEDSIDE,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,696.38,909.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US ABDOMINAL  LIMITED,76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,377.2,OTHER,353.63,462.07,PERCENT OF CHARGES BASED ON HCPCS CODE
US ABDOMINAL  LIMITED,76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,MONUMENT,COMMERCIAL,,,,377.2,,353.63,462.07,
US VEN DOPPLER UNILATERAL,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,696.38,909.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US OB LIMITED SIZE,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB LIMITED SIZE,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
VASCULAR STUDY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UNITED HEALTH,UNITED COMMERCIAL,,,,389.878,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED TWINS,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
OB LIMITED TWINS,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
RENAL ARTERY DOPPLER COMPLETE,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UNITED HEALTH,UNITED COMMERCIAL,,,,389.878,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED POST PARTUM,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,335,OTHER,314.06,410.38,PERCENT OF CHARGES BASED ON HCPCS CODE
OB LIMITED POST PARTUM,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,MONUMENT,COMMERCIAL,,,,335,,314.06,410.38,
LIVER DOPPLER ONLY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UNITED HEALTH,UNITED COMMERCIAL,,,,389.878,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB >14 WKS EA/GEST,76810,CPT,402,RC,,OUTPATIENT,,,296.5,118.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.2,OTHER,222.38,290.57,PERCENT OF CHARGES BASED ON HCPCS CODE
US TRANSABD OB >14 WKS EA/GEST,76810,CPT,402,RC,,OUTPATIENT,,,296.5,118.6,MONUMENT,COMMERCIAL,,,,237.2,,222.38,290.57,
RENAL ARTERY WITH DOPPLER,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,UNITED HEALTH,UNITED COMMERCIAL,,,,496.4,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
AXILLA MARKER PLACEMENT,10035,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,929.8,1214.9,PERCENT OF CHARGES BASED ON HCPCS CODE
AXILLA MARKER PLACEMENT,10035,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,991.8,,929.8,1214.9,
LIVER DOPPLER LIMITED,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,UNITED HEALTH,UNITED COMMERCIAL,,,,496.4,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
US OB FETAL RE-EVAL SZ  FLUID,76816,CPT,402,RC,,OUTPATIENT,,,402.25,160.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,321.8,OTHER,301.69,394.21,PERCENT OF CHARGES BASED ON HCPCS CODE
US OB FETAL RE-EVAL SZ  FLUID,76816,CPT,402,RC,,OUTPATIENT,,,402.25,160.9,MONUMENT,COMMERCIAL,,,,321.8,,301.69,394.21,
VENTILATOR FIRST DAY,94002,CPT,410,RC,,OUTPATIENT,,,2575.5,1030.2,UNITED HEALTH,UNITED COMMERCIAL,,,,2189.175,OTHER,1931.63,2523.99,PERCENT OF TOTAL BILLED CHARGES
US PARACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US PARACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
VENTILATOR SUBSEQUENT DAY,94003,CPT,410,RC,,OUTPATIENT,,,2087.75,835.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1774.5875,OTHER,1565.81,2046,PERCENT OF TOTAL BILLED CHARGES
US NEEDLE PLACEMENT PER LESION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US NEEDLE PLACEMENT PER LESION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
PFT  SPIROMETRY  PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UNITED HEALTH,UNITED COMMERCIAL,,,,275.4,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UNITED HEALTH,UNITED COMMERCIAL,,,,275.4,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,433.88,566.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,462.8,,433.88,566.93,
AE PFT SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UNITED HEALTH,UNITED COMMERCIAL,,,,275.4,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,433.88,566.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,462.8,,433.88,566.93,
SPIROMETRY PRE/POST BRDIAL,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
RETROPERITONEAL COMPLETE,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,748.6,OTHER,701.81,917.04,PERCENT OF CHARGES BASED ON HCPCS CODE
RETROPERITONEAL COMPLETE,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,MONUMENT,COMMERCIAL,,,,748.6,,701.81,917.04,
PFT SPIROMETRY PRE/POST BRDIA,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLCMT ADD'L,19286,CPT,402,RC,,OUTPATIENT,,,231.75,92.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.4,OTHER,173.81,227.12,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST MARKER PLCMT ADD'L,19286,CPT,402,RC,,OUTPATIENT,,,231.75,92.7,MONUMENT,COMMERCIAL,,,,185.4,,173.81,227.12,
AE PFT SPIROMETRY PRE/POST BRD,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,,510,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BILATERAL 1EA,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,3137.4,OTHER,2941.31,3843.32,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY BREAST BILATERAL 1EA,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,MONUMENT,COMMERCIAL,,,,3137.4,,2941.31,3843.32,
BRONCHOSPASM PROVOCATION EVAL,94070,CPT,460,RC,,OUTPATIENT,,,874.25,349.7,UNITED HEALTH,UNITED COMMERCIAL,,,,743.1125,OTHER,655.69,856.77,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2259,OTHER,2117.81,2767.28,PERCENT OF CHARGES BASED ON HCPCS CODE
US BRST BX VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,MONUMENT,COMMERCIAL,,,,2259,,2117.81,2767.28,
WEANING PARAMETERS,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,UNITED HEALTH,UNITED COMMERCIAL,,,,236.4275,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
VITALOR SCREENING,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,UNITED HEALTH,UNITED COMMERCIAL,,,,236.4275,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2259,OTHER,2117.81,2767.28,PERCENT OF CHARGES BASED ON HCPCS CODE
US BRST BX VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,MONUMENT,COMMERCIAL,,,,2259,,2117.81,2767.28,
PULMONARY STRESS TESTING 6 MIN,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
WALK TEST W/O2 SATS 6 MINS,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 2 SITES,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST R 2 SITES,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
AEROSOL DAILY,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L2 SITES,19084,CPT,402,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST L2 SITES,19084,CPT,402,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
IPPB SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2,1908350,CPT,401,RC,50,OUTPATIENT,,,5137.75,2055.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,4110.2,OTHER,3853.31,5035,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST BIL 2,1908350,CPT,401,RC,50,OUTPATIENT,,,5137.75,2055.1,MONUMENT,COMMERCIAL,,,,4110.2,,3853.31,5035,
MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 1ST,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST BIL 1ST,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
HHN MED AEROSOL SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2ND,1908450,CPT,401,RC,50,OUTPATIENT,,,2027.75,811.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1622.2,OTHER,1520.81,1987.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST VAC ASSIST BIL 2ND,1908450,CPT,401,RC,50,OUTPATIENT,,,2027.75,811.1,MONUMENT,COMMERCIAL,,,,1622.2,,1520.81,1987.2,
SPUTUM INDUCTION,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST 1ST LESION,19083,CPT,401,RC,,OUTPATIENT,,,1960.75,784.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1568.6,OTHER,1470.56,1921.54,PERCENT OF CHARGES BASED ON HCPCS CODE
US BX BREAST 1ST LESION,19083,CPT,401,RC,,OUTPATIENT,,,1960.75,784.3,MONUMENT,COMMERCIAL,,,,1568.6,,1470.56,1921.54,
AE MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST ADD LESION,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1647.2,OTHER,1544.25,2017.82,PERCENT OF CHARGES BASED ON HCPCS CODE
US BX BREAST ADD LESION,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,MONUMENT,COMMERCIAL,,,,1647.2,,1544.25,2017.82,
AE NEB SUBSEQUENT MED AEROSOL,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
US LIVER FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1411.2,OTHER,1323,1728.72,PERCENT OF CHARGES BASED ON HCPCS CODE
US LIVER FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,MONUMENT,COMMERCIAL,,,,1411.2,,1323,1728.72,
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
US LIVER CORE BX,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1221.4,OTHER,1145.06,1496.22,PERCENT OF CHARGES BASED ON HCPCS CODE
US LIVER CORE BX,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,MONUMENT,COMMERCIAL,,,,1221.4,,1145.06,1496.22,
NEBULIZER TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1647.2,OTHER,1544.25,2017.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION RT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,MONUMENT,COMMERCIAL,,,,1647.2,,1544.25,2017.82,
CONT MED AEROSOL TRMT 1ST HR,94644,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1647.2,OTHER,1544.25,2017.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION LT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,MONUMENT,COMMERCIAL,,,,1647.2,,1544.25,2017.82,
CONT MED AEROSOL TRMT ADD'L HR,94645,CPT,410,RC,,OUTPATIENT,,,176.5,70.6,UNITED HEALTH,UNITED COMMERCIAL,,,,150.025,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION RT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1102.6,OTHER,1033.69,1350.69,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION RT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,MONUMENT,COMMERCIAL,,,,1102.6,,1033.69,1350.69,
CPAP INITIAL DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UNITED HEALTH,UNITED COMMERCIAL,,,,560.15,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION LT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1102.6,OTHER,1033.69,1350.69,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION LT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,MONUMENT,COMMERCIAL,,,,1102.6,,1033.69,1350.69,
CPAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UNITED HEALTH,UNITED COMMERCIAL,,,,560.15,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
CATHETER FOR HYSTEROGRAPHY,58340,CPT,320,RC,,OUTPATIENT,,,447.5,179,BLUE CROSS ANTHEM,COMMERCIAL,,,,358,OTHER,335.63,438.55,PERCENT OF CHARGES BASED ON HCPCS CODE
CATHETER FOR HYSTEROGRAPHY,58340,CPT,320,RC,,OUTPATIENT,,,447.5,179,MONUMENT,COMMERCIAL,,,,358,,335.63,438.55,
BI-PAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UNITED HEALTH,UNITED COMMERCIAL,,,,560.15,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,3137.4,OTHER,2941.31,3843.32,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,MONUMENT,COMMERCIAL,,,,3137.4,,2941.31,3843.32,
BI-PAP FIRST DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UNITED HEALTH,UNITED COMMERCIAL,,,,560.15,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION BI,19084,CPT,402,RC,,OUTPATIENT,,,787.5,315,BLUE CROSS ANTHEM,COMMERCIAL,,,,630,OTHER,590.63,771.75,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION BI,19084,CPT,402,RC,,OUTPATIENT,,,787.5,315,MONUMENT,COMMERCIAL,,,,630,,590.63,771.75,
MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,4117.5,1647,BLUE CROSS ANTHEM,COMMERCIAL,,,,3294,OTHER,3088.13,4035.15,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,4117.5,1647,MONUMENT,COMMERCIAL,,,,3294,,3088.13,4035.15,
IPPB INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
US MUSCLE CORE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,998.4,OTHER,936,1223.04,PERCENT OF CHARGES BASED ON HCPCS CODE
US MUSCLE CORE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,MONUMENT,COMMERCIAL,,,,998.4,,936,1223.04,
HHN MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY LYMPH SUPERFICIAL,38505,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1478.2,OTHER,1385.81,1810.8,PERCENT OF CHARGES BASED ON HCPCS CODE
US BIOPSY LYMPH SUPERFICIAL,38505,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,MONUMENT,COMMERCIAL,,,,1478.2,,1385.81,1810.8,
NEBULIZER INITIAL TREATMENT,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
HEMATOMA/SEROMA/FLUID DRAIN,10140,CPT,402,RC,,OUTPATIENT,,,427.5,171,BLUE CROSS ANTHEM,COMMERCIAL,,,,342,OTHER,320.63,418.95,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMATOMA/SEROMA/FLUID DRAIN,10140,CPT,402,RC,,OUTPATIENT,,,427.5,171,MONUMENT,COMMERCIAL,,,,342,,320.63,418.95,
AE MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1074.8,OTHER,1007.63,1316.63,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,MONUMENT,COMMERCIAL,,,,1074.8,,1007.63,1316.63,
AE NEB MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY WITH DOPPLER,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,467.2,OTHER,438,572.32,PERCENT OF CHARGES BASED ON HCPCS CODE
RENAL ARTERY WITH DOPPLER,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,MONUMENT,COMMERCIAL,,,,467.2,,438,572.32,
MANIPULATION CHEST WALL INITL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY DOPPLER COMPLETE,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.944,OTHER,344,449.5,PERCENT OF CHARGES BASED ON HCPCS CODE
RENAL ARTERY DOPPLER COMPLETE,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,MONUMENT,COMMERCIAL,,,,366.9,,344,449.5,
CPT PD INITIAL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
DUPLEX PELVIC OUTFLOW,93976QQ,CPT,,,QQ,OUTPATIENT,,,529.5,211.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,423.6,OTHER,397.13,518.91,PERCENT OF CHARGES BASED ON HCPCS CODE
DUPLEX PELVIC OUTFLOW,93976QQ,CPT,,,QQ,OUTPATIENT,,,529.5,211.8,MONUMENT,COMMERCIAL,,,,423.6,,397.13,518.91,
CPT PD SUBSEQUENT,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
BREAST MARKER PLACEMENT,19281,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,409.13,534.59,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST MARKER PLACEMENT,19281,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,436.4,,409.13,534.59,
MANIPULATION CHEST WALL SUBSEQ,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,189.6605,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS BILATERAL,3255550,CPT,402,RC,50,OUTPATIENT,,,3200,1280,BLUE CROSS ANTHEM,COMMERCIAL,,,,2560,OTHER,2400,3136,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACENTESIS BILATERAL,3255550,CPT,402,RC,50,OUTPATIENT,,,3200,1280,MONUMENT,COMMERCIAL,,,,2560,,2400,3136,
PFT  LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,UNITED HEALTH,UNITED COMMERCIAL,,,,568.225,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
IMAGE CATH FLUID COLXN VISC US,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,2274.912,OTHER,2132.7,2786.8,PERCENT OF CHARGES BASED ON HCPCS CODE
IMAGE CATH FLUID COLXN VISC US,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,MONUMENT,COMMERCIAL,,,,2274.9,,2132.7,2786.8,
AE PFT LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,UNITED HEALTH,UNITED COMMERCIAL,,,,568.225,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL CORD DOPPLER,76820,CPT,402,RC,,OUTPATIENT,,,215.38,86.152,BLUE CROSS ANTHEM,COMMERCIAL,,,,172.304,OTHER,161.5,211.1,PERCENT OF CHARGES BASED ON HCPCS CODE
UMBILICAL CORD DOPPLER,76820,CPT,402,RC,,OUTPATIENT,,,215.38,86.152,MONUMENT,COMMERCIAL,,,,172.3,,161.5,211.1,
PFT  DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,UNITED HEALTH,UNITED COMMERCIAL,,,,286.025,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1009,OTHER,945.94,1236.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION AND DRAINAGE,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,MONUMENT,COMMERCIAL,,,,1009,,945.94,1236.03,
AE PFT DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,UNITED HEALTH,UNITED COMMERCIAL,,,,286.025,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
US PICC LINE ONLY,36573,CPT,320,RC,,OUTPATIENT,,,2578.5,1031.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2062.8,OTHER,1933.88,2526.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US PICC LINE ONLY,36573,CPT,320,RC,,OUTPATIENT,,,2578.5,1031.4,MONUMENT,COMMERCIAL,,,,2062.8,,1933.88,2526.93,
OXIMETRY ONCE DAILY,94760,CPT,460,RC,,OUTPATIENT,,,96.25,38.5,UNITED HEALTH,UNITED COMMERCIAL,,,,81.8125,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
US SPINAL CANAL,76800,CPT,402,RC,,OUTPATIENT,,,526.75,210.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,421.4,OTHER,395.06,516.22,PERCENT OF CHARGES BASED ON HCPCS CODE
US SPINAL CANAL,76800,CPT,402,RC,,OUTPATIENT,,,526.75,210.7,MONUMENT,COMMERCIAL,,,,421.4,,395.06,516.22,
OXIMETRY EVALUATION REPEAT(NSY,94760,CPT,460,RC,,OUTPATIENT,,,96.75,38.7,UNITED HEALTH,UNITED COMMERCIAL,,,,82.2375,OTHER,72.56,94.82,PERCENT OF TOTAL BILLED CHARGES
US PSEUDOANEURYSM REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,527.09,210.836,BLUE CROSS ANTHEM,COMMERCIAL,,,,421.672,OTHER,319.88,417.97,PERCENT OF CHARGES BASED ON HCPCS CODE
US PSEUDOANEURYSM REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,527.09,210.836,MONUMENT,COMMERCIAL,,,,341.2,,319.88,417.97,
OXIMETRY MULTIPLES DAILY,94761,CPT,460,RC,,OUTPATIENT,,,275.5,110.2,UNITED HEALTH,UNITED COMMERCIAL,,,,234.175,OTHER,206.63,269.99,PERCENT OF TOTAL BILLED CHARGES
US SOFT TISSUE MISC,76999,CPT,402,RC,,OUTPATIENT,,,334.5,133.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,267.6,OTHER,250.88,327.81,PERCENT OF CHARGES BASED ON HCPCS CODE
US SOFT TISSUE MISC,76999,CPT,402,RC,,OUTPATIENT,,,334.5,133.8,MONUMENT,COMMERCIAL,,,,267.6,,250.88,327.81,
OXIMETRY WITH AMBULATION,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,UNITED HEALTH,UNITED COMMERCIAL,,,,163.625,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
FOLLICLE STUDY,7685752,CPT,402,RC,52,OUTPATIENT,,,217.19,86.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.752,OTHER,89.81,117.36,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLLICLE STUDY,7685752,CPT,402,RC,52,OUTPATIENT,,,217.19,86.876,MONUMENT,COMMERCIAL,,,,95.8,,89.81,117.36,
OXIMETRY/PER DAY,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,UNITED HEALTH,UNITED COMMERCIAL,,,,163.625,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
DIGITAL BREAST TOMO SCRN BIL,77063,CPT,403,RC,,OUTPATIENT,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.6,OTHER,65.25,85.26,PERCENT OF CHARGES BASED ON HCPCS CODE
DIGITAL BREAST TOMO SCRN BIL,77063,CPT,403,RC,,OUTPATIENT,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
OXIMETRY NOCTURNAL STUDY,94762,CPT,460,RC,,OUTPATIENT,,,374.47,149.788,UNITED HEALTH,UNITED COMMERCIAL,,,,318.2995,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI RT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.6,OTHER,65.25,85.26,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST TOMO SCRN UNI RT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
ETCO2 FIRST DAY,94770,CPT,460,RC,,OUTPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,189.3375,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI LT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.6,OTHER,65.25,85.26,PERCENT OF CHARGES BASED ON HCPCS CODE
BREAST TOMO SCRN UNI LT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
SLEEP STAGING <6 YRS,95782,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3314.575,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
AEROSOL DAILY,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
AEROSOL DAILY,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
"SS, CPAP STAGING <6 YRS",95783,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3654.15,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT 1ST HR,94644,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,132.38,172.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CONT MED AEROSOL TRMT 1ST HR,94644,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,141.2,,132.38,172.97,
MULTI SLEEP LATENCY TEST,95805,CPT,740,RC,,OUTPATIENT,,,4094.5,1637.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3480.325,OTHER,3070.88,4012.61,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT ADD'L HR,94645,CPT,410,RC,,OUTPATIENT,,,176.5,70.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.2,OTHER,132.38,172.97,PERCENT OF CHARGES BASED ON HCPCS CODE
CONT MED AEROSOL TRMT ADD'L HR,94645,CPT,410,RC,,OUTPATIENT,,,176.5,70.6,MONUMENT,COMMERCIAL,,,,141.2,,132.38,172.97,
SLEEP STUDY UNATTENDED,95806,CPT,740,RC,,OUTPATIENT,,,278.15,111.26,UNITED HEALTH,UNITED COMMERCIAL,,,,236.4275,OTHER,206.25,269.5,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON-VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,57.75,75.46,PERCENT OF CHARGES BASED ON HCPCS CODE
SUCTION ENDOTRACHEAL NON-VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,61.6,,57.75,75.46,
POLYSOMNOGRAM STAGING,95810,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,UNITED HEALTH,UNITED COMMERCIAL,,,,3314.575,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
IPPB SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IPPB SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
POLYSOMNOGRAM CPAP-STAGING,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3654.15,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES  INITIAL,G0238,HCPCS,410,RC,,INPATIENT,,,117,46.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.47,OTHER,87.75,114.66,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BREATHING EXERCISES  INITIAL,G0238,HCPCS,410,RC,,INPATIENT,,,117,46.8,MONUMENT,COMMERCIAL,,,,93.6,,87.75,114.66,
BREATHING EXERCISES  INITIAL,G0238,HCPCS,410,RC,,INPATIENT,,,117,46.8,UNITED HEALTH,UNITED COMMERCIAL,,,,87.75,,87.75,114.66,
MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
POLYSOMNOGRAM W/CPAP,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3654.15,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
HHN MED AEROSOL SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
ELECTROENCEPHALOGRAM,95816,CPT,740,RC,,OUTPATIENT,,,1063,425.2,UNITED HEALTH,UNITED COMMERCIAL,,,,903.55,OTHER,797.25,1041.74,PERCENT OF TOTAL BILLED CHARGES
CPT PD SUBSEQUENT,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,83.44,109.03,PERCENT OF CHARGES BASED ON HCPCS CODE
CPT PD SUBSEQUENT,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
EEG ALL NIGHT RECORDING,95827,CPT,740,RC,,OUTPATIENT,,,3742.25,1496.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3180.9125,OTHER,2806.69,3667.41,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL SUBSEQ,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,83.44,109.03,PERCENT OF CHARGES BASED ON HCPCS CODE
MANIPULATION CHEST WALL SUBSEQ,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,89,,83.44,109.03,
LIMB MUSCLE TESTING MANUAL,95831,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,UNITED HEALTH,UNITED COMMERCIAL,,,,108.5875,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL INITL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
MANIPULATION CHEST WALL INITL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
CANALITH REPOSITIONING,95992,CPT,420,RC,,OUTPATIENT,,,148.75,59.5,UNITED HEALTH,UNITED COMMERCIAL,,,,126.4375,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
DEVELOPMENTAL TEST LIM,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,UNITED HEALTH,UNITED COMMERCIAL,,,,171.4875,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
IPPB INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
IPPB INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
DEVELOPMENTAL TEST LIMITED,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,UNITED HEALTH,UNITED COMMERCIAL,,,,171.4875,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
SPUTUM INDUCTION,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
SPUTUM INDUCTION,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
IV HYDRATION INITIAL,96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,UNITED HEALTH,UNITED COMMERCIAL,,,,380.8,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.8,OTHER,60,78.4,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,MONUMENT,COMMERCIAL,,,,64,,60,78.4,
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,UNITED HEALTH,UNITED COMMERCIAL,,,,60,,60,78.4,
VENTILATOR SUBSEQUENT DAY,94003,CPT,410,RC,,OUTPATIENT,,,2087.75,835.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1670.2,OTHER,1565.81,2046,PERCENT OF CHARGES BASED ON HCPCS CODE
VENTILATOR SUBSEQUENT DAY,94003,CPT,410,RC,,OUTPATIENT,,,2087.75,835.1,MONUMENT,COMMERCIAL,,,,1670.2,,1565.81,2046,
IV HYDRATION INITIAL LEVEL I,96360,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
VENTILATOR FIRST DAY,94002,CPT,410,RC,,OUTPATIENT,,,2575.5,1030.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2060.4,OTHER,1931.63,2523.99,PERCENT OF CHARGES BASED ON HCPCS CODE
VENTILATOR FIRST DAY,94002,CPT,410,RC,,OUTPATIENT,,,2575.5,1030.2,MONUMENT,COMMERCIAL,,,,2060.4,,1931.63,2523.99,
IV HYDRATION INITIAL LEVEL II,96360,CPT,450,RC,,OUTPATIENT,,,522.5,209,UNITED HEALTH,UNITED COMMERCIAL,,,,444.125,OTHER,391.88,512.05,PERCENT OF TOTAL BILLED CHARGES
WEANING PARAMETERS,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.52,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
WEANING PARAMETERS,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
IV HYDRATION INITIAL LEVEL III,96360,CPT,450,RC,,OUTPATIENT,,,532.25,212.9,UNITED HEALTH,UNITED COMMERCIAL,,,,452.4125,OTHER,399.19,521.61,PERCENT OF TOTAL BILLED CHARGES
CPT PD INITIAL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,93.19,121.77,PERCENT OF CHARGES BASED ON HCPCS CODE
CPT PD INITIAL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
IV INFUSION INITIAL;31-60 MINS,96360,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES,G0238,HCPCS,410,RC,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BREATHING EXERCISES,G0238,HCPCS,410,RC,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
BREATHING EXERCISES,G0238,HCPCS,410,RC,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
CPAP INITIAL DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,527.2,OTHER,494.25,645.82,PERCENT OF CHARGES BASED ON HCPCS CODE
CPAP INITIAL DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,MONUMENT,COMMERCIAL,,,,527.2,,494.25,645.82,
IV HYDRATION (INITIAL),96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,UNITED HEALTH,UNITED COMMERCIAL,,,,380.8,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
CPAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,527.2,OTHER,494.25,645.82,PERCENT OF CHARGES BASED ON HCPCS CODE
CPAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,MONUMENT,COMMERCIAL,,,,527.2,,494.25,645.82,
IV HYDRATION ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,,100.3,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,80.81,105.6,PERCENT OF CHARGES BASED ON HCPCS CODE
SUCTION ENDOTRACHEAL NON VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,86.2,,80.81,105.6,
IV HYDRATION EA ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,,100.3,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
ABG PUNCTURE,36600,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,55.69,72.77,PERCENT OF CHARGES BASED ON HCPCS CODE
ABG PUNCTURE,36600,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,59.4,,55.69,72.77,
IV INFUSION EA ADDT'L HR,96361,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,UNITED HEALTH,UNITED COMMERCIAL,,,,67.7705,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
HHN MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
IV HYDRATION ADD'L HR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,,100.3,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE ED,97112GP,CPT,420,RC,GP,OUTPATIENT,,,142,56.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUROMUSCULAR RE ED,97112GP,CPT,420,RC,GP,OUTPATIENT,,,142,56.8,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
THER/PROPH/DIAG IV INF INIT,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,UNITED HEALTH,UNITED COMMERCIAL,,,,404.3875,OTHER,356.8,466.2,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY,97140GP,CPT,420,RC,GP,OUTPATIENT,,,144.38,57.752,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.504,OTHER,81,105.84,PERCENT OF CHARGES BASED ON HCPCS CODE
MANUAL THERAPY,97140GP,CPT,420,RC,GP,OUTPATIENT,,,144.38,57.752,MONUMENT,COMMERCIAL,,,,86.4,,81,105.84,
IV INFUSION >16 MINS INITIAL,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,UNITED HEALTH,UNITED COMMERCIAL,,,,404.3875,OTHER,356.81,466.24,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACT,97530GP,CPT,420,RC,GP,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC ACT,97530GP,CPT,420,RC,GP,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
INFUSION THERAPY,96365,CPT,260,RC,,OUTPATIENT,,,496.25,198.5,UNITED HEALTH,UNITED COMMERCIAL,,,,421.8125,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.096,OTHER,43.2,56.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,MONUMENT,COMMERCIAL,,,,46.1,,43.2,56.5,
IV INFUS THERAPY INIT LVL I,96365,CPT,260,RC,,OUTPATIENT,,,618.25,247.3,UNITED HEALTH,UNITED COMMERCIAL,,,,525.5125,OTHER,463.69,605.89,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.096,OTHER,43.2,56.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,MONUMENT,COMMERCIAL,,,,46.1,,43.2,56.5,
IV INFUS THERAPY INIT LVL II,96365,CPT,260,RC,,OUTPATIENT,,,550.25,220.1,UNITED HEALTH,UNITED COMMERCIAL,,,,467.7125,OTHER,412.69,539.25,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE >20CM,97598GP,CPT,420,RC,GP,OUTPATIENT,,,155.75,62.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,124.6,OTHER,116.81,152.64,PERCENT OF CHARGES BASED ON HCPCS CODE
ACTIVE WOUND CARE >20CM,97598GP,CPT,420,RC,GP,OUTPATIENT,,,155.75,62.3,MONUMENT,COMMERCIAL,,,,124.6,,116.81,152.64,
IV INFU THERAPY INIT LVL III,96365,CPT,260,RC,,OUTPATIENT,,,562.75,225.1,UNITED HEALTH,UNITED COMMERCIAL,,,,478.3375,OTHER,422.06,551.5,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MAJOR,97606,CPT,,,,OUTPATIENT,,,751.82,300.728,BLUE CROSS ANTHEM,COMMERCIAL,,,,601.456,OTHER,563.9,736.8,PERCENT OF CHARGES BASED ON HCPCS CODE
WOUND VAC MAJOR,97606,CPT,,,,OUTPATIENT,,,751.82,300.728,MONUMENT,COMMERCIAL,,,,601.5,,563.9,736.8,
THER/PROPH/DIAG IV INF ADDON,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,83.5125,OTHER,73.7,96.3,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MINOR,97605,CPT,,,,OUTPATIENT,,,363.92,145.568,BLUE CROSS ANTHEM,COMMERCIAL,,,,291.136,OTHER,272.9,356.6,PERCENT OF CHARGES BASED ON HCPCS CODE
WOUND VAC MINOR,97605,CPT,,,,OUTPATIENT,,,363.92,145.568,MONUMENT,COMMERCIAL,,,,291.1,,272.9,356.6,
IV INFUSION EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,83.5125,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - GROUP,97150GP,CPT,423,RC,GP,OUTPATIENT,,,91.25,36.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,73,OTHER,68.44,89.43,PERCENT OF CHARGES BASED ON HCPCS CODE
AQUATIC THERAPY - GROUP,97150GP,CPT,423,RC,GP,OUTPATIENT,,,91.25,36.5,MONUMENT,COMMERCIAL,,,,73,,68.44,89.43,
INFUSION THERAPY EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,83.5125,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - INDIV/15 MN,97113GP,CPT,420,RC,GP,OUTPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,74.2,OTHER,69.56,90.9,PERCENT OF CHARGES BASED ON HCPCS CODE
AQUATIC THERAPY - INDIV/15 MN,97113GP,CPT,420,RC,GP,OUTPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
IV INFUSION THERAPY ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,83.5125,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
ELEC STIMULATION ATTENDED/15 M,97032GP,CPT,420,RC,GP,OUTPATIENT,,,133.25,53.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.6,OTHER,99.94,130.59,PERCENT OF CHARGES BASED ON HCPCS CODE
ELEC STIMULATION ATTENDED/15 M,97032GP,CPT,420,RC,GP,OUTPATIENT,,,133.25,53.3,MONUMENT,COMMERCIAL,,,,106.6,,99.94,130.59,
IV INFUSED SEQ EA ADD'L,96367,CPT,450,RC,,OUTPATIENT,,,156,62.4,UNITED HEALTH,UNITED COMMERCIAL,,,,132.6,OTHER,117,152.88,PERCENT OF TOTAL BILLED CHARGES
ELEC STIM UNATTENDED/VISIT,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELEC STIM UNATTENDED/VISIT,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ELEC STIM UNATTENDED/VISIT,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
ELECT STIM UNATTENDED,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ELECT STIM UNATTENDED,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
ELECT STIM UNATTENDED,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
PREEMPLOYMENT SCREEN BASIC,4210052,CDM,,,,INPATIENT,,,150,60,BLUE CROSS ANTHEM,COMMERCIAL,,,,136.5,OTHER,112.5,147,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PREEMPLOYMENT SCREEN BASIC,4210052,CDM,,,,INPATIENT,,,150,60,MONUMENT,COMMERCIAL,,,,120,,112.5,147,
PREEMPLOYMENT SCREEN BASIC,4210052,CDM,,,,INPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,,112.5,,112.5,147,
PREEMPLOYMENT SCREEN/INTER,4210053,CDM,,,,INPATIENT,,,300,120,BLUE CROSS ANTHEM,COMMERCIAL,,,,273,OTHER,225,294,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PREEMPLOYMENT SCREEN/INTER,4210053,CDM,,,,INPATIENT,,,300,120,MONUMENT,COMMERCIAL,,,,240,,225,294,
PREEMPLOYMENT SCREEN/INTER,4210053,CDM,,,,INPATIENT,,,300,120,UNITED HEALTH,UNITED COMMERCIAL,,,,225,,225,294,
PT THERAPY EVAL MODERATE COMP,97162GP,CPT,424,RC,GP,OUTPATIENT,,,349,139.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,279.2,OTHER,134.81,176.16,PERCENT OF CHARGES BASED ON HCPCS CODE
PT THERAPY EVAL MODERATE COMP,97162GP,CPT,424,RC,GP,OUTPATIENT,,,349,139.6,MONUMENT,COMMERCIAL,,,,143.8,,134.81,176.16,
IV INFUSION SEQUENTIAL,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,116.875,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVALHIGH COMPLEXITY,97163GP,CPT,424,RC,GP,OUTPATIENT,,,394,157.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,315.2,OTHER,134.81,176.16,PERCENT OF CHARGES BASED ON HCPCS CODE
PT THERAPY EVALHIGH COMPLEXITY,97163GP,CPT,424,RC,GP,OUTPATIENT,,,394,157.6,MONUMENT,COMMERCIAL,,,,143.8,,134.81,176.16,
SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,116.875,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
PT REASSESSMENT,97164GP,CPT,424,RC,GP,OUTPATIENT,,,142.26,56.904,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.808,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
PT REASSESSMENT,97164GP,CPT,424,RC,GP,OUTPATIENT,,,142.26,56.904,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
IV CONCURRENTLY INFUSED,96368,CPT,450,RC,,OUTPATIENT,,,216,86.4,UNITED HEALTH,UNITED COMMERCIAL,,,,183.6,OTHER,162,211.68,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVAL LOW COMPLEXITY,97161GP,CPT,424,RC,GP,OUTPATIENT,,,303,121.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,242.4,OTHER,134.81,176.16,PERCENT OF CHARGES BASED ON HCPCS CODE
PT THERAPY EVAL LOW COMPLEXITY,97161GP,CPT,424,RC,GP,OUTPATIENT,,,303,121.2,MONUMENT,COMMERCIAL,,,,143.8,,134.81,176.16,
IV INFUSION CONCURRENT,96368,CPT,450,RC,,OUTPATIENT,,,183.5,73.4,UNITED HEALTH,UNITED COMMERCIAL,,,,155.975,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
GAIT TRAINING / 15 MIN,97116GP,CPT,420,RC,GP,OUTPATIENT,,,131.45,52.58,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.16,OTHER,76.13,99.47,PERCENT OF CHARGES BASED ON HCPCS CODE
GAIT TRAINING / 15 MIN,97116GP,CPT,420,RC,GP,OUTPATIENT,,,131.45,52.58,MONUMENT,COMMERCIAL,,,,81.2,,76.13,99.47,
OB THER/DIAG CONCURRENT INF,96368,CPT,450,RC,,OUTPATIENT,,,132.25,52.9,UNITED HEALTH,UNITED COMMERCIAL,,,,112.4125,OTHER,99.2,129.6,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GP,CPT,420,RC,GP,OUTPATIENT,,,139,55.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,111.2,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SELF CARE MANAGEMENT/15 MIN,97535GP,CPT,420,RC,GP,OUTPATIENT,,,139,55.6,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
INJ THER/PROPH/DIAG SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,157,62.8,UNITED HEALTH,UNITED COMMERCIAL,,,,133.45,OTHER,117.75,153.86,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GP,CPT,420,RC,GP,OUTPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,108.6,OTHER,101.81,133.04,PERCENT OF CHARGES BASED ON HCPCS CODE
IONTOPHORESIS 15 MINS,97033GP,CPT,420,RC,GP,OUTPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
"INJ, THERAPEUTIC OR DIAGNOSTIC",96372,CPT,260,RC,,OUTPATIENT,,,123.52,49.408,UNITED HEALTH,UNITED COMMERCIAL,,,,104.992,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
MASSAGE THERAPY 15 MINS,97124GP,CPT,420,RC,GP,OUTPATIENT,,,120.75,48.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,96.6,OTHER,90.56,118.34,PERCENT OF CHARGES BASED ON HCPCS CODE
MASSAGE THERAPY 15 MINS,97124GP,CPT,420,RC,GP,OUTPATIENT,,,120.75,48.3,MONUMENT,COMMERCIAL,,,,96.6,,90.56,118.34,
INJ THER/PROPH/DIAG  SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,UNITED HEALTH,UNITED COMMERCIAL,,,,161.925,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST 15 M,97750GP,CPT,420,RC,GP,OUTPATIENT,,,148,59.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,118.4,OTHER,111,145.04,PERCENT OF CHARGES BASED ON HCPCS CODE
PHYSICAL PERFORMANCE TEST 15 M,97750GP,CPT,420,RC,GP,OUTPATIENT,,,148,59.2,MONUMENT,COMMERCIAL,,,,118.4,,111,145.04,
INJECTION PROCEDURE,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,UNITED HEALTH,UNITED COMMERCIAL,,,,161.925,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
MOIST HEAT THERAPY,97010GP,CPT,420,RC,GP,OUTPATIENT,,,65.5,26.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.4,OTHER,49.13,64.19,PERCENT OF CHARGES BASED ON HCPCS CODE
MOIST HEAT THERAPY,97010GP,CPT,420,RC,GP,OUTPATIENT,,,65.5,26.2,MONUMENT,COMMERCIAL,,,,52.4,,49.13,64.19,
THERAPEUTIC/DIAG INJ LEVEL I,96372,CPT,260,RC,,OUTPATIENT,,,272.5,109,UNITED HEALTH,UNITED COMMERCIAL,,,,231.625,OTHER,204.38,267.05,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FITTING 15 MINS,97760GP,CPT,420,RC,GP,OUTPATIENT,,,117.75,47.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.2,OTHER,88.31,115.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ORTHOTICS FITTING 15 MINS,97760GP,CPT,420,RC,GP,OUTPATIENT,,,117.75,47.1,MONUMENT,COMMERCIAL,,,,94.2,,88.31,115.4,
THERAPEUTIC/DIAG INJ LEVEL II,96372,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,UNITED HEALTH,UNITED COMMERCIAL,,,,137.9125,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH,97018GP,CPT,420,RC,GP,OUTPATIENT,,,72.5,29,BLUE CROSS ANTHEM,COMMERCIAL,,,,58,OTHER,54.38,71.05,PERCENT OF CHARGES BASED ON HCPCS CODE
PARAFFIN BATH,97018GP,CPT,420,RC,GP,OUTPATIENT,,,72.5,29,MONUMENT,COMMERCIAL,,,,58,,54.38,71.05,
INJ INTER ARTERIAL,96373,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISE 15 MINS,97110GP,CPT,420,RC,GP,OUTPATIENT,,,146.94,58.776,BLUE CROSS ANTHEM,COMMERCIAL,,,,117.552,OTHER,85.13,111.23,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC EXERCISE 15 MINS,97110GP,CPT,420,RC,GP,OUTPATIENT,,,146.94,58.776,MONUMENT,COMMERCIAL,,,,90.8,,85.13,111.23,
IV PUSH INTL THER/DIAG LVL I,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,270.94,354.03,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXCLUDE HANDS,95833GP,CPT,420,RC,GP,OUTPATIENT,,,79.5,31.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.6,OTHER,59.63,77.91,PERCENT OF CHARGES BASED ON HCPCS CODE
MUSCLE TESTING EXCLUDE HANDS,95833GP,CPT,420,RC,GP,OUTPATIENT,,,79.5,31.8,MONUMENT,COMMERCIAL,,,,63.6,,59.63,77.91,
IV PUSH INTL THER/DIAG LVL II,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,219.94,287.39,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING INCLUDE HANDS,95834GP,CPT,420,RC,GP,OUTPATIENT,,,106,42.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.8,OTHER,79.5,103.88,PERCENT OF CHARGES BASED ON HCPCS CODE
MUSCLE TESTING INCLUDE HANDS,95834GP,CPT,420,RC,GP,OUTPATIENT,,,106,42.4,MONUMENT,COMMERCIAL,,,,84.8,,79.5,103.88,
IV PUSH INTL THER/DIAG LVL III,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
TRACTION - MECHANICAL,97012GP,CPT,420,RC,GP,OUTPATIENT,,,91.25,36.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,73,OTHER,68.44,89.43,PERCENT OF CHARGES BASED ON HCPCS CODE
TRACTION - MECHANICAL,97012GP,CPT,420,RC,GP,OUTPATIENT,,,91.25,36.5,MONUMENT,COMMERCIAL,,,,73,,68.44,89.43,
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GP,CPT,420,RC,GP,OUTPATIENT,,,32,12.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,25.6,OTHER,24,31.36,PERCENT OF CHARGES BASED ON HCPCS CODE
INFRARED THERAPY,97026GP,CPT,420,RC,GP,OUTPATIENT,,,32,12.8,MONUMENT,COMMERCIAL,,,,25.6,,24,31.36,
IV PUSH SINGLE OR INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UNITED HEALTH,UNITED COMMERCIAL,,,,344.7685,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GP,CPT,420,RC,GP,OUTPATIENT,,,113.9,45.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,91.12,OTHER,63.38,82.81,PERCENT OF CHARGES BASED ON HCPCS CODE
ULTRASOUND THERAPY 15 MINS,97035GP,CPT,420,RC,GP,OUTPATIENT,,,113.9,45.56,MONUMENT,COMMERCIAL,,,,67.6,,63.38,82.81,
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.1,214.4,PERCENT OF TOTAL BILLED CHARGES
WHIRLPOOL,97022GP,CPT,420,RC,GP,OUTPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.2,OTHER,167.06,218.3,PERCENT OF CHARGES BASED ON HCPCS CODE
WHIRLPOOL,97022GP,CPT,420,RC,GP,OUTPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
IV PUSH EA ADD'L SEQ THERA DGN,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
WOUND CARE NON SELECTIVE,97602GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,155.06,202.62,PERCENT OF CHARGES BASED ON HCPCS CODE
WOUND CARE NON SELECTIVE,97602GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,165.4,,155.06,202.62,
IV PUSH MED EA ADD'L,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE <20CM,97597GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,168.75,220.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ACTIVE WOUND CARE <20CM,97597GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
IV PUSH EA NEW ADDT'L DRUGS,96375,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,UNITED HEALTH,UNITED COMMERCIAL,,,,67.7705,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,402,RC,,OUTPATIENT,,,233.98,93.592,BLUE CROSS ANTHEM,COMMERCIAL,,,,187.184,OTHER,175.5,229.3,PERCENT OF CHARGES BASED ON HCPCS CODE
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,402,RC,,OUTPATIENT,,,233.98,93.592,MONUMENT,COMMERCIAL,,,,187.2,,175.5,229.3,
IV PUSH NEW MED ADDON,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXTREMITY,95831GP,CPT,420,RC,GP,OUTPATIENT,,,54.25,21.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.4,OTHER,40.69,53.17,PERCENT OF CHARGES BASED ON HCPCS CODE
MUSCLE TESTING EXTREMITY,95831GP,CPT,420,RC,GP,OUTPATIENT,,,54.25,21.7,MONUMENT,COMMERCIAL,,,,43.4,,40.69,53.17,
IV PUSH SAME DRUG,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING-HAND,95832GP,CPT,420,RC,GP,OUTPATIENT,,,118.25,47.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.6,OTHER,88.69,115.89,PERCENT OF CHARGES BASED ON HCPCS CODE
MUSCLE TESTING-HAND,95832GP,CPT,420,RC,GP,OUTPATIENT,,,118.25,47.3,MONUMENT,COMMERCIAL,,,,94.6,,88.69,115.89,
IV PUSH SAME MED ADDON,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GP,CPT,420,RC,GP,OUTPATIENT,,,125,50,BLUE CROSS ANTHEM,COMMERCIAL,,,,100,OTHER,93.75,122.5,PERCENT OF CHARGES BASED ON HCPCS CODE
WHEELCHAIR MANAGEMENT / 15 MIN,97542GP,CPT,420,RC,GP,OUTPATIENT,,,125,50,MONUMENT,COMMERCIAL,,,,100,,93.75,122.5,
THERAPEUTIC EA ADD'L IVP,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
CANALITH REPOSITIONING,95992,CPT,420,RC,,OUTPATIENT,,,148.75,59.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,119,OTHER,111.56,145.78,PERCENT OF CHARGES BASED ON HCPCS CODE
CANALITH REPOSITIONING,95992,CPT,420,RC,,OUTPATIENT,,,148.75,59.5,MONUMENT,COMMERCIAL,,,,119,,111.56,145.78,
APPLICATION ON BODY INJECTOR,96377,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,UNITED HEALTH,UNITED COMMERCIAL,,,,137.9125,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
CHEMO INJ SQ IM NONHORMONAL,96401,CPT,331,RC,,OUTPATIENT,,,271,108.4,UNITED HEALTH,UNITED COMMERCIAL,,,,230.35,OTHER,203.25,265.58,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY/WORK REINTEGRATION,97537,CPT,420,RC,,OUTPATIENT,,,117,46.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.6,OTHER,87.75,114.66,PERCENT OF CHARGES BASED ON HCPCS CODE
COMMUNITY/WORK REINTEGRATION,97537,CPT,420,RC,,OUTPATIENT,,,117,46.8,MONUMENT,COMMERCIAL,,,,93.6,,87.75,114.66,
CHEMO INJ SQ IM HORMONAL AGENT,96402,CPT,331,RC,,OUTPATIENT,,,272,108.8,UNITED HEALTH,UNITED COMMERCIAL,,,,231.2,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING,97761,CPT,420,RC,,OUTPATIENT,,,123.75,49.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,99,OTHER,92.81,121.28,PERCENT OF CHARGES BASED ON HCPCS CODE
PROSTHETIC TRAINING,97761,CPT,420,RC,,OUTPATIENT,,,123.75,49.5,MONUMENT,COMMERCIAL,,,,99,,92.81,121.28,
CHEM ADMIN IVP SNGL/INT LVL I,96409,CPT,331,RC,,OUTPATIENT,,,602,240.8,UNITED HEALTH,UNITED COMMERCIAL,,,,511.7,OTHER,451.5,589.96,PERCENT OF TOTAL BILLED CHARGES
C/O FOR ORTHOTIC/PROSTH USE,97763GP,CPT,420,RC,GP,OUTPATIENT,,,123.75,49.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,99,OTHER,92.81,121.28,PERCENT OF CHARGES BASED ON HCPCS CODE
C/O FOR ORTHOTIC/PROSTH USE,97763GP,CPT,420,RC,GP,OUTPATIENT,,,123.75,49.5,MONUMENT,COMMERCIAL,,,,99,,92.81,121.28,
CHEM ADMIN IVP SNGL/INT LVL II,96409,CPT,331,RC,,OUTPATIENT,,,534,213.6,UNITED HEALTH,UNITED COMMERCIAL,,,,453.9,OTHER,400.5,523.32,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES,97530GP,CPT,420,RC,GP,OUTPATIENT,,,113.75,45.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,91,OTHER,85.31,111.48,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC ACTIVITIES,97530GP,CPT,420,RC,GP,OUTPATIENT,,,113.75,45.5,MONUMENT,COMMERCIAL,,,,91,,85.31,111.48,
CHEM ADMIN IVP PICC LVL III,96409,CPT,331,RC,,OUTPATIENT,,,468.25,187.3,UNITED HEALTH,UNITED COMMERCIAL,,,,398.0125,OTHER,351.19,458.89,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY OT,97140GO,CPT,430,RC,GO,OUTPATIENT,,,102.75,41.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,82.2,OTHER,77.06,100.7,PERCENT OF CHARGES BASED ON HCPCS CODE
MANUAL THERAPY OT,97140GO,CPT,430,RC,GO,OUTPATIENT,,,102.75,41.1,MONUMENT,COMMERCIAL,,,,82.2,,77.06,100.7,
CHEM ADMIN IVP PICC LVL IV,96409,CPT,331,RC,,OUTPATIENT,,,520.25,208.1,UNITED HEALTH,UNITED COMMERCIAL,,,,442.2125,OTHER,390.19,509.85,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.344,OTHER,36.9,48.2,PERCENT OF CHARGES BASED ON HCPCS CODE
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,MONUMENT,COMMERCIAL,,,,39.3,,36.9,48.2,
CHEMO IV PUSH ADD'L DRUG,96411,CPT,331,RC,,OUTPATIENT,,,491.75,196.7,UNITED HEALTH,UNITED COMMERCIAL,,,,417.9875,OTHER,368.81,481.92,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.344,OTHER,36.9,48.2,PERCENT OF CHARGES BASED ON HCPCS CODE
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,MONUMENT,COMMERCIAL,,,,39.3,,36.9,48.2,
IV INFUS CHEMO INIT LEVEL I,96413,CPT,335,RC,,OUTPATIENT,,,793.25,317.3,UNITED HEALTH,UNITED COMMERCIAL,,,,674.2625,OTHER,594.94,777.39,PERCENT OF TOTAL BILLED CHARGES
APPLICATION CAST FINGER,29086,CPT,,,,OUTPATIENT,,,281.4,112.56,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.12,OTHER,211.1,275.8,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION CAST FINGER,29086,CPT,,,,OUTPATIENT,,,281.4,112.56,MONUMENT,COMMERCIAL,,,,225.1,,211.1,275.8,
IV INFUS CHEMO INIT LEVEL II,96413,CPT,335,RC,,OUTPATIENT,,,694,277.6,UNITED HEALTH,UNITED COMMERCIAL,,,,589.9,OTHER,520.5,680.12,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GO,CPT,430,RC,GO,OUTPATIENT,,,80.25,32.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,64.2,OTHER,60.19,78.65,PERCENT OF CHARGES BASED ON HCPCS CODE
ULTRASOUND THERAPY 15 MINS,97035GO,CPT,430,RC,GO,OUTPATIENT,,,80.25,32.1,MONUMENT,COMMERCIAL,,,,64.2,,60.19,78.65,
IV INFUS CHEMO INIT LEVEL III,96413,CPT,335,RC,,OUTPATIENT,,,740.75,296.3,UNITED HEALTH,UNITED COMMERCIAL,,,,629.6375,OTHER,555.56,725.94,PERCENT OF TOTAL BILLED CHARGES
RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,BLUE CROSS ANTHEM,COMMERCIAL,,,,92,OTHER,86.25,112.7,PERCENT OF CHARGES BASED ON HCPCS CODE
RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,MONUMENT,COMMERCIAL,,,,92,,86.25,112.7,
IV INFUS CHEMO INIT LEVEL IV,96413,CPT,335,RC,,OUTPATIENT,,,662,264.8,UNITED HEALTH,UNITED COMMERCIAL,,,,562.7,OTHER,496.5,648.76,PERCENT OF TOTAL BILLED CHARGES
ELE STIMULATION ATTENDED 15MIN,97032GO,CPT,430,RC,GO,OUTPATIENT,,,90.5,36.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,72.4,OTHER,67.88,88.69,PERCENT OF CHARGES BASED ON HCPCS CODE
ELE STIMULATION ATTENDED 15MIN,97032GO,CPT,430,RC,GO,OUTPATIENT,,,90.5,36.2,MONUMENT,COMMERCIAL,,,,72.4,,67.88,88.69,
IV INFUSION CHEMO EA ADD'L HR,96415,CPT,335,RC,,OUTPATIENT,,,148.75,59.5,UNITED HEALTH,UNITED COMMERCIAL,,,,126.4375,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISES/15 MIN,97110GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.4,OTHER,81,105.84,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC EXERCISES/15 MIN,97110GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,MONUMENT,COMMERCIAL,,,,86.4,,81,105.84,
INITIATION OF INFUSION PUMP,96416,CPT,335,RC,,OUTPATIENT,,,830.75,332.3,UNITED HEALTH,UNITED COMMERCIAL,,,,706.1375,OTHER,623.06,814.14,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - LOW COMPLEXITY,97165GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.688,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
OT EVAL - LOW COMPLEXITY,97165GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
EA ADD'L/SEQ INFUSED CHEMO<1HR,96417,CPT,335,RC,,OUTPATIENT,,,159.25,63.7,UNITED HEALTH,UNITED COMMERCIAL,,,,135.3625,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - MODERATE COMPLEXITY,97166GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.688,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
OT EVAL - MODERATE COMPLEXITY,97166GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
REFILL MAINTAIN PUMP,96521,CPT,760,RC,,OUTPATIENT,,,604.75,241.9,UNITED HEALTH,UNITED COMMERCIAL,,,,514.0375,OTHER,453.56,592.66,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - HIGH COMPLEXITY,97167GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,BLUE CROSS ANTHEM,COMMERCIAL,,,,160.688,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
OT EVAL - HIGH COMPLEXITY,97167GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
FLUSHING IMPLANTABLE PORT,96523,CPT,260,RC,,OUTPATIENT,,,282.25,112.9,UNITED HEALTH,UNITED COMMERCIAL,,,,239.9125,OTHER,211.69,276.61,PERCENT OF TOTAL BILLED CHARGES
OT RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,BLUE CROSS ANTHEM,COMMERCIAL,,,,92,OTHER,86.25,112.7,PERCENT OF CHARGES BASED ON HCPCS CODE
OT RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,MONUMENT,COMMERCIAL,,,,92,,86.25,112.7,
IRRIG DRUG DELIVERY DEVICE,96523,CPT,260,RC,,OUTPATIENT,,,172,68.8,UNITED HEALTH,UNITED COMMERCIAL,,,,146.2,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GO,CPT,430,RC,GO,OUTPATIENT,,,129.25,51.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,103.4,OTHER,96.94,126.67,PERCENT OF CHARGES BASED ON HCPCS CODE
IONTOPHORESIS 15 MINS,97033GO,CPT,430,RC,GO,OUTPATIENT,,,129.25,51.7,MONUMENT,COMMERCIAL,,,,103.4,,96.94,126.67,
CONCURRENT ADMIN OF CHEMO,96549,CPT,261,RC,,OUTPATIENT,,,301.75,120.7,UNITED HEALTH,UNITED COMMERCIAL,,,,256.4875,OTHER,226.31,295.72,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING MANUAL HAND,95832GO,CPT,430,RC,GO,OUTPATIENT,,,112.5,45,BLUE CROSS ANTHEM,COMMERCIAL,,,,90,OTHER,84.38,110.25,PERCENT OF CHARGES BASED ON HCPCS CODE
MUSCLE TESTING MANUAL HAND,95832GO,CPT,430,RC,GO,OUTPATIENT,,,112.5,45,MONUMENT,COMMERCIAL,,,,90,,84.38,110.25,
PARAFFIN BATH THERAPY,97018,CPT,430,RC,,OUTPATIENT,,,101.25,40.5,UNITED HEALTH,UNITED COMMERCIAL,,,,86.0625,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE-EDUC/15 MIN,97112GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.4,OTHER,81,105.84,PERCENT OF CHARGES BASED ON HCPCS CODE
NEUROMUSCULAR RE-EDUC/15 MIN,97112GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,MONUMENT,COMMERCIAL,,,,86.4,,81,105.84,
THER IVNTJ 1ST 15 MIN,97129,CPT,,,,OUTPATIENT,,,240,96,UNITED HEALTH,UNITED COMMERCIAL,,,,204,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GO,CPT,430,RC,GO,OUTPATIENT,,,30.25,12.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,24.2,OTHER,22.69,29.65,PERCENT OF CHARGES BASED ON HCPCS CODE
INFRARED THERAPY,97026GO,CPT,430,RC,GO,OUTPATIENT,,,30.25,12.1,MONUMENT,COMMERCIAL,,,,24.2,,22.69,29.65,
THER IVNTJ EA ADDL 15 MIN,97130,CPT,,,,OUTPATIENT,,,42,16.8,UNITED HEALTH,UNITED COMMERCIAL,,,,35.7,OTHER,31.5,41.2,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY / 15 MIN,97113GO,CPT,430,RC,GO,OUTPATIENT,,,88.25,35.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,70.6,OTHER,66.19,86.49,PERCENT OF CHARGES BASED ON HCPCS CODE
AQUATIC THERAPY / 15 MIN,97113GO,CPT,430,RC,GO,OUTPATIENT,,,88.25,35.3,MONUMENT,COMMERCIAL,,,,70.6,,66.19,86.49,
ST COG FUNC PT ADD 15,97130,CPT,,,,OUTPATIENT,,,220.3,88.12,UNITED HEALTH,UNITED COMMERCIAL,,,,187.255,OTHER,165.2,215.9,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PROC GROUP (VISIT),97150GO,CPT,433,RC,GO,OUTPATIENT,,,86.5,34.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.2,OTHER,64.88,84.77,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC PROC GROUP (VISIT),97150GO,CPT,433,RC,GO,OUTPATIENT,,,86.5,34.6,MONUMENT,COMMERCIAL,,,,69.2,,64.88,84.77,
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,137.5,55,UNITED HEALTH,UNITED COMMERCIAL,,,,116.875,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FIT-TRAINING/15 MIN,97760GO,CPT,430,RC,GO,OUTPATIENT,,,275,110,BLUE CROSS ANTHEM,COMMERCIAL,,,,220,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
ORTHOTICS FIT-TRAINING/15 MIN,97760GO,CPT,430,RC,GO,OUTPATIENT,,,275,110,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,UNITED HEALTH,UNITED COMMERCIAL,,,,108.5875,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING / 15 MIN,97761GO,CPT,430,RC,GO,OUTPATIENT,,,87.14,34.856,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.712,OTHER,63,82.32,PERCENT OF CHARGES BASED ON HCPCS CODE
PROSTHETIC TRAINING / 15 MIN,97761GO,CPT,430,RC,GO,OUTPATIENT,,,87.14,34.856,MONUMENT,COMMERCIAL,,,,67.2,,63,82.32,
COMMUNITY/WORK REINTEGRATION,97537,CPT,420,RC,,OUTPATIENT,,,117,46.8,UNITED HEALTH,UNITED COMMERCIAL,,,,99.45,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES/15 MIN,97530GO,CPT,430,RC,GO,OUTPATIENT,,,108.25,43.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,86.6,OTHER,81.19,106.09,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC ACTIVITIES/15 MIN,97530GO,CPT,430,RC,GO,OUTPATIENT,,,108.25,43.3,MONUMENT,COMMERCIAL,,,,86.6,,81.19,106.09,
ACTIVE WOUND CARE <20CM,97597,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.4,OTHER,56.63,73.99,PERCENT OF CHARGES BASED ON HCPCS CODE
SELF CARE MANAGEMENT/15 MIN,97535GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,MONUMENT,COMMERCIAL,,,,60.4,,56.63,73.99,
WOUND VAC MINOR,97605,CPT,,,,OUTPATIENT,,,363.92,145.568,UNITED HEALTH,UNITED COMMERCIAL,,,,309.332,OTHER,272.9,356.6,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY-WORK REINT TRN/15 MN,97537GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,60.4,OTHER,56.63,73.99,PERCENT OF CHARGES BASED ON HCPCS CODE
COMMUNITY-WORK REINT TRN/15 MN,97537GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,MONUMENT,COMMERCIAL,,,,60.4,,56.63,73.99,
WOUND VAC MAJOR,97606,CPT,,,,OUTPATIENT,,,751.82,300.728,UNITED HEALTH,UNITED COMMERCIAL,,,,639.047,OTHER,563.9,736.8,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GO,CPT,430,RC,GO,OUTPATIENT,,,119,47.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,95.2,OTHER,89.25,116.62,PERCENT OF CHARGES BASED ON HCPCS CODE
WHEELCHAIR MANAGEMENT / 15 MIN,97542GO,CPT,430,RC,GO,OUTPATIENT,,,119,47.6,MONUMENT,COMMERCIAL,,,,95.2,,89.25,116.62,
PHYSICAL PERFORMANCE TEST,97750,CPT,440,RC,,OUTPATIENT,,,140.75,56.3,UNITED HEALTH,UNITED COMMERCIAL,,,,119.6375,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
ORHOTIC/PROSTHETIC CHECK/15 MN,97763GO,CPT,430,RC,GO,OUTPATIENT,,,250.54,100.216,BLUE CROSS ANTHEM,COMMERCIAL,,,,200.432,OTHER,40.31,52.68,PERCENT OF CHARGES BASED ON HCPCS CODE
ORHOTIC/PROSTHETIC CHECK/15 MN,97763GO,CPT,430,RC,GO,OUTPATIENT,,,250.54,100.216,MONUMENT,COMMERCIAL,,,,43,,40.31,52.68,
ASSISTIVE TECHNOLOGY ASSESS,97755,CPT,430,RC,,OUTPATIENT,,,121.5,48.6,UNITED HEALTH,UNITED COMMERCIAL,,,,103.275,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORM-CAP TEST/15MN,97750GO,CPT,430,RC,GO,OUTPATIENT,,,140.75,56.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.6,OTHER,105.56,137.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PHYSICAL PERFORM-CAP TEST/15MN,97750GO,CPT,430,RC,GO,OUTPATIENT,,,140.75,56.3,MONUMENT,COMMERCIAL,,,,112.6,,105.56,137.94,
PROSTHETIC TRAINING,97761,CPT,420,RC,,OUTPATIENT,,,123.75,49.5,UNITED HEALTH,UNITED COMMERCIAL,,,,105.1875,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
DEVELOP COGNITIVE SKILLS/15 MN,G0515GO,HCPCS,430,RC,GO,BOTH,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.41,OTHER,73.69,96.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DEVELOP COGNITIVE SKILLS/15 MN,G0515GO,HCPCS,430,RC,GO,BOTH,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
DEVELOP COGNITIVE SKILLS/15 MN,G0515GO,HCPCS,430,RC,GO,BOTH,,,98.25,39.3,UNITED HEALTH,UNITED COMMERCIAL,,,,73.69,,73.69,96.29,
THER IVNTJ EA ADDL 15 MIN,97130,CPT,,,,OUTPATIENT,,,42,16.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,33.6,OTHER,31.5,41.2,PERCENT OF CHARGES BASED ON HCPCS CODE
THER IVNTJ EA ADDL 15 MIN,97130,CPT,,,,OUTPATIENT,,,42,16.8,MONUMENT,COMMERCIAL,,,,33.6,,31.5,41.2,
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,450,RC,,OUTPATIENT,,,340,136,UNITED HEALTH,UNITED COMMERCIAL,,,,289,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
EVALUATE SWALLOWING FUNCTION,92610,CPT,430,RC,,OUTPATIENT,,,436.5,174.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,349.2,OTHER,327.38,427.77,PERCENT OF CHARGES BASED ON HCPCS CODE
EVALUATE SWALLOWING FUNCTION,92610,CPT,430,RC,,OUTPATIENT,,,436.5,174.6,MONUMENT,COMMERCIAL,,,,349.2,,327.38,427.77,
MOD SED SAME PHYS/QHP 5/>YRS,99152,CPT,761,RC,,OUTPATIENT,,,650,260,UNITED HEALTH,UNITED COMMERCIAL,,,,552.5,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
LIMB MUSCLE TESTING MANUAL,95831,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,102.2,OTHER,95.81,125.2,PERCENT OF CHARGES BASED ON HCPCS CODE
LIMB MUSCLE TESTING MANUAL,95831,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,MONUMENT,COMMERCIAL,,,,102.2,,95.81,125.2,
MODERATE SEDATION INITIAL RAD,99152,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIM,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.4,OTHER,151.31,197.72,PERCENT OF CHARGES BASED ON HCPCS CODE
DEVELOPMENTAL TEST LIM,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
MOD SED SAME PHYS/QHP EA,99153,CPT,761,RC,,OUTPATIENT,,,340,136,UNITED HEALTH,UNITED COMMERCIAL,,,,289,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH THERAPY,97018,CPT,430,RC,,OUTPATIENT,,,101.25,40.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,81,OTHER,75.94,99.23,PERCENT OF CHARGES BASED ON HCPCS CODE
PARAFFIN BATH THERAPY,97018,CPT,430,RC,,OUTPATIENT,,,101.25,40.5,MONUMENT,COMMERCIAL,,,,81,,75.94,99.23,
MODERATE SEDATION (RAD),99153,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,UNITED HEALTH,UNITED COMMERCIAL,,,,185.9375,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,102.2,OTHER,95.81,125.2,PERCENT OF CHARGES BASED ON HCPCS CODE
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,MONUMENT,COMMERCIAL,,,,102.2,,95.81,125.2,
MOD SED OTH PHYS/QHP 5>YRS,99156,CPT,450,RC,,OUTPATIENT,,,335,134,UNITED HEALTH,UNITED COMMERCIAL,,,,284.75,OTHER,251.3,328.3,PERCENT OF TOTAL BILLED CHARGES
ASSISTIVE TECHNOLOGY ASSESS,97755,CPT,430,RC,,OUTPATIENT,,,121.5,48.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,97.2,OTHER,91.13,119.07,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSISTIVE TECHNOLOGY ASSESS,97755,CPT,430,RC,,OUTPATIENT,,,121.5,48.6,MONUMENT,COMMERCIAL,,,,97.2,,91.13,119.07,
MOD SED OTHER PHYS/QHP EA,99157,CPT,450,RC,,OUTPATIENT,,,189.5,75.8,UNITED HEALTH,UNITED COMMERCIAL,,,,161.075,OTHER,142.1,185.7,PERCENT OF TOTAL BILLED CHARGES
THER IVNTJ 1ST 15 MIN,97129,CPT,,,,OUTPATIENT,,,240,96,BLUE CROSS ANTHEM,COMMERCIAL,,,,192,OTHER,180,235.2,PERCENT OF CHARGES BASED ON HCPCS CODE
THER IVNTJ 1ST 15 MIN,97129,CPT,,,,OUTPATIENT,,,240,96,MONUMENT,COMMERCIAL,,,,192,,180,235.2,
PHLEBOTOMY  THERAPEUTIC,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,UNITED HEALTH,UNITED COMMERCIAL,,,,226.1,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
ST COG FUNC PT ADD 15,97130,CPT,,,,OUTPATIENT,,,220.3,88.12,BLUE CROSS ANTHEM,COMMERCIAL,,,,176.24,OTHER,165.2,215.9,PERCENT OF CHARGES BASED ON HCPCS CODE
ST COG FUNC PT ADD 15,97130,CPT,,,,OUTPATIENT,,,220.3,88.12,MONUMENT,COMMERCIAL,,,,176.2,,165.2,215.9,
THERAPEUTIC PHLEBOTOMY,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,UNITED HEALTH,UNITED COMMERCIAL,,,,226.1,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE EVAL,92523GN,CPT,444,RC,GN,OUTPATIENT,,,261.33,104.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,209.064,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
SPEECH/LANG/AUD/VOICE EVAL,92523GN,CPT,444,RC,GN,OUTPATIENT,,,261.33,104.532,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
"OFFICE/OP VISIT, NEW",99201,CPT,516,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,,95.2,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE TX,92507GN,CPT,440,RC,GN,OUTPATIENT,,,316,126.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,252.8,OTHER,105.75,138.18,PERCENT OF CHARGES BASED ON HCPCS CODE
SPEECH/LANG/AUD/VOICE TX,92507GN,CPT,440,RC,GN,OUTPATIENT,,,316,126.4,MONUMENT,COMMERCIAL,,,,112.8,,105.75,138.18,
OFFICE/OP VISIT NEW,99202,CPT,516,RC,,OUTPATIENT,,,190,76,UNITED HEALTH,UNITED COMMERCIAL,,,,161.5,OTHER,142.5,186.2,PERCENT OF TOTAL BILLED CHARGES
EVAL SWALLOWING FUNCTION,92610GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.8,OTHER,229.5,299.88,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL SWALLOWING FUNCTION,92610GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,MONUMENT,COMMERCIAL,,,,244.8,,229.5,299.88,
"OFFICE/OP VISIT, NEW, MOD",99203,CPT,516,RC,,OUTPATIENT,,,277,110.8,UNITED HEALTH,UNITED COMMERCIAL,,,,235.45,OTHER,207.75,271.46,PERCENT OF TOTAL BILLED CHARGES
SP SWALLOWING/ORAL TREATMENT,92526GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,244.8,OTHER,229.5,299.88,PERCENT OF CHARGES BASED ON HCPCS CODE
SP SWALLOWING/ORAL TREATMENT,92526GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,MONUMENT,COMMERCIAL,,,,244.8,,229.5,299.88,
"OFFICE/OP VISIT, NEW, MOD",99204,CPT,516,RC,,OUTPATIENT,,,421,168.4,UNITED HEALTH,UNITED COMMERCIAL,,,,357.85,OTHER,315.75,412.58,PERCENT OF TOTAL BILLED CHARGES
ASSESSMENT OF APHASIA PER HR,96105GN,CPT,442,RC,GN,OUTPATIENT,,,291.25,116.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,233,OTHER,218.44,285.43,PERCENT OF CHARGES BASED ON HCPCS CODE
ASSESSMENT OF APHASIA PER HR,96105GN,CPT,442,RC,GN,OUTPATIENT,,,291.25,116.5,MONUMENT,COMMERCIAL,,,,233,,218.44,285.43,
LACTATION CONSULT PAST 30 DAYS,99211,CPT,510,RC,,OUTPATIENT,,,170.25,68.1,UNITED HEALTH,UNITED COMMERCIAL,,,,144.7125,OTHER,127.7,166.8,PERCENT OF TOTAL BILLED CHARGES
COGNITIVE FNCT INTERVENTION,G0515GN,HCPCS,440,RC,GN,BOTH,,,59.25,23.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,53.92,OTHER,44.44,58.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
COGNITIVE FNCT INTERVENTION,G0515GN,HCPCS,440,RC,GN,BOTH,,,59.25,23.7,MONUMENT,COMMERCIAL,,,,47.4,,44.44,58.07,
COGNITIVE FNCT INTERVENTION,G0515GN,HCPCS,440,RC,GN,BOTH,,,59.25,23.7,UNITED HEALTH,UNITED COMMERCIAL,,,,44.44,,44.44,58.07,
VOICE PROSTHETIC EVA,92597GN,CPT,444,RC,GN,OUTPATIENT,,,167.25,66.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,133.8,OTHER,125.44,163.91,PERCENT OF CHARGES BASED ON HCPCS CODE
VOICE PROSTHETIC EVA,92597GN,CPT,444,RC,GN,OUTPATIENT,,,167.25,66.9,MONUMENT,COMMERCIAL,,,,133.8,,125.44,163.91,
"OFFICE/OP VISIT, EST, MIN",99211,CPT,510,RC,,OUTPATIENT,,,51,20.4,UNITED HEALTH,UNITED COMMERCIAL,,,,43.35,OTHER,38.25,49.98,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE 1 HR,92607GN,CPT,444,RC,GN,OUTPATIENT,,,260.32,104.128,BLUE CROSS ANTHEM,COMMERCIAL,,,,208.256,OTHER,175.5,229.32,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL FOR SPEECH DEVICE 1 HR,92607GN,CPT,444,RC,GN,OUTPATIENT,,,260.32,104.128,MONUMENT,COMMERCIAL,,,,187.2,,175.5,229.32,
BABY CHECK AND EVAL,99211,CPT,510,RC,,OUTPATIENT,,,102,40.8,UNITED HEALTH,UNITED COMMERCIAL,,,,86.7,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE ADDL,92608GN,CPT,444,RC,GN,OUTPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,94,OTHER,88.13,115.15,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL FOR SPEECH DEVICE ADDL,92608GN,CPT,444,RC,GN,OUTPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
"OFFICE/OP VISIT EST, LOW",99212,CPT,510,RC,,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,,95.2,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
SPEECH GENERATING DEVICE SERV,92609GN,CPT,440,RC,GN,OUTPATIENT,,,242.25,96.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,193.8,OTHER,181.69,237.41,PERCENT OF CHARGES BASED ON HCPCS CODE
SPEECH GENERATING DEVICE SERV,92609GN,CPT,440,RC,GN,OUTPATIENT,,,242.25,96.9,MONUMENT,COMMERCIAL,,,,193.8,,181.69,237.41,
"OFFICE/OP VISIT, EST MOD",99213,CPT,510,RC,,OUTPATIENT,,,185,74,UNITED HEALTH,UNITED COMMERCIAL,,,,157.25,OTHER,138.75,181.3,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIMITED,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.4,OTHER,151.31,197.72,PERCENT OF CHARGES BASED ON HCPCS CODE
DEVELOPMENTAL TEST LIMITED,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,MONUMENT,COMMERCIAL,,,,161.4,,151.31,197.72,
"OFFICE/OP VISIT, EST, MOD",99214,CPT,510,RC,,OUTPATIENT,,,274,109.6,UNITED HEALTH,UNITED COMMERCIAL,,,,232.9,OTHER,205.5,268.52,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST,97750,CPT,440,RC,,OUTPATIENT,,,140.75,56.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,112.6,OTHER,105.56,137.94,PERCENT OF CHARGES BASED ON HCPCS CODE
PHYSICAL PERFORMANCE TEST,97750,CPT,440,RC,,OUTPATIENT,,,140.75,56.3,MONUMENT,COMMERCIAL,,,,112.6,,105.56,137.94,
"OFFICE/OP VISIT, EST, HIGH",99215,CPT,510,RC,,OUTPATIENT,,,371,148.4,UNITED HEALTH,UNITED COMMERCIAL,,,,315.35,OTHER,278.25,363.58,PERCENT OF TOTAL BILLED CHARGES
TRMT OF SWALLOWING DYSFUNCTION,92526GN,CPT,440,RC,GN,OUTPATIENT,,,175.92,70.368,BLUE CROSS ANTHEM,COMMERCIAL,,,,140.736,OTHER,74.25,97.02,PERCENT OF CHARGES BASED ON HCPCS CODE
TRMT OF SWALLOWING DYSFUNCTION,92526GN,CPT,440,RC,GN,OUTPATIENT,,,175.92,70.368,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
ER ACUITY 1,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,325,OTHER,210.94,275.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SPEECH GROUPS THERAPY,92508GN,CPT,443,RC,GN,OUTPATIENT,,,161.5,64.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.2,OTHER,121.13,158.27,PERCENT OF CHARGES BASED ON HCPCS CODE
SPEECH GROUPS THERAPY,92508GN,CPT,443,RC,GN,OUTPATIENT,,,161.5,64.6,MONUMENT,COMMERCIAL,,,,129.2,,121.13,158.27,
ER ACUITY 1 W/O MODIFIER,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,325,OTHER,210.94,275.63,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STD COGNITIVE TEST PER HR,96125GN,CPT,444,RC,GN,OUTPATIENT,,,350.25,140.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,280.2,OTHER,262.69,343.25,PERCENT OF CHARGES BASED ON HCPCS CODE
STD COGNITIVE TEST PER HR,96125GN,CPT,444,RC,GN,OUTPATIENT,,,350.25,140.1,MONUMENT,COMMERCIAL,,,,280.2,,262.69,343.25,
ER ACUITY 2 W/O MODIFIER,99282,CPT,450,RC,,OUTPATIENT,,,371.25,148.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,5500,OTHER,278.44,363.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVAL OF SPEECH FLUENCY,92521GN,CPT,444,RC,GN,OUTPATIENT,,,277.46,110.984,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.968,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL OF SPEECH FLUENCY,92521GN,CPT,444,RC,GN,OUTPATIENT,,,277.46,110.984,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
ER ACUITY 3 W/O MODIFIER,99283,CPT,450,RC,,OUTPATIENT,,,461.62,184.648,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1700,OTHER,325.88,425.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVAL OF SPEECH SOUND PROD,92522GN,CPT,444,RC,GN,OUTPATIENT,,,182,72.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.6,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL OF SPEECH SOUND PROD,92522GN,CPT,444,RC,GN,OUTPATIENT,,,182,72.8,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
ER ACUITY 4 W/O MODIFIER,99284,CPT,450,RC,,OUTPATIENT,,,820.25,328.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,2800,OTHER,615.19,803.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EVAL OF SPEECH SND W/EVAL LANG,92523GN,CPT,444,RC,GN,OUTPATIENT,,,477.2,190.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,381.76,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
EVAL OF SPEECH SND W/EVAL LANG,92523GN,CPT,444,RC,GN,OUTPATIENT,,,477.2,190.88,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
ER ACUITY 5 W/O MODIFIER,99285,CPT,450,RC,,OUTPATIENT,,,1448.5,579.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,3800,OTHER,1086.38,1419.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BEHAVIORAL ANALYSIS OF VOICE,92524GN,CPT,444,RC,GN,OUTPATIENT,,,226.82,90.728,BLUE CROSS ANTHEM,COMMERCIAL,,,,181.456,OTHER,136.5,178.36,PERCENT OF CHARGES BASED ON HCPCS CODE
BEHAVIORAL ANALYSIS OF VOICE,92524GN,CPT,444,RC,GN,OUTPATIENT,,,226.82,90.728,MONUMENT,COMMERCIAL,,,,145.6,,136.5,178.36,
CRITICAL CARE,99291,CPT,450,RC,,OUTPATIENT,,,1571,628.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,3800,OTHER,1178.25,1539.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,,,,OUTPATIENT,,,534,213.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.2,OTHER,400.5,523.3,PERCENT OF CHARGES BASED ON HCPCS CODE
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,,,,OUTPATIENT,,,534,213.6,MONUMENT,COMMERCIAL,,,,427.2,,400.5,523.3,
CRITICAL CARE ADD'L 30 MIN,99292,CPT,450,RC,,OUTPATIENT,,,271.25,108.5,UNITED HEALTH,UNITED COMMERCIAL,,,,230.5625,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPY SWALLOW (FEES) VID,92612,CPT,444,RC,,OUTPATIENT,,,531,212.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,424.8,OTHER,398.3,520.4,PERCENT OF CHARGES BASED ON HCPCS CODE
ENDOSCOPY SWALLOW (FEES) VID,92612,CPT,444,RC,,OUTPATIENT,,,531,212.4,MONUMENT,COMMERCIAL,,,,424.8,,398.3,520.4,
DRUG MISC MED TOX LABORATORIES,99999,CPT,300,RC,,OUTPATIENT,,,286,114.4,UNITED HEALTH,UNITED COMMERCIAL,,,,243.1,OTHER,214.5,280.28,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 4-8 HR,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1159.8,OTHER,1087.3,1420.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANSFUSION SERV 4-8 HR,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,MONUMENT,COMMERCIAL,,,,1159.8,,1087.3,1420.8,
BREAST ASPIRATION BIL 1 SITE,1900050,CPT,402,RC,50,OUTPATIENT,,,1299.75,519.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1104.7875,OTHER,974.81,1273.76,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 1,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,225,OTHER,210.94,275.63,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 1,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,MONUMENT,COMMERCIAL,,,,225,,210.94,275.63,
BREAST ASPIRATION BIL 2 SITES,1900150,CPT,402,RC,50,OUTPATIENT,,,1535.5,614.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1305.175,OTHER,1151.63,1504.79,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 2,9928225,CPT,450,RC,25,OUTPATIENT,,,371.25,148.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,297,OTHER,278.44,363.83,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 2,9928225,CPT,450,RC,25,OUTPATIENT,,,371.25,148.5,MONUMENT,COMMERCIAL,,,,297,,278.44,363.83,
BX BREAST 1ST LESION STEREO BI,1908150,CPT,401,RC,50,OUTPATIENT,,,5808.75,2323.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4937.4375,OTHER,4356.56,5692.58,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 3,9928325,CPT,450,RC,25,OUTPATIENT,,,461.62,184.648,BLUE CROSS ANTHEM,COMMERCIAL,,,,369.296,OTHER,325.88,425.81,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 3,9928325,CPT,450,RC,25,OUTPATIENT,,,461.62,184.648,MONUMENT,COMMERCIAL,,,,347.6,,325.88,425.81,
BX BREAST ADD LESION STEREO BI,1908250,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 4,9928425,CPT,450,RC,25,OUTPATIENT,,,820.25,328.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,656.2,OTHER,615.19,803.85,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 4,9928425,CPT,450,RC,25,OUTPATIENT,,,820.25,328.1,MONUMENT,COMMERCIAL,,,,656.2,,615.19,803.85,
BX BREAST 1ST LESION STEREO BI,1908350,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 5,9928525,CPT,450,RC,25,OUTPATIENT,,,1448.5,579.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1158.8,OTHER,1086.38,1419.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 5,9928525,CPT,450,RC,25,OUTPATIENT,,,1448.5,579.4,MONUMENT,COMMERCIAL,,,,1158.8,,1086.38,1419.53,
BX BREAST VAC ASSIST BIL 2,1908350,CPT,401,RC,50,OUTPATIENT,,,5137.75,2055.1,UNITED HEALTH,UNITED COMMERCIAL,,,,4367.0875,OTHER,3853.31,5035,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE,99291,CPT,450,RC,,OUTPATIENT,,,1571,628.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1256.8,OTHER,1178.25,1539.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CRITICAL CARE,99291,CPT,450,RC,,OUTPATIENT,,,1571,628.4,MONUMENT,COMMERCIAL,,,,1256.8,,1178.25,1539.58,
BX BREAST ADD LESION STEREO BI,1908450,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE ADD'L 30 MIN,99292,CPT,450,RC,,OUTPATIENT,,,271.25,108.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,217,OTHER,203.44,265.83,PERCENT OF CHARGES BASED ON HCPCS CODE
CRITICAL CARE ADD'L 30 MIN,99292,CPT,450,RC,,OUTPATIENT,,,271.25,108.5,MONUMENT,COMMERCIAL,,,,217,,203.44,265.83,
BX BREAST VAC ASSIST BIL 2ND,1908450,CPT,401,RC,50,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
NEBULIZER INITIAL TREATMENT,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
NEBULIZER INITIAL TREATMENT,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
BX BREAST 1ST LESION BI,1908550,CPT,610,RC,50,OUTPATIENT,,,3589.75,1435.9,UNITED HEALTH,UNITED COMMERCIAL,,,,3051.2875,OTHER,2692.31,3517.96,PERCENT OF TOTAL BILLED CHARGES
TRAUMA TEAM ACTIVATION,G0390,HCPCS,684,RC,,INPATIENT,,,2695.25,1078.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2452.68,OTHER,2021.44,2641.35,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRAUMA TEAM ACTIVATION,G0390,HCPCS,684,RC,,INPATIENT,,,2695.25,1078.1,MONUMENT,COMMERCIAL,,,,2156.2,,2021.44,2641.35,
TRAUMA TEAM ACTIVATION,G0390,HCPCS,684,RC,,INPATIENT,,,2695.25,1078.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2021.44,,2021.44,2641.35,
IV PUSH MED EA ADD'L,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH MED EA ADD'L,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
BX BREAST ADD LESION BI,1908650,CPT,610,RC,50,OUTPATIENT,,,2823.75,1129.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2400.1875,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION 1ST,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,108,141.12,PERCENT OF CHARGES BASED ON HCPCS CODE
IM/SQ VACCINATION 1ST,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.12,
PERQ DEVICE BREAST 1ST BI,1928150,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION EA ADD'L,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,73.4,OTHER,68.81,89.92,PERCENT OF CHARGES BASED ON HCPCS CODE
IM/SQ VACCINATION EA ADD'L,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,MONUMENT,COMMERCIAL,,,,73.4,,68.81,89.92,
PERQ DEVICE BREAST EA IMAGE,1928250,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION >16 MINS INITIAL,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,380.6,OTHER,356.81,466.24,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION >16 MINS INITIAL,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,MONUMENT,COMMERCIAL,,,,380.6,,356.81,466.24,
PERQ DEV BREAST 1ST BI,1928350,CPT,401,RC,50,OUTPATIENT,,,2846.75,1138.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2419.7375,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.6,OTHER,73.69,96.29,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
DRAIN/INJECT JOINT/BURSA BI,2060550,CPT,320,RC,50,OUTPATIENT,,,1124.25,449.7,UNITED HEALTH,UNITED COMMERCIAL,,,,955.6125,OTHER,843.19,1101.77,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION CONCURRENT,96368,CPT,450,RC,,OUTPATIENT,,,183.5,73.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.8,OTHER,137.63,179.83,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION CONCURRENT,96368,CPT,450,RC,,OUTPATIENT,,,183.5,73.4,MONUMENT,COMMERCIAL,,,,146.8,,137.63,179.83,
DRAIN/INJ JNT/BURSA W/O US BIL,2061050,CPT,320,RC,50,OUTPATIENT,,,1300,520,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,975,1274,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV INFUSION SEQUENTIAL,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION SEQUENTIAL,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
INJ/DRAIN MAJOR JOINT,2061050,CPT,320,RC,50,OUTPATIENT,,,1324.75,529.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1126.0375,OTHER,993.56,1298.26,PERCENT OF TOTAL BILLED CHARGES
CORONARY THROMBOLYSIS,92977,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1078.8,OTHER,1011.38,1321.53,PERCENT OF CHARGES BASED ON HCPCS CODE
CORONARY THROMBOLYSIS,92977,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,MONUMENT,COMMERCIAL,,,,1078.8,,1011.38,1321.53,
CLOSED REDUCT SHLD W/O ANES BI,2365050,CPT,450,RC,50,OUTPATIENT,,,884.75,353.9,UNITED HEALTH,UNITED COMMERCIAL,,,,752.0375,OTHER,663.56,867.06,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
CLSD REDUCT OF SHOULDER ANES,2365550,CPT,450,RC,50,OUTPATIENT,,,3768.5,1507.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3203.225,OTHER,2826.38,3693.13,PERCENT OF TOTAL BILLED CHARGES
URINE DIP,81002,CPT,307,RC,,OUTPATIENT,,,38.25,15.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,30.6,OTHER,28.69,37.49,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE DIP,81002,CPT,307,RC,,OUTPATIENT,,,38.25,15.3,MONUMENT,COMMERCIAL,,,,30.6,,28.69,37.49,
VECTRA,3003033,CDM,,,,OUTPATIENT,,,29.25,11.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.94,28.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,497.2,OTHER,466.13,609.07,PERCENT OF CHARGES BASED ON HCPCS CODE
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,MONUMENT,COMMERCIAL,,,,497.2,,466.13,609.07,
CONTROL OF NOSEBLEED SIMP BI,3090150,CPT,450,RC,50,OUTPATIENT,,,233.98,93.592,UNITED HEALTH,UNITED COMMERCIAL,,,,198.883,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
STRAIGHT CATHETER,51701,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,108.75,142.1,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAIGHT CATHETER,51701,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
CONTROL OF NOSEBLEED COMPLEX,3090350,CPT,450,RC,50,OUTPATIENT,,,589,235.6,UNITED HEALTH,UNITED COMMERCIAL,,,,500.65,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER,51702,CPT,320,RC,,OUTPATIENT,,,343.75,137.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,275,OTHER,257.81,336.88,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLEY CATHETER,51702,CPT,320,RC,,OUTPATIENT,,,343.75,137.5,MONUMENT,COMMERCIAL,,,,275,,257.81,336.88,
THORACENTESIS BILATERAL,3255550,CPT,402,RC,50,OUTPATIENT,,,3200,1280,UNITED HEALTH,UNITED COMMERCIAL,,,,2720,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER COMP,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.4,OTHER,337.88,441.49,PERCENT OF CHARGES BASED ON HCPCS CODE
FOLEY CATHETER COMP,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,MONUMENT,COMMERCIAL,,,,360.4,,337.88,441.49,
NEPHROSTOMY TUBE CHANGE BIL,5043550,CPT,350,RC,50,OUTPATIENT,,,3200,1280,UNITED HEALTH,UNITED COMMERCIAL,,,,2720,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
CHEST TUBE ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,915.6,OTHER,858.38,1121.61,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEST TUBE ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
BILATERAL N BLOCK INJ OCCIPITA,6445050,CPT,450,RC,50,OUTPATIENT,,,1264.84,505.936,UNITED HEALTH,UNITED COMMERCIAL,,,,1075.114,OTHER,801.75,1047.62,PERCENT OF TOTAL BILLED CHARGES
NG-OG TUBE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,BLUE CROSS ANTHEM,COMMERCIAL,,,,421.672,OTHER,203.44,265.83,PERCENT OF CHARGES BASED ON HCPCS CODE
NG-OG TUBE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,MONUMENT,COMMERCIAL,,,,217,,203.44,265.83,
CT INJ 1 LEV PARAVRT F JNT L/S,6449350,CPT,350,RC,50,OUTPATIENT,,,2665,1066,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1998.75,2611.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
G-TUBE CHANGE,43762,CPT,450,RC,,OUTPATIENT,,,720.25,288.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,576.2,OTHER,540.19,705.85,PERCENT OF CHARGES BASED ON HCPCS CODE
G-TUBE CHANGE,43762,CPT,450,RC,,OUTPATIENT,,,720.25,288.1,MONUMENT,COMMERCIAL,,,,576.2,,540.19,705.85,
CT INJ 2 LEV PARAVRT F JNT L/S,6449450,CPT,350,RC,50,OUTPATIENT,,,639,255.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,479.25,626.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEFIBRILLATION,92950,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1185.2,OTHER,1111.13,1451.87,PERCENT OF CHARGES BASED ON HCPCS CODE
DEFIBRILLATION,92950,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,MONUMENT,COMMERCIAL,,,,1185.2,,1111.13,1451.87,
CT INJ 3 LEV PARAVRT F JNT L/S,6449550,CPT,350,RC,50,OUTPATIENT,,,600,240,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,450,588,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TC PACING,92953,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1078.8,OTHER,1011.38,1321.53,PERCENT OF CHARGES BASED ON HCPCS CODE
TC PACING,92953,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,MONUMENT,COMMERCIAL,,,,1078.8,,1011.38,1321.53,
CLAVICLE BILATERAL,7300050,CPT,320,RC,50,OUTPATIENT,,,520.75,208.3,UNITED HEALTH,UNITED COMMERCIAL,,,,442.6375,OTHER,390.56,510.34,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE PLCMT ASSIST>5YRS,36556,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1627.8,OTHER,1526.06,1994.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CENTRAL LINE PLCMT ASSIST>5YRS,36556,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,MONUMENT,COMMERCIAL,,,,1627.8,,1526.06,1994.06,
SHOULDER BILATERAL 1 VIEW,7302050,CPT,320,RC,50,OUTPATIENT,,,491,196.4,UNITED HEALTH,UNITED COMMERCIAL,,,,417.35,OTHER,368.25,481.18,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST LG,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.2,OTHER,497.06,649.5,PERCENT OF CHARGES BASED ON HCPCS CODE
JOINT ARTHOCENTESIS ASSIST LG,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,MONUMENT,COMMERCIAL,,,,530.2,,497.06,649.5,
SHOULDER BILATERAL,7303050,CPT,320,RC,50,OUTPATIENT,,,696.25,278.5,UNITED HEALTH,UNITED COMMERCIAL,,,,591.8125,OTHER,522.19,682.33,PERCENT OF TOTAL BILLED CHARGES
THORACOTOMY ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,915.6,OTHER,858.38,1121.61,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACOTOMY ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
HUMERUS BILATERAL,7306050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UNITED HEALTH,UNITED COMMERCIAL,,,,573.5375,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
I O INSERTION,36680,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.872,OTHER,135.94,177.63,PERCENT OF CHARGES BASED ON HCPCS CODE
I O INSERTION,36680,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,MONUMENT,COMMERCIAL,,,,145,,135.94,177.63,
ELBOWS BILATERAL,7308050,CPT,320,RC,50,OUTPATIENT,,,633.5,253.4,UNITED HEALTH,UNITED COMMERCIAL,,,,538.475,OTHER,475.13,620.83,PERCENT OF TOTAL BILLED CHARGES
SHORT ARM,29125,CPT,450,RC,,OUTPATIENT,,,330.75,132.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,264.6,OTHER,248.06,324.14,PERCENT OF CHARGES BASED ON HCPCS CODE
SHORT ARM,29125,CPT,450,RC,,OUTPATIENT,,,330.75,132.3,MONUMENT,COMMERCIAL,,,,264.6,,248.06,324.14,
FOREARM BILATERAL,7309050,CPT,320,RC,50,OUTPATIENT,,,624.75,249.9,UNITED HEALTH,UNITED COMMERCIAL,,,,531.0375,OTHER,468.56,612.26,PERCENT OF TOTAL BILLED CHARGES
SHORT LEG,29515,CPT,450,RC,,OUTPATIENT,,,361,144.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,288.8,OTHER,270.75,353.78,PERCENT OF CHARGES BASED ON HCPCS CODE
SHORT LEG,29515,CPT,450,RC,,OUTPATIENT,,,361,144.4,MONUMENT,COMMERCIAL,,,,288.8,,270.75,353.78,
UPPER EXTREMITY INFANT BIL,7309250,CPT,320,RC,50,OUTPATIENT,,,350,140,UNITED HEALTH,UNITED COMMERCIAL,,,,297.5,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
LONG LEG,29505,CPT,450,RC,,OUTPATIENT,,,450.5,180.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,360.4,OTHER,337.88,441.49,PERCENT OF CHARGES BASED ON HCPCS CODE
LONG LEG,29505,CPT,450,RC,,OUTPATIENT,,,450.5,180.2,MONUMENT,COMMERCIAL,,,,360.4,,337.88,441.49,
WRIST BILATERAL,7311050,CPT,320,RC,50,OUTPATIENT,,,490.5,196.2,UNITED HEALTH,UNITED COMMERCIAL,,,,416.925,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,600.25,240.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,480.2,OTHER,450.19,588.25,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOSTOMY TUBE CHANGE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,600.25,240.1,MONUMENT,COMMERCIAL,,,,480.2,,450.19,588.25,
HAND BILATERAL,7313050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UNITED HEALTH,UNITED COMMERCIAL,,,,573.5375,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE COMPL,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2053.4,OTHER,1925.06,2515.42,PERCENT OF CHARGES BASED ON HCPCS CODE
CYSTOSTOMY TUBE CHANGE COMPL,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,MONUMENT,COMMERCIAL,,,,2053.4,,1925.06,2515.42,
CT UPPER EXTREMITY BIL,7320050,CPT,350,RC,50,OUTPATIENT,,,2400,960,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1800,2352,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ALCOHOL/SUBS INTERV 15-30MN,G0396,HCPCS,450,RC,,INPATIENT,,,52.28,20.912,BLUE CROSS ANTHEM,COMMERCIAL,,,,47.57,OTHER,39.2,51.2,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ALCOHOL/SUBS INTERV 15-30MN,G0396,HCPCS,450,RC,,INPATIENT,,,52.28,20.912,MONUMENT,COMMERCIAL,,,,41.8,,39.2,51.2,
ALCOHOL/SUBS INTERV 15-30MN,G0396,HCPCS,450,RC,,INPATIENT,,,52.28,20.912,UNITED HEALTH,UNITED COMMERCIAL,,,,39.2,,39.2,51.2,
ALCOHOL/SUBS INTERV >30 MIN,G0397,HCPCS,450,RC,,INPATIENT,,,266.34,106.536,BLUE CROSS ANTHEM,COMMERCIAL,,,,242.37,OTHER,199.8,261,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ALCOHOL/SUBS INTERV >30 MIN,G0397,HCPCS,450,RC,,INPATIENT,,,266.34,106.536,MONUMENT,COMMERCIAL,,,,213.1,,199.8,261,
ALCOHOL/SUBS INTERV >30 MIN,G0397,HCPCS,450,RC,,INPATIENT,,,266.34,106.536,UNITED HEALTH,UNITED COMMERCIAL,,,,199.8,,199.8,261,
BLOOD TRANSFUSION SERV 1-2 HR,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,919.8,OTHER,862.3,1126.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANSFUSION SERV 1-2 HR,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,MONUMENT,COMMERCIAL,,,,919.8,,862.3,1126.8,
UPPER EXT ANGIO BILATERAL,7320650,CPT,350,RC,50,OUTPATIENT,,,3097.5,1239,UNITED HEALTH,UNITED COMMERCIAL,,,,2632.875,OTHER,2323.13,3035.55,PERCENT OF TOTAL BILLED CHARGES
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,63,25.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,57.33,OTHER,47.25,61.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,63,25.2,MONUMENT,COMMERCIAL,,,,50.4,,47.25,61.74,
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,63,25.2,UNITED HEALTH,UNITED COMMERCIAL,,,,47.25,,47.25,61.74,
IV HYDRATION INITIAL,96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,358.4,OTHER,336,439.04,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION INITIAL,96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,MONUMENT,COMMERCIAL,,,,358.4,,336,439.04,
HAND W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,5402.25,2160.9,UNITED HEALTH,UNITED COMMERCIAL,,,,4591.9125,OTHER,4051.69,5294.21,PERCENT OF TOTAL BILLED CHARGES
FNA W/O IMAGE,10021,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,625.2,OTHER,586.13,765.87,PERCENT OF CHARGES BASED ON HCPCS CODE
FNA W/O IMAGE,10021,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,MONUMENT,COMMERCIAL,,,,625.2,,586.13,765.87,
SHOULDER W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,4727.5,1891,UNITED HEALTH,UNITED COMMERCIAL,,,,4018.375,OTHER,3545.63,4632.95,PERCENT OF TOTAL BILLED CHARGES
REMOVE NAIL PLATE ADD-ON,11732,CPT,450,RC,,OUTPATIENT,,,255,102,BLUE CROSS ANTHEM,COMMERCIAL,,,,204,OTHER,191.25,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE NAIL PLATE ADD-ON,11732,CPT,450,RC,,OUTPATIENT,,,255,102,MONUMENT,COMMERCIAL,,,,204,,191.25,249.9,
MRI WRIST BILATERAL W/WO,7322350,CPT,610,RC,50,OUTPATIENT,,,5700,2280,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,4275,5586,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTER REPAIR GENITIAL 2.6-7.5,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTER REPAIR GENITIAL 2.6-7.5,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
HAND W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6504.75,2601.9,UNITED HEALTH,UNITED COMMERCIAL,,,,5529.0375,OTHER,4878.56,6374.66,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 20.1-30.0CM,12017,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 20.1-30.0CM,12017,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
SHOULDER W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6763.25,2705.3,UNITED HEALTH,UNITED COMMERCIAL,,,,5748.7625,OTHER,5072.44,6627.99,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCTION OF SHDLR ANES,23655,CPT,450,RC,,OUTPATIENT,,,1884.25,753.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1507.4,OTHER,1413.19,1846.57,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSED REDUCTION OF SHDLR ANES,23655,CPT,450,RC,,OUTPATIENT,,,1884.25,753.7,MONUMENT,COMMERCIAL,,,,1507.4,,1413.19,1846.57,
FEMUR BILATERAL,7355250,CPT,320,RC,50,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,,425,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCT SHLD W/O ANES BI,2365050,CPT,450,RC,50,OUTPATIENT,,,884.75,353.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,707.8,OTHER,663.56,867.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSED REDUCT SHLD W/O ANES BI,2365050,CPT,450,RC,50,OUTPATIENT,,,884.75,353.9,MONUMENT,COMMERCIAL,,,,707.8,,663.56,867.06,
KNEE BILATERAL,7356250,CPT,320,RC,50,OUTPATIENT,,,749.75,299.9,UNITED HEALTH,UNITED COMMERCIAL,,,,637.2875,OTHER,562.31,734.76,PERCENT OF TOTAL BILLED CHARGES
TRT OF ANKLE FRACTURE,45027816,CDM,,,,INPATIENT,,,619.25,247.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,563.52,OTHER,464.44,606.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRT OF ANKLE FRACTURE,45027816,CDM,,,,INPATIENT,,,619.25,247.7,MONUMENT,COMMERCIAL,,,,495.4,,464.44,606.87,
TRT OF ANKLE FRACTURE,45027816,CDM,,,,INPATIENT,,,619.25,247.7,UNITED HEALTH,UNITED COMMERCIAL,,,,464.44,,464.44,606.87,
CONTROL OF NOSEBLEED POSTERIOR,30905,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CONTROL OF NOSEBLEED POSTERIOR,30905,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
TIB FIB BILATERAL,7359050,CPT,320,RC,50,OUTPATIENT,,,500,200,UNITED HEALTH,UNITED COMMERCIAL,,,,425,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
DENTAL SURGERY PROCEDURE,41899,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
DENTAL SURGERY PROCEDURE,41899,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
ANKLE BILATERAL,7361050,CPT,320,RC,50,OUTPATIENT,,,640,256,UNITED HEALTH,UNITED COMMERCIAL,,,,544,OTHER,480,627.2,PERCENT OF TOTAL BILLED CHARGES
INC OF THROMBOSED HEMORRD EXT,46083,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INC OF THROMBOSED HEMORRD EXT,46083,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
FOOT BILATERAL,7363050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UNITED HEALTH,UNITED COMMERCIAL,,,,573.5375,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF SCROTUM ABCESS,55100,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF SCROTUM ABCESS,55100,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
HEEL CALCANEUS BILATERAL,7365050,CPT,320,RC,50,OUTPATIENT,,,525,210,UNITED HEALTH,UNITED COMMERCIAL,,,,446.25,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
I&D OF VULVA/PERINEUM,56405,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,BLUE CROSS ANTHEM,COMMERCIAL,,,,448.824,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
I&D OF VULVA/PERINEUM,56405,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
CT LOWER EXT BI,7370050,CPT,350,RC,50,OUTPATIENT,,,3125.75,1250.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2344.31,3063.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1369.75,547.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1095.8,OTHER,1027.31,1342.36,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1369.75,547.9,MONUMENT,COMMERCIAL,,,,1095.8,,1027.31,1342.36,
TIB/FIB W/WO BILATERAL,7371850,CPT,610,RC,50,OUTPATIENT,,,3675,1470,UNITED HEALTH,UNITED COMMERCIAL,,,,3123.75,OTHER,2756.25,3601.5,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 2-4 HR,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,999.8,OTHER,937.3,1224.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANSFUSION SERV 2-4 HR,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,MONUMENT,COMMERCIAL,,,,999.8,,937.3,1224.8,
FEMUR BILATERAL W/O,7371850,CPT,610,RC,50,OUTPATIENT,,,3526,1410.4,UNITED HEALTH,UNITED COMMERCIAL,,,,2997.1,OTHER,2644.5,3455.48,PERCENT OF TOTAL BILLED CHARGES
REMOVAL IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,226.6,OTHER,212.44,277.59,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,MONUMENT,COMMERCIAL,,,,226.6,,212.44,277.59,
MRI FOOT WO CONT BI,7371850,CPT,610,RC,50,OUTPATIENT,,,5046,2018.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,3784.5,4945.08,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CATHETERIZATION FOR COLLECTION,P9612,HCPCS,300,RC,,INPATIENT,,,6,2.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,5.46,OTHER,4.5,5.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATHETERIZATION FOR COLLECTION,P9612,HCPCS,300,RC,,INPATIENT,,,6,2.4,MONUMENT,COMMERCIAL,,,,4.8,,4.5,5.9,
CATHETERIZATION FOR COLLECTION,P9612,HCPCS,300,RC,,INPATIENT,,,6,2.4,UNITED HEALTH,UNITED COMMERCIAL,,,,4.5,,4.5,5.9,
ACNE SURGERY,10040,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
ACNE SURGERY,10040,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
FEMUR BILATERAL W/WO,7372050,CPT,610,RC,50,OUTPATIENT,,,4811.25,1924.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4089.5625,OTHER,3608.44,4715.03,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
TIB/FIB BILATERAL W/O,7372050,CPT,610,RC,50,OUTPATIENT,,,3400,1360,UNITED HEALTH,UNITED COMMERCIAL,,,,2890,OTHER,2550,3332,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS COMP/MULT,10061,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INCIS/DRAIN ABCESS COMP/MULT,10061,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
FOOT W/WO CONT BI,7372050,CPT,610,RC,50,OUTPATIENT,,,6848.75,2739.5,UNITED HEALTH,UNITED COMMERCIAL,,,,5821.4375,OTHER,5136.56,6711.78,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE PILONIDAL,10080,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,731.25,955.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION & DRAINAGE PILONIDAL,10080,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,780,,731.25,955.5,
ANKLE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3662.225,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE EPIDIDYMIS,54700,CPT,450,RC,,OUTPATIENT,,,975,390,BLUE CROSS ANTHEM,COMMERCIAL,,,,780,OTHER,731.25,955.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION & DRAINAGE EPIDIDYMIS,54700,CPT,450,RC,,OUTPATIENT,,,975,390,MONUMENT,COMMERCIAL,,,,780,,731.25,955.5,
KNEE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3662.225,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY SUB-Q SIMPLE,10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY SUB-Q SIMPLE,10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
HIP W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UNITED HEALTH,UNITED COMMERCIAL,,,,3662.225,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
INC/REMOVAL FOREIGN BODY;COMPL,10121,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,843.6,OTHER,790.88,1033.41,PERCENT OF CHARGES BASED ON HCPCS CODE
INC/REMOVAL FOREIGN BODY;COMPL,10121,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
ANKLE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UNITED HEALTH,UNITED COMMERCIAL,,,,5695.6375,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE HEMOTOMA,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1009,OTHER,945.94,1236.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION AND DRAINAGE HEMOTOMA,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,MONUMENT,COMMERCIAL,,,,1009,,945.94,1236.03,
KNEE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UNITED HEALTH,UNITED COMMERCIAL,,,,5695.6375,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
PUNCTURE ASPIRATE ABCESS SMPL,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,320.63,418.95,PERCENT OF CHARGES BASED ON HCPCS CODE
PUNCTURE ASPIRATE ABCESS SMPL,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,342,,320.63,418.95,
HIP W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UNITED HEALTH,UNITED COMMERCIAL,,,,5695.6375,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
DBRDMT SKIN UP TO 10% OF BODY,11000,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,698.63,912.87,PERCENT OF CHARGES BASED ON HCPCS CODE
DBRDMT SKIN UP TO 10% OF BODY,11000,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,745.2,,698.63,912.87,
IVP LIMITED,7440052,CPT,,,52,OUTPATIENT,,,752.25,300.9,UNITED HEALTH,UNITED COMMERCIAL,,,,639.4125,OTHER,564.19,737.21,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT OPEN FX SUBQ ONLY,11010,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2637.2,OTHER,2472.38,3230.57,PERCENT OF CHARGES BASED ON HCPCS CODE
DEBRIDEMENT OPEN FX SUBQ ONLY,11010,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,MONUMENT,COMMERCIAL,,,,2637.2,,2472.38,3230.57,
BEDSIDE ULTRASOUND OF THE EYES,7651250,CPT,450,RC,50,OUTPATIENT,,,943,377.2,UNITED HEALTH,UNITED COMMERCIAL,,,,801.55,OTHER,707.25,924.14,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SKIN SUBQ TISSUE,11011,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2637.2,OTHER,2472.38,3230.57,PERCENT OF CHARGES BASED ON HCPCS CODE
DEBRIDEMENT SKIN SUBQ TISSUE,11011,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,MONUMENT,COMMERCIAL,,,,2637.2,,2472.38,3230.57,
BREAST COMPLETE BILATERAL,7664150,CPT,402,RC,50,OUTPATIENT,,,586.5,234.6,UNITED HEALTH,UNITED COMMERCIAL,,,,498.525,OTHER,439.88,574.77,PERCENT OF TOTAL BILLED CHARGES
DEBRIDMENT SKIN PARTIAL THICK,4511040,CDM,,,,INPATIENT,,,470,188,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.7,OTHER,352.5,460.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DEBRIDMENT SKIN PARTIAL THICK,4511040,CDM,,,,INPATIENT,,,470,188,MONUMENT,COMMERCIAL,,,,376,,352.5,460.6,
DEBRIDMENT SKIN PARTIAL THICK,4511040,CDM,,,,INPATIENT,,,470,188,UNITED HEALTH,UNITED COMMERCIAL,,,,352.5,,352.5,460.6,
DEBRIDEMENT SKIN FULL THICK,4511041,CDM,,,,INPATIENT,,,470,188,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.7,OTHER,352.5,460.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DEBRIDEMENT SKIN FULL THICK,4511041,CDM,,,,INPATIENT,,,470,188,MONUMENT,COMMERCIAL,,,,376,,352.5,460.6,
DEBRIDEMENT SKIN FULL THICK,4511041,CDM,,,,INPATIENT,,,470,188,UNITED HEALTH,UNITED COMMERCIAL,,,,352.5,,352.5,460.6,
DEBRIDEMENT SUBQ TISSUE 20 SQ,11042,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,745.2,OTHER,698.63,912.87,PERCENT OF CHARGES BASED ON HCPCS CODE
DEBRIDEMENT SUBQ TISSUE 20 SQ,11042,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,MONUMENT,COMMERCIAL,,,,745.2,,698.63,912.87,
BREAST LIMITED BILATERAL,7664250,CPT,402,RC,50,OUTPATIENT,,,392,156.8,UNITED HEALTH,UNITED COMMERCIAL,,,,333.2,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
DEB BONE 20 SQ CM OR LESS,11044,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,745.2,OTHER,698.63,912.87,PERCENT OF CHARGES BASED ON HCPCS CODE
DEB BONE 20 SQ CM OR LESS,11044,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,MONUMENT,COMMERCIAL,,,,745.2,,698.63,912.87,
FOLLICLE STUDY,7685752,CPT,402,RC,52,OUTPATIENT,,,217.19,86.876,UNITED HEALTH,UNITED COMMERCIAL,,,,184.6115,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SKIN LESION,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,345,OTHER,323.44,422.63,PERCENT OF CHARGES BASED ON HCPCS CODE
BIOPSY SKIN LESION,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,MONUMENT,COMMERCIAL,,,,345,,323.44,422.63,
US LIMITED NONVAS EXTR BILAT,7688250,CPT,450,RC,50,OUTPATIENT,,,554.5,221.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,415.88,543.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INCISIONAL BIOPSY SINGLE LESN,11106,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,323.44,422.63,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISIONAL BIOPSY SINGLE LESN,11106,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,345,,323.44,422.63,
US GUIDED NEEDLE PLACEMENT BI,7694250,CPT,402,RC,50,OUTPATIENT,,,1608.5,643.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1206.38,1576.33,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DEBRIDEMENT NAIL 1-5,11720,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,63.94,83.55,PERCENT OF CHARGES BASED ON HCPCS CODE
DEBRIDEMENT NAIL 1-5,11720,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,68.2,,63.94,83.55,
US GUIDED 2ND NEEDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL OF SKIN TAGS UP TO 15,11200,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL OF SKIN TAGS UP TO 15,11200,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
US GUIDANCE BI NEEDLE 2ND PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXC TR-EXT B9+MART 0.6-ICM,11401,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
EXC TR-EXT B9+MART 0.6-ICM,11401,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
US GUIDANCE BI NEEDLE 3RD PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUID EXC H-F-NK-SP B9+MARG,11422,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUID EXC H-F-NK-SP B9+MARG,11422,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
US GUIDED 2ND NEEDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
US GUIDANCE 3RD NDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,450,RC,,OUTPATIENT,,,605,242,BLUE CROSS ANTHEM,COMMERCIAL,,,,484,OTHER,453.8,592.9,PERCENT OF CHARGES BASED ON HCPCS CODE
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,450,RC,,OUTPATIENT,,,605,242,MONUMENT,COMMERCIAL,,,,484,,453.8,592.9,
US GUIDANCE 3RD NDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,687.56,898.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXC MALIGN LESION INCL MARGINS,11606,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
EXC MALIGN LESION INCL MARGINS,11606,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
NEEDLE LOCAL BY XRAY BILATERAL,7700250,CPT,,,50,OUTPATIENT,,,550,220,UNITED HEALTH,UNITED COMMERCIAL,,,,467.5,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
TRIMMING OF FINGER/TOE NAIL(S),11719,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,49.69,64.93,PERCENT OF CHARGES BASED ON HCPCS CODE
TRIMMING OF FINGER/TOE NAIL(S),11719,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,53,,49.69,64.93,
BREAST TOMO SCRN UNI RT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,,73.95,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
AVULSION OF NAIL PLATE SINGLE,11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,191.25,249.9,PERCENT OF CHARGES BASED ON HCPCS CODE
AVULSION OF NAIL PLATE SINGLE,11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,204,,191.25,249.9,
BREAST TOMO SCRN UNI LT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,UNITED HEALTH,UNITED COMMERCIAL,,,,73.95,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
EVACUATION SUBUNGAL HEMOTOMA,11740,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,161.25,210.7,PERCENT OF CHARGES BASED ON HCPCS CODE
EVACUATION SUBUNGAL HEMOTOMA,11740,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,172,,161.25,210.7,
DIGITAL MAM UNI SCREEN CAD,7706752,CPT,,,52,OUTPATIENT,,,20.75,8.3,UNITED HEALTH,UNITED COMMERCIAL,,,,17.6375,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
EXCISION OF NAIL PERM RM,11750,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,843.6,OTHER,790.88,1033.41,PERCENT OF CHARGES BASED ON HCPCS CODE
EXCISION OF NAIL PERM RM,11750,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
Z PHENCYCLIDINE,8010191,CPT,300,RC,91,OUTPATIENT,,,70.5,28.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,52.88,69.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR OF NAIL BED,11760,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,254.44,332.47,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR OF NAIL BED,11760,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,271.4,,254.44,332.47,
SIROLIMUS,8019559,CPT,,,59,OUTPATIENT,,,402.25,160.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,301.69,394.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR OF TENDON,4511754,CDM,,,,INPATIENT,,,1910.25,764.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1738.33,OTHER,1432.69,1872.05,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
REPAIR OF TENDON,4511754,CDM,,,,INPATIENT,,,1910.25,764.1,MONUMENT,COMMERCIAL,,,,1528.2,,1432.69,1872.05,
REPAIR OF TENDON,4511754,CDM,,,,INPATIENT,,,1910.25,764.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1432.69,,1432.69,1872.05,
WEDGE EXCISION OF SKIN OF NAIL,11765,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,625.2,OTHER,586.13,765.87,PERCENT OF CHARGES BASED ON HCPCS CODE
WEDGE EXCISION OF SKIN OF NAIL,11765,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,MONUMENT,COMMERCIAL,,,,625.2,,586.13,765.87,
Z IMMUNOASSAY EA DRUG CLASS,8030159,CPT,300,RC,59,OUTPATIENT,,,190.5,76.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,142.88,186.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE PILONIDAL CYST SIMPLE,11770,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,625.2,OTHER,586.13,765.87,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE PILONIDAL CYST SIMPLE,11770,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,MONUMENT,COMMERCIAL,,,,625.2,,586.13,765.87,
Z AMPHETAMINE ASSAY,8214559,CPT,300,RC,59,OUTPATIENT,,,56.25,22.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,42.19,55.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 2.5 CM OR LESS,12001,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 2.5 CM OR LESS,12001,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z THIOPURINE METABOLITES,8249191,CPT,300,RC,91,OUTPATIENT,,,176,70.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,132,172.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 2.6CM TO 7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 2.6CM TO 7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z ELECTROPHORECTIC TEST,8266491,CPT,301,RC,91,OUTPATIENT,,,154.5,61.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,115.88,151.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 7.6-12.5 CM,12004,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 7.6-12.5 CM,12004,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 12.6 TO 20 CM,12005,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 12.6 TO 20 CM,12005,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 20.1 TO 30 CM,12006,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 20.1 TO 30 CM,12006,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR > 30CM,12007,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR > 30CM,12007,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,32.25,42.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR FACE <2.5CM,12011,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR FACE <2.5CM,12011,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
PROTEINASE 3 ANTIBODY,8351659,CPT,,,59,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR FACE 2.6 - 5.0CM,12013,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR FACE 2.6 - 5.0CM,12013,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR FACE 5.1-7.5CM,12014,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR FACE 5.1-7.5CM,12014,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 7.6-12.5CM,12015,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 7.6-12.5CM,12015,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR 12.6-20.0,12016,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR 12.6-20.0,12016,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SIMPLE REPAIR OVER 30CM,12018,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,767.4,OTHER,719.44,940.07,PERCENT OF CHARGES BASED ON HCPCS CODE
SIMPLE REPAIR OVER 30CM,12018,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,MONUMENT,COMMERCIAL,,,,767.4,,719.44,940.07,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRMT OF SUPERFICIAL WND SIMPLE,12020,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
TRMT OF SUPERFICIAL WND SIMPLE,12020,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR > 2.5 CM,12031,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR > 2.5 CM,12031,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 2.6-7.5CM,12032,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 2.6-7.5CM,12032,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z TISS TRANSGLUTAMINASE IGG,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 7.6-12.5CM,12034,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 7.6-12.5CM,12034,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z GLIADIN IGA ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,85.31,111.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 12.6-20.0CM,12035,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 12.6-20.0CM,12035,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 20.1-30.0CM,12036,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 20.1-30.0CM,12036,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR OVER 30.0 CM,12037,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,BLUE CROSS ANTHEM,COMMERCIAL,,,,2735.192,OTHER,2391.75,3125.22,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR OVER 30.0 CM,12037,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,MONUMENT,COMMERCIAL,,,,2551.2,,2391.75,3125.22,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTER REPAIR GENITAL 2.5 CM<,12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
INTER REPAIR GENITAL 2.5 CM<,12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 2.6-7.5CM,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 2.6-7.5CM,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 7.6-12.5CM,12044,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 7.6-12.5CM,12044,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 12.6-20.0CM,12045,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 12.6-20.0CM,12045,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR INTERMED 20.1-30.0CM,12046,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR INTERMED 20.1-30.0CM,12046,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,21.75,28.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR OVER 30.0 CM,12047,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,BLUE CROSS ANTHEM,COMMERCIAL,,,,2735.192,OTHER,2391.75,3125.22,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR OVER 30.0 CM,12047,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,MONUMENT,COMMERCIAL,,,,2551.2,,2391.75,3125.22,
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR < 2.5CM FACE,12051,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR < 2.5CM FACE,12051,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 2.5-5.0CM,12052,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 2.5-5.0CM,12052,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z ACH RECEPTOR BINDING AB,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 5.1-7.5CM,12053,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 5.1-7.5CM,12053,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
ACH RECEPTORS,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,170.63,222.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 7.6-12.5CM,12054,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 7.6-12.5CM,12054,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
PROMETHEUS INFLIXAMAB HACA,8352059,CPT,301,RC,59,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 12.6-20.0CM,12055,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,277.88,363.09,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 12.6-20.0CM,12055,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,296.4,,277.88,363.09,
Z GALOP AUTOANTIBODIES,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR 20.1-30.0CM,12056,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR 20.1-30.0CM,12056,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z SULFATIDE AUTOANTIBODY,8352091,CPT,300,RC,91,OUTPATIENT,,,443,177.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,332.25,434.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTERMED REPAIR OVER 30.0CM,12057,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2551.2,OTHER,2391.75,3125.22,PERCENT OF CHARGES BASED ON HCPCS CODE
INTERMED REPAIR OVER 30.0CM,12057,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,MONUMENT,COMMERCIAL,,,,2551.2,,2391.75,3125.22,
MYELIN ASSOC GLYCOPROTEIN,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.25,140.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 1.1-2.5CM,13100,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 1.1-2.5CM,13100,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24.19,31.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 2.6-7.5CM,13101,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 2.6-7.5CM,13101,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,24.19,31.61,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR EACH ADD 5.0CM,13102,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,161,OTHER,150.94,197.23,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR EACH ADD 5.0CM,13102,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,MONUMENT,COMMERCIAL,,,,161,,150.94,197.23,
Z MASS SPECTOMETRY,8378859,CPT,300,RC,59,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 1.1-2.5CM,13120,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 1.1-2.5CM,13120,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
MOLECULE ISOLATE NUCLEIC ADD'L,8381959,CPT,300,RC,59,OUTPATIENT,,,449.5,179.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,337.13,440.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIRED SCALP/EXTREMI,13121,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIRED SCALP/EXTREMI,13121,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
Z IMMUNOGLOB LIGHT CHAINS,8388391,CPT,300,RC,91,OUTPATIENT,,,131,52.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,98.25,128.38,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR EACH ADD 5.0 CM,13122,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,161,OTHER,150.94,197.23,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR EACH ADD 5.0 CM,13122,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,MONUMENT,COMMERCIAL,,,,161,,150.94,197.23,
Z MOLECULE ISOLATE NUCLEIC,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 1.1-2.5CM,13131,CPT,450,RC,,OUTPATIENT,,,985.75,394.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,788.6,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 1.1-2.5CM,13131,CPT,450,RC,,OUTPATIENT,,,985.75,394.3,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 2.6-7.5CM,13132,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 2.6-7.5CM,13132,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,19.5,25.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR EACH ADD 5.0CM,13133,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,161,OTHER,150.94,197.23,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR EACH ADD 5.0CM,13133,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,MONUMENT,COMMERCIAL,,,,161,,150.94,197.23,
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR > 1.0CM,13150,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2551.2,OTHER,2391.75,3125.22,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR > 1.0CM,13150,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,MONUMENT,COMMERCIAL,,,,2551.2,,2391.75,3125.22,
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 1.1-2.5CM,13151,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 1.1-2.5CM,13151,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR 2.6-7.5CM,13152,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,739.31,966.04,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR 2.6-7.5CM,13152,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,788.6,,739.31,966.04,
Z ENZYME DIGEST,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COMPLEX REPAIR EACH ADD 5CM,13153,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,161,OTHER,150.94,197.23,PERCENT OF CHARGES BASED ON HCPCS CODE
COMPLEX REPAIR EACH ADD 5CM,13153,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,MONUMENT,COMMERCIAL,,,,161,,150.94,197.23,
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE SUTURES SAME SURGEON,15850,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,835.8,OTHER,146.06,190.86,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE SUTURES SAME SURGEON,15850,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,MONUMENT,COMMERCIAL,,,,155.8,,146.06,190.86,
Z MOLECULAR DIAGNOS ENZ DIGEST,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT 1ST DEGREE BURN LOCAL,16000,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,135.94,177.63,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT 1ST DEGREE BURN LOCAL,16000,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,145,,135.94,177.63,
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRESS/DEBRIDE SML BURN W/O ANE,16020,CPT,450,RC,,OUTPATIENT,,,361,144.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,288.8,OTHER,270.75,353.78,PERCENT OF CHARGES BASED ON HCPCS CODE
DRESS/DEBRIDE SML BURN W/O ANE,16020,CPT,450,RC,,OUTPATIENT,,,361,144.4,MONUMENT,COMMERCIAL,,,,288.8,,270.75,353.78,
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRESS/DEBRISE MED BRN W/O ANE,16025,CPT,450,RC,,OUTPATIENT,,,495.25,198.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,396.2,OTHER,371.44,485.35,PERCENT OF CHARGES BASED ON HCPCS CODE
DRESS/DEBRISE MED BRN W/O ANE,16025,CPT,450,RC,,OUTPATIENT,,,495.25,198.1,MONUMENT,COMMERCIAL,,,,396.2,,371.44,485.35,
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRESS/DEBRIDE LRG BURN W/O ANE,16030,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,472.88,617.89,PERCENT OF CHARGES BASED ON HCPCS CODE
DRESS/DEBRIDE LRG BURN W/O ANE,16030,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,504.4,,472.88,617.89,
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CHEMICAL CAUTERIZATION,17250,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,65.25,85.26,PERCENT OF CHARGES BASED ON HCPCS CODE
CHEMICAL CAUTERIZATION,17250,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,69.6,,65.25,85.26,
Z ENZYME DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.25,57.82,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SKIN TISSUE,17999,CPT,450,RC,,INPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,703.89,OTHER,580.13,758.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SKIN TISSUE,17999,CPT,450,RC,,INPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
SKIN TISSUE,17999,CPT,450,RC,,INPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,580.13,,580.13,758.03,
I&D ABSCESS,4520005,CDM,450,RC,,INPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,703.89,OTHER,580.13,758.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
I&D ABSCESS,4520005,CDM,450,RC,,INPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
I&D ABSCESS,4520005,CDM,450,RC,,INPATIENT,,,773.5,309.4,UNITED HEALTH,UNITED COMMERCIAL,,,,580.13,,580.13,758.03,
EXPLORE WOUND,20103,CPT,450,RC,,INPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,1128.12,OTHER,790.88,1033.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EXPLORE WOUND,20103,CPT,450,RC,,INPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
EXPLORE WOUND,20103,CPT,450,RC,,INPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,790.88,,790.88,1033.41,
REM FOREIGN BODY IN MUSCLE,20520,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,843.6,OTHER,790.88,1033.41,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY IN MUSCLE,20520,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.31,29.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ TENDONS/LIGAMENTS;SINGLE,20550,CPT,320,RC,,OUTPATIENT,,,561.25,224.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,449,OTHER,420.94,550.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ TENDONS/LIGAMENTS;SINGLE,20550,CPT,320,RC,,OUTPATIENT,,,561.25,224.5,MONUMENT,COMMERCIAL,,,,449,,420.94,550.03,
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.31,29.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ SGL/MULT TRIGGER PTS 1OR2,20552,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,449,OTHER,420.94,550.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ SGL/MULT TRIGGER PTS 1OR2,20552,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,MONUMENT,COMMERCIAL,,,,449,,420.94,550.03,
Z AMP NUCLEIC ACID EA SEQ,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ SGL/MULT TRIGGER PTS 3>,20553,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,449,OTHER,420.94,550.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ SGL/MULT TRIGGER PTS 3>,20553,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,MONUMENT,COMMERCIAL,,,,449,,420.94,550.03,
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JOINT ARTHOCENTESIS ASSIST SM,20600,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
JOINT ARTHOCENTESIS ASSIST SM,20600,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ARTHRO SM W/US GUIDANCE,20604,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
ARTHRO SM W/US GUIDANCE,20604,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
JOINT ARTHOCENTESIS ASSIST MED,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
JOINT ARTHOCENTESIS ASSIST MED,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.5,60.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL MJR JOINT OR BURSA,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,530.2,OTHER,497.06,649.5,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL MJR JOINT OR BURSA,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,MONUMENT,COMMERCIAL,,,,530.2,,497.06,649.5,
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"ARTHRO,ASSIST LG W/US GUIDANCE",20611,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
"ARTHRO,ASSIST LG W/US GUIDANCE",20611,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ASPIRATE/INJ GAGLION,20612,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
ASPIRATE/INJ GAGLION,20612,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
Z NUCLEIC ACID PROBE EA ADD'L,8389691,CPT,300,RC,91,OUTPATIENT,,,393.25,157.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,294.94,385.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL FIXATION DEVICE;SUPER,20670,CPT,450,RC,,OUTPATIENT,,,3136.96,1254.784,BLUE CROSS ANTHEM,COMMERCIAL,,,,2509.568,OTHER,2352.7,3074.2,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL FIXATION DEVICE;SUPER,20670,CPT,450,RC,,OUTPATIENT,,,3136.96,1254.784,MONUMENT,COMMERCIAL,,,,2509.6,,2352.7,3074.2,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FLUID PRESSURE MUSCLE,20950,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
FLUID PRESSURE MUSCLE,20950,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD NASAL BONE FRACTURE,21310,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD NASAL BONE FRACTURE,21310,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOSED TRMT OF NASAL BONE FX,21315,CPT,450,RC,,OUTPATIENT,,,1297.25,518.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1037.8,OTHER,972.94,1271.31,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSED TRMT OF NASAL BONE FX,21315,CPT,450,RC,,OUTPATIENT,,,1297.25,518.9,MONUMENT,COMMERCIAL,,,,1037.8,,972.94,1271.31,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DISLOCATION CLOSED TREATMENT,21480,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
DISLOCATION CLOSED TREATMENT,21480,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD RIB FRACTURE UNCOMP,21800,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD RIB FRACTURE UNCOMP,21800,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
HIP DISLOCATION W/MANIPULATION,27257,CPT,450,RC,,OUTPATIENT,,,3282.25,1312.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2625.8,OTHER,2461.69,3216.61,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP DISLOCATION W/MANIPULATION,27257,CPT,450,RC,,OUTPATIENT,,,3282.25,1312.9,MONUMENT,COMMERCIAL,,,,2625.8,,2461.69,3216.61,
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD CLAVICULAR FRACTURE,23500,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD CLAVICULAR FRACTURE,23500,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD PRX HUMERAL FX W/O,23600,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD PRX HUMERAL FX W/O,23600,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DISLOCATION CLOSED SHLD UNI,23650,CPT,450,RC,,OUTPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,354,OTHER,331.88,433.65,PERCENT OF CHARGES BASED ON HCPCS CODE
DISLOCATION CLOSED SHLD UNI,23650,CPT,450,RC,,OUTPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD REDUCT SHLDER W/ANES BILA,23655,CPT,450,RC,,OUTPATIENT,,,2890.9,1156.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,2312.72,OTHER,2168.2,2833.1,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD REDUCT SHLDER W/ANES BILA,23655,CPT,450,RC,,OUTPATIENT,,,2890.9,1156.36,MONUMENT,COMMERCIAL,,,,2312.7,,2168.2,2833.1,
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD REDUCT OF SHOULDER ANES,2365550,CPT,450,RC,50,OUTPATIENT,,,3768.5,1507.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,3014.8,OTHER,2826.38,3693.13,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD REDUCT OF SHOULDER ANES,2365550,CPT,450,RC,50,OUTPATIENT,,,3768.5,1507.4,MONUMENT,COMMERCIAL,,,,3014.8,,2826.38,3693.13,
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.56,43.86,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLTX SHLD DISLC W/FX HUMERAL,23665,CPT,450,RC,,OUTPATIENT,,,1500,600,BLUE CROSS ANTHEM,COMMERCIAL,,,,1200,OTHER,1125,1470,PERCENT OF CHARGES BASED ON HCPCS CODE
CLTX SHLD DISLC W/FX HUMERAL,23665,CPT,450,RC,,OUTPATIENT,,,1500,600,MONUMENT,COMMERCIAL,,,,1200,,1125,1470,
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT SHLD DIS W/SURG,23675,CPT,450,RC,,OUTPATIENT,,,1500,600,BLUE CROSS ANTHEM,COMMERCIAL,,,,1200,OTHER,1125,1470,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT SHLD DIS W/SURG,23675,CPT,450,RC,,OUTPATIENT,,,1500,600,MONUMENT,COMMERCIAL,,,,1200,,1125,1470,
MOLECULE NUCLEIC AMPLIFICATION,8389859,CPT,301,RC,59,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL FB UPPER ARM/ELBOW SUB,24200,CPT,450,RC,,OUTPATIENT,,,675,270,BLUE CROSS ANTHEM,COMMERCIAL,,,,540,OTHER,506.25,661.5,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL FB UPPER ARM/ELBOW SUB,24200,CPT,450,RC,,OUTPATIENT,,,675,270,MONUMENT,COMMERCIAL,,,,540,,506.25,661.5,
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,171.75,68.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,128.81,168.32,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT HUMERAL FRACTURE,24535,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT HUMERAL FRACTURE,24535,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,856.5,342.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,642.38,839.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT HUMERAL FX,24565,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT HUMERAL FX,24565,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z MOLECULAR EA NUCLEIC SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD ELBOW DISLOCATION,24600,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD ELBOW DISLOCATION,24600,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRMT CLOSED ELBOW DISLOCATION,24605,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRMT CLOSED ELBOW DISLOCATION,24605,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD RAD HD W/MANIPUL,24640,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD RAD HD W/MANIPUL,24640,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD HD W/O MANIPULATION,24650,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD HD W/O MANIPULATION,24650,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT RAD HD OR NK FX W/MA,24655,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT RAD HD OR NK FX W/MA,24655,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXCISE TENDON FOREARM/WRIST,25109,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,843.6,OTHER,790.88,1033.41,PERCENT OF CHARGES BASED ON HCPCS CODE
EXCISE TENDON FOREARM/WRIST,25109,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR TENDON FLEXOR FA/WRIST,25260,CPT,450,RC,,OUTPATIENT,,,1910.25,764.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,1528.2,OTHER,1432.69,1872.05,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR TENDON FLEXOR FA/WRIST,25260,CPT,450,RC,,OUTPATIENT,,,1910.25,764.1,MONUMENT,COMMERCIAL,,,,1528.2,,1432.69,1872.05,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD RAD SHAFT FRCT W/O MA,25500,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD RAD SHAFT FRCT W/O MA,25500,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD RAD SHAFT FRCT W/MAN,25505,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD RAD SHAFT FRCT W/MAN,25505,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT FRACTURE OF RADIUS,25520,CPT,450,RC,,OUTPATIENT,,,2814.98,1125.992,BLUE CROSS ANTHEM,COMMERCIAL,,,,2251.984,OTHER,2111.2,2758.7,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT FRACTURE OF RADIUS,25520,CPT,450,RC,,OUTPATIENT,,,2814.98,1125.992,MONUMENT,COMMERCIAL,,,,2252,,2111.2,2758.7,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD ULNAR SH W/O MANIP,25530,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD ULNAR SH W/O MANIP,25530,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD RADIAL&ULNAR FX,4525560,CDM,,,,INPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,523.25,OTHER,431.25,563.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TRT CLSD RADIAL&ULNAR FX,4525560,CDM,,,,INPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
TRT CLSD RADIAL&ULNAR FX,4525560,CDM,,,,INPATIENT,,,575,230,UNITED HEALTH,UNITED COMMERCIAL,,,,431.25,,431.25,563.5,
CLSD TRMT RAD/ULN SHAFT,25565,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT RAD/ULN SHAFT,25565,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD COLLES FX W/O MANIP,25600,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD COLLES FX W/O MANIP,25600,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT DISTAL RADIAL FRACTU,25605,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT DISTAL RADIAL FRACTU,25605,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,3105.75,1242.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2329.31,3043.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF FINGER ABS/SIMPLE,26010,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF FINGER ABS/SIMPLE,26010,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
AMPLIFICATION X2,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF FINGER ABSCESS,26011,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,618.8,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF FINGER ABSCESS,26011,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
Z AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.31,40.92,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DISTAL PHALANX OF FINGER,26236,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
DISTAL PHALANX OF FINGER,26236,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR FINGER/HAND TENDON,26350,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1481.8,OTHER,1389.19,1815.21,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR FINGER/HAND TENDON,26350,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,MONUMENT,COMMERCIAL,,,,1481.8,,1389.19,1815.21,
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"REPAIR EXT TENDON, FINGER",26418,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1481.8,OTHER,1389.19,1815.21,PERCENT OF CHARGES BASED ON HCPCS CODE
"REPAIR EXT TENDON, FINGER",26418,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,MONUMENT,COMMERCIAL,,,,1481.8,,1389.19,1815.21,
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD MCAPRAL FX W/O MAN,26600,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD MCAPRAL FX W/O MAN,26600,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,29.81,38.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FRACTURE W/MANIPULATION,26605,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
FRACTURE W/MANIPULATION,26605,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MUTATION SCANNING,8390359,CPT,300,RC,59,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD DISL THUMB W/MANIP,26641,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD DISL THUMB W/MANIP,26641,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MUTATION SCANNING,8390391,CPT,300,RC,91,OUTPATIENT,,,95.75,38.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,71.81,93.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD CMC FX THUMB W/MANIP,26645,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD CMC FX THUMB W/MANIP,26645,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD CMC DISL EX THUMB W/M,26670,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD CMC DISL EX THUMB W/M,26670,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD MCP DISL W/MANIP,26700,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD MCP DISL W/MANIP,26700,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD PHALANGEAL FX W/O MAN,26720,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD PHALANGEAL FX W/O MAN,26720,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD PHALANGEAL FX W/MANIP,26725,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD PHALANGEAL FX W/MANIP,26725,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,58.5,76.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT FINGER FRACTURE,26742,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT FINGER FRACTURE,26742,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,2677.25,1070.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,2007.94,2623.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD DIST PHAL FX W/O MANI,26750,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD DIST PHAL FX W/O MANI,26750,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z MOLECULE MUTATION IDENTIFY,8390559,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD DIST PHAL FX W/MANIP,26755,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD DIST PHAL FX W/MANIP,26755,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z MOLECULE MUTATION IDENTIFY,8390659,CPT,300,RC,59,OUTPATIENT,,,40.75,16.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.56,39.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT FINGER FRACTURE EACH,26765,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,BLUE CROSS ANTHEM,COMMERCIAL,,,,4578.784,OTHER,4292.6,5609,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT FINGER FRACTURE EACH,26765,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,MONUMENT,COMMERCIAL,,,,4578.8,,4292.6,5609,
Z SIGNAL AMPLIFICATION,8390891,CPT,300,RC,91,OUTPATIENT,,,60.75,24.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.56,59.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREATMENT JOINT DISLOCATION,26770,CPT,450,RC,,OUTPATIENT,,,442.5,177,BLUE CROSS ANTHEM,COMMERCIAL,,,,354,OTHER,331.88,433.65,PERCENT OF CHARGES BASED ON HCPCS CODE
TREATMENT JOINT DISLOCATION,26770,CPT,450,RC,,OUTPATIENT,,,442.5,177,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
Z SEP ID BY HIGH RESOLUTION,8390959,CPT,300,RC,59,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT FINGER DISLOCATION,26775,CPT,450,RC,,OUTPATIENT,,,580,232,BLUE CROSS ANTHEM,COMMERCIAL,,,,464,OTHER,435,568.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT FINGER DISLOCATION,26775,CPT,450,RC,,OUTPATIENT,,,580,232,MONUMENT,COMMERCIAL,,,,464,,435,568.4,
NUCLEIC ACID HIGH RESOLUTE ADD,8390959,CPT,300,RC,59,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AMPUTATION OF FINGER/THUMB,26951,CPT,450,RC,,OUTPATIENT,,,3417.75,1367.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2734.2,OTHER,2563.31,3349.4,PERCENT OF CHARGES BASED ON HCPCS CODE
AMPUTATION OF FINGER/THUMB,26951,CPT,450,RC,,OUTPATIENT,,,3417.75,1367.1,MONUMENT,COMMERCIAL,,,,2734.2,,2563.31,3349.4,
Z SEPARATE & ID BY HIGH RESLTN,8390959,CPT,300,RC,59,OUTPATIENT,,,1601.75,640.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1201.31,1569.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRT FEMO FX W/MANIP,27503,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRT FEMO FX W/MANIP,27503,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
MOLECULAR DIAG ISO EA NUCLEIC,8390991,CPT,300,RC,91,OUTPATIENT,,,126,50.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,94.5,123.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD HIP DSLOC W/O ANESTH,27250,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD HIP DSLOC W/O ANESTH,27250,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z MOLECULAR DIAG SEP AND IDENT,8390991,CPT,300,RC,91,OUTPATIENT,,,2146.5,858.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,1609.88,2103.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT HIP,27252,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1481.8,OTHER,1389.19,1815.21,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT HIP,27252,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,MONUMENT,COMMERCIAL,,,,1481.8,,1389.19,1815.21,
Z INTERPRETATION & REPORT,8391291,CPT,300,RC,91,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POST HIP ARTHROPLASTY DISLOCAT,27265,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
POST HIP ARTHROPLASTY DISLOCAT,27265,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.63,26.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT POST HIP ARTHRO,27266,CPT,450,RC,,OUTPATIENT,,,887.75,355.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,710.2,OTHER,665.81,870,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT POST HIP ARTHRO,27266,CPT,450,RC,,OUTPATIENT,,,887.75,355.1,MONUMENT,COMMERCIAL,,,,710.2,,665.81,870,
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.63,26.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLTX THIGH FX W/MNPJ,27268,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLTX THIGH FX W/MNPJ,27268,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z OLIGOCLONAL BAND CSF,8391691,CPT,300,RC,91,OUTPATIENT,,,83.5,33.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,62.63,81.83,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN THIGH/KNEE LESION,27301,CPT,450,RC,,OUTPATIENT,,,4791.96,1916.784,BLUE CROSS ANTHEM,COMMERCIAL,,,,3833.568,OTHER,3594,4696.1,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN THIGH/KNEE LESION,27301,CPT,450,RC,,OUTPATIENT,,,4791.96,1916.784,MONUMENT,COMMERCIAL,,,,3833.6,,3594,4696.1,
Z SPECTROPHOTOMETRY ANALYTE,8431191,CPT,300,RC,91,OUTPATIENT,,,86.25,34.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,64.69,84.53,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY KNEE/THIGH,27372,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2212.2,OTHER,2073.94,2709.95,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY KNEE/THIGH,27372,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,MONUMENT,COMMERCIAL,,,,2212.2,,2073.94,2709.95,
DRVVT CONFIRM,8559759,CPT,300,RC,59,OUTPATIENT,,,206.75,82.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,155.06,202.62,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SUTURE INFRAPATELLAR TENDON PR,27380,CPT,450,RC,,OUTPATIENT,,,892.5,357,BLUE CROSS ANTHEM,COMMERCIAL,,,,714,OTHER,669.38,874.65,PERCENT OF CHARGES BASED ON HCPCS CODE
SUTURE INFRAPATELLAR TENDON PR,27380,CPT,450,RC,,OUTPATIENT,,,892.5,357,MONUMENT,COMMERCIAL,,,,714,,669.38,874.65,
DRVVT 1:1 MIX,8561359,CPT,300,RC,59,OUTPATIENT,,,130.25,52.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,97.69,127.65,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD OF THIGH FRACTURE,27502,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.3,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD OF THIGH FRACTURE,27502,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.3,563.5,
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD KNEE DISL W/O ANESTHE,27550,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD KNEE DISL W/O ANESTHE,27550,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT KNEECAP,27560,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT KNEECAP,27560,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOSED TRMT OF PATELLAR DISC,27562,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSED TRMT OF PATELLAR DISC,27562,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD TIBIAL FX W/O MANIP,27750,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD TIBIAL FX W/O MANIP,27750,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREATMENT OF TIBIA FRACTURE,27752,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TREATMENT OF TIBIA FRACTURE,27752,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD MEDIAL MAL FX W/O MAN,27760,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD MEDIAL MAL FX W/O MAN,27760,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT MED MALLCOLOURS FX,27762,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT MED MALLCOLOURS FX,27762,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,2220.144,OTHER,2081.4,2719.7,PERCENT OF CHARGES BASED ON HCPCS CODE
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,MONUMENT,COMMERCIAL,,,,2220.1,,2081.4,2719.7,
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,BLUE CROSS ANTHEM,COMMERCIAL,,,,2220.144,OTHER,2081.4,2719.7,PERCENT OF CHARGES BASED ON HCPCS CODE
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,MONUMENT,COMMERCIAL,,,,2220.1,,2081.4,2719.7,
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT DISTAL FIBULAR FX WO,27786,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT DISTAL FIBULAR FX WO,27786,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD FX DISTAL FIBULA W/MA,27788,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD FX DISTAL FIBULA W/MA,27788,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT BIMALLEOLAR ANKLE FX,27810,CPT,450,RC,,OUTPATIENT,,,634,253.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,507.2,OTHER,475.5,621.32,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT BIMALLEOLAR ANKLE FX,27810,CPT,450,RC,,OUTPATIENT,,,634,253.6,MONUMENT,COMMERCIAL,,,,507.2,,475.5,621.32,
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT TRIMALLCOLAR ANK FX,27818,CPT,450,RC,,OUTPATIENT,,,708.75,283.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,567,OTHER,531.56,694.58,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT TRIMALLCOLAR ANK FX,27818,CPT,450,RC,,OUTPATIENT,,,708.75,283.5,MONUMENT,COMMERCIAL,,,,567,,531.56,694.58,
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TREAT LOWER LEG FRACTURE,27825,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,465.2,OTHER,436.13,569.87,PERCENT OF CHARGES BASED ON HCPCS CODE
TREAT LOWER LEG FRACTURE,27825,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,MONUMENT,COMMERCIAL,,,,465.2,,436.13,569.87,
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLOSED TX ANKLE DISLOCATION,27840,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,465.2,OTHER,436.13,569.87,PERCENT OF CHARGES BASED ON HCPCS CODE
CLOSED TX ANKLE DISLOCATION,27840,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,MONUMENT,COMMERCIAL,,,,465.2,,436.13,569.87,
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,790.88,1033.41,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,843.6,,790.88,1033.41,
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2212.2,OTHER,2073.94,2709.95,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,MONUMENT,COMMERCIAL,,,,2212.2,,2073.94,2709.95,
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY FOOT COMPLICA,28193,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1374.6,OTHER,1288.69,1683.89,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY FOOT COMPLICA,28193,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,MONUMENT,COMMERCIAL,,,,1374.6,,1288.69,1683.89,
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR OF FOOT TENDON EXTENSOR,28208,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,BLUE CROSS ANTHEM,COMMERCIAL,,,,4578.784,OTHER,4292.6,5609,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR OF FOOT TENDON EXTENSOR,28208,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,MONUMENT,COMMERCIAL,,,,4578.8,,4292.6,5609,
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD FX GREAT TOE W/O MANI,28490,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD FX GREAT TOE W/O MANI,28490,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD FX GREAT TOE W/MANIP,28495,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD FX GREAT TOE W/MANIP,28495,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD FX OTH PHALANX W/O MA,28510,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD FX OTH PHALANX W/O MA,28510,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD FX OTH PHALANX W/MANI,28515,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD FX OTH PHALANX W/MANI,28515,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLSD TRMT TARSAL BONE DISLOC,28545,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLSD TRMT TARSAL BONE DISLOC,28545,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD TARSOMETAT DISL W/O A,28600,CPT,450,RC,,OUTPATIENT,,,575,230,BLUE CROSS ANTHEM,COMMERCIAL,,,,460,OTHER,431.25,563.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD TARSOMETAT DISL W/O A,28600,CPT,450,RC,,OUTPATIENT,,,575,230,MONUMENT,COMMERCIAL,,,,460,,431.25,563.5,
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD META JOINT DISL W/O A,28630,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD META JOINT DISL W/O A,28630,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRT CLSD INTPHAL JT DISL W/O A,28660,CPT,450,RC,,OUTPATIENT,,,430,172,BLUE CROSS ANTHEM,COMMERCIAL,,,,344,OTHER,322.5,421.4,PERCENT OF CHARGES BASED ON HCPCS CODE
TRT CLSD INTPHAL JT DISL W/O A,28660,CPT,450,RC,,OUTPATIENT,,,430,172,MONUMENT,COMMERCIAL,,,,344,,322.5,421.4,
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLTX INTERPHALANGEAL JT,28665,CPT,450,RC,,OUTPATIENT,,,675,270,BLUE CROSS ANTHEM,COMMERCIAL,,,,540,OTHER,506.25,661.5,PERCENT OF CHARGES BASED ON HCPCS CODE
CLTX INTERPHALANGEAL JT,28665,CPT,450,RC,,OUTPATIENT,,,675,270,MONUMENT,COMMERCIAL,,,,540,,506.25,661.5,
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LONG ARM CAST,29065,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,BLUE CROSS ANTHEM,COMMERCIAL,,,,384.552,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
LONG ARM CAST,29065,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION SHORT ARM CAST,29075,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,BLUE CROSS ANTHEM,COMMERCIAL,,,,384.552,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION SHORT ARM CAST,29075,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION HAND/FOREARM CAST,29085,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION HAND/FOREARM CAST,29085,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION LONG ARM SPLINT,29105,CPT,450,RC,,OUTPATIENT,,,361,144.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,288.8,OTHER,270.75,353.78,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION LONG ARM SPLINT,29105,CPT,450,RC,,OUTPATIENT,,,361,144.4,MONUMENT,COMMERCIAL,,,,288.8,,270.75,353.78,
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLY FOREARM SPLINT,29126,CPT,450,RC,,OUTPATIENT,,,331,132.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,264.8,OTHER,248.3,324.4,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLY FOREARM SPLINT,29126,CPT,450,RC,,OUTPATIENT,,,331,132.4,MONUMENT,COMMERCIAL,,,,264.8,,248.3,324.4,
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FINGER SPLINT: STATIC,29130,CPT,450,RC,,OUTPATIENT,,,287.75,115.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,230.2,OTHER,215.81,282,PERCENT OF CHARGES BASED ON HCPCS CODE
FINGER SPLINT: STATIC,29130,CPT,450,RC,,OUTPATIENT,,,287.75,115.1,MONUMENT,COMMERCIAL,,,,230.2,,215.81,282,
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION OF FINGER SPLINT,29131,CPT,450,RC,,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,108,141.1,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION OF FINGER SPLINT,29131,CPT,450,RC,,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.1,
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING THORAX,29200,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING THORAX,29200,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING OF SHOULDER,29240,CPT,450,RC,,OUTPATIENT,,,912,364.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,729.6,OTHER,684,893.8,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING OF SHOULDER,29240,CPT,450,RC,,OUTPATIENT,,,912,364.8,MONUMENT,COMMERCIAL,,,,729.6,,684,893.8,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING FINGER OR HAND,29280,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING FINGER OR HAND,29280,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION LONG LEG CAST,29345,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION LONG LEG CAST,29345,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION SHORT LEG CAST,29405,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,364.6,OTHER,341.81,446.64,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION SHORT LEG CAST,29405,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,MONUMENT,COMMERCIAL,,,,364.6,,341.81,446.64,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING OF HIP,29520,CPT,450,RC,,OUTPATIENT,,,297,118.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.6,OTHER,222.8,291.1,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING OF HIP,29520,CPT,450,RC,,OUTPATIENT,,,297,118.8,MONUMENT,COMMERCIAL,,,,237.6,,222.8,291.1,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING KNEE,29530,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING KNEE,29530,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING ANKLE,29540,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING ANKLE,29540,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING TOES,29550,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING TOES,29550,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRAPPING UNNA BOOT,29580,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
STRAPPING UNNA BOOT,29580,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM OR BIVALV ARM/LEG CAST,29705,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
REM OR BIVALV ARM/LEG CAST,29705,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
WINDOWING OF CAST,29730,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,237.8,OTHER,222.94,291.31,PERCENT OF CHARGES BASED ON HCPCS CODE
WINDOWING OF CAST,29730,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL NASAL FOREIGN,30300,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL NASAL FOREIGN,30300,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONTROL NASAL HEMORRHAGE SIMPL,30901,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CONTROL NASAL HEMORRHAGE SIMPL,30901,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONTROL OF NOSEBLEED SIMP BI,3090150,CPT,450,RC,50,OUTPATIENT,,,233.98,93.592,BLUE CROSS ANTHEM,COMMERCIAL,,,,187.184,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CONTROL OF NOSEBLEED SIMP BI,3090150,CPT,450,RC,50,OUTPATIENT,,,233.98,93.592,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONTROL NASAL HEMORRHAGE COMPL,30903,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CONTROL NASAL HEMORRHAGE COMPL,30903,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CONTROL OF NOSEBLEED COMPLEX,3090350,CPT,450,RC,50,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
CONTROL OF NOSEBLEED COMPLEX,3090350,CPT,450,RC,50,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NASAL SURGERY,30999,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
NASAL SURGERY,30999,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ENDOTRACHEAL INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.8,OTHER,592.31,773.96,PERCENT OF CHARGES BASED ON HCPCS CODE
ENDOTRACHEAL INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,MONUMENT,COMMERCIAL,,,,631.8,,592.31,773.96,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LARYNGOSCOPY FLEXIBLE DIAG,31575,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.8,OTHER,592.31,773.96,PERCENT OF CHARGES BASED ON HCPCS CODE
LARYNGOSCOPY FLEXIBLE DIAG,31575,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,MONUMENT,COMMERCIAL,,,,631.8,,592.31,773.96,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TRACHEOSTOMY TRANSTRACHAEL,31603,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2627,OTHER,2462.81,3218.08,PERCENT OF CHARGES BASED ON HCPCS CODE
TRACHEOSTOMY TRANSTRACHAEL,31603,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,MONUMENT,COMMERCIAL,,,,2627,,2462.81,3218.08,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"TRACHEOSTOMY, EME PROCEDURE",31605,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2627,OTHER,2462.81,3218.08,PERCENT OF CHARGES BASED ON HCPCS CODE
"TRACHEOSTOMY, EME PROCEDURE",31605,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,MONUMENT,COMMERCIAL,,,,2627,,2462.81,3218.08,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,OUTPATIENT,,,385.92,154.368,BLUE CROSS ANTHEM,COMMERCIAL,,,,308.736,OTHER,289.4,378.2,PERCENT OF CHARGES BASED ON HCPCS CODE
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,OUTPATIENT,,,385.92,154.368,MONUMENT,COMMERCIAL,,,,308.7,,289.4,378.2,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THORACENTESIS,32554,CPT,450,RC,,OUTPATIENT,,,1079.54,431.816,BLUE CROSS ANTHEM,COMMERCIAL,,,,863.632,OTHER,719.44,940.07,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACENTESIS,32554,CPT,450,RC,,OUTPATIENT,,,1079.54,431.816,MONUMENT,COMMERCIAL,,,,767.4,,719.44,940.07,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TUBE THORACOSTOMY,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,915.6,OTHER,858.38,1121.61,PERCENT OF CHARGES BASED ON HCPCS CODE
TUBE THORACOSTOMY,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THORACENTESIS;W/IMAGING,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,BLUE CROSS ANTHEM,COMMERCIAL,,,,1572,OTHER,1473.75,1925.7,PERCENT OF CHARGES BASED ON HCPCS CODE
THORACENTESIS;W/IMAGING,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,MONUMENT,COMMERCIAL,,,,1572,,1473.75,1925.7,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PERICARDIOCENTESIS INITIAL,33010,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,767.4,OTHER,719.44,940.07,PERCENT OF CHARGES BASED ON HCPCS CODE
PERICARDIOCENTESIS INITIAL,33010,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,MONUMENT,COMMERCIAL,,,,767.4,,719.44,940.07,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSERT ELECTRD/PM CATH SNGL,33210,CPT,450,RC,,OUTPATIENT,,,16488.76,6595.504,BLUE CROSS ANTHEM,COMMERCIAL,,,,13191.008,OTHER,12366.6,16159,PERCENT OF CHARGES BASED ON HCPCS CODE
INSERT ELECTRD/PM CATH SNGL,33210,CPT,450,RC,,OUTPATIENT,,,16488.76,6595.504,MONUMENT,COMMERCIAL,,,,13191,,12366.6,16159,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR BLOOD VESSEL UPPER EXT,35206,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2540.2,OTHER,2381.44,3111.75,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR BLOOD VESSEL UPPER EXT,35206,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,MONUMENT,COMMERCIAL,,,,2540.2,,2381.44,3111.75,
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"RPR BLOOD VESSEL, HAND, FINGER",35207,CPT,450,RC,,OUTPATIENT,,,2625,1050,BLUE CROSS ANTHEM,COMMERCIAL,,,,2100,OTHER,1968.75,2572.5,PERCENT OF CHARGES BASED ON HCPCS CODE
"RPR BLOOD VESSEL, HAND, FINGER",35207,CPT,450,RC,,OUTPATIENT,,,2625,1050,MONUMENT,COMMERCIAL,,,,2100,,1968.75,2572.5,
Z ALLERGEN SPECIFIC (X28),8600391,CPT,300,RC,91,OUTPATIENT,,,994.25,397.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,745.69,974.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR BLD VESSEL LOWER EXTREM,35226,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2540.2,OTHER,2381.44,3111.75,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR BLD VESSEL LOWER EXTREM,35226,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,MONUMENT,COMMERCIAL,,,,2540.2,,2381.44,3111.75,
Z ALLERGEN SPECIFIC X20,8600391,CPT,300,RC,91,OUTPATIENT,,,710,284,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,532.5,695.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BLOOD TRANSFUSION SERV 0-1 HR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,839.8,OTHER,787.3,1028.8,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD TRANSFUSION SERV 0-1 HR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,MONUMENT,COMMERCIAL,,,,839.8,,787.3,1028.8,
ALLERGEN DAIRY & GRAIN,8600391,CPT,300,RC,91,OUTPATIENT,,,143.25,57.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,107.44,140.39,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CENTRAL LINE PLCMT ASSIST<5YRS,36555,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1627.8,OTHER,1526.06,1994.06,PERCENT OF CHARGES BASED ON HCPCS CODE
CENTRAL LINE PLCMT ASSIST<5YRS,36555,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,MONUMENT,COMMERCIAL,,,,1627.8,,1526.06,1994.06,
Z CARDIOLIPIN AB IGM (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,50.9,20.36,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,30.38,39.69,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSERT NON-TUNNEL CV CATH,36556,CPT,450,RC,,OUTPATIENT,,,5703.74,2281.496,BLUE CROSS ANTHEM,COMMERCIAL,,,,4562.992,OTHER,4277.8,5589.7,PERCENT OF CHARGES BASED ON HCPCS CODE
INSERT NON-TUNNEL CV CATH,36556,CPT,450,RC,,OUTPATIENT,,,5703.74,2281.496,MONUMENT,COMMERCIAL,,,,4563,,4277.8,5589.7,
CARDIOLIPIN AB IGG (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,156.25,62.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,117.19,153.13,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSERT TUNNELED CV CATH,36558,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1627.8,OTHER,1526.06,1994.06,PERCENT OF CHARGES BASED ON HCPCS CODE
INSERT TUNNELED CV CATH,36558,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,MONUMENT,COMMERCIAL,,,,1627.8,,1526.06,1994.06,
Z SSA,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INSERT PICC CATH,36569,CPT,361,RC,,OUTPATIENT,,,1672,668.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1337.6,OTHER,1254,1638.56,PERCENT OF CHARGES BASED ON HCPCS CODE
INSERT PICC CATH,36569,CPT,361,RC,,OUTPATIENT,,,1672,668.8,MONUMENT,COMMERCIAL,,,,1337.6,,1254,1638.56,
Z SSB,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,BLUE CROSS ANTHEM,COMMERCIAL,,,,230,OTHER,215.6,281.8,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,MONUMENT,COMMERCIAL,,,,230,,215.6,281.8,
Z SM,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,224,89.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,179.2,OTHER,168,219.5,PERCENT OF CHARGES BASED ON HCPCS CODE
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,224,89.6,MONUMENT,COMMERCIAL,,,,179.2,,168,219.5,
Z RNP,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ARTERIAL CATH; PERCUTANEOUS,36620,CPT,450,RC,,OUTPATIENT,,,550,220,BLUE CROSS ANTHEM,COMMERCIAL,,,,440,OTHER,412.5,539,PERCENT OF CHARGES BASED ON HCPCS CODE
ARTERIAL CATH; PERCUTANEOUS,36620,CPT,450,RC,,OUTPATIENT,,,550,220,MONUMENT,COMMERCIAL,,,,440,,412.5,539,
Z SC/70,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
THROMBOLYTIC CEREBRAL IV INFUS,37195,CPT,450,RC,,OUTPATIENT,,,619.37,247.748,BLUE CROSS ANTHEM,COMMERCIAL,,,,495.496,OTHER,330.75,432.18,PERCENT OF CHARGES BASED ON HCPCS CODE
THROMBOLYTIC CEREBRAL IV INFUS,37195,CPT,450,RC,,OUTPATIENT,,,619.37,247.748,MONUMENT,COMMERCIAL,,,,352.8,,330.75,432.18,
Z JO1,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
UNLIST PROCEDURE SUTURE VEIN,37799,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1374.6,OTHER,1288.69,1683.89,PERCENT OF CHARGES BASED ON HCPCS CODE
UNLIST PROCEDURE SUTURE VEIN,37799,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,MONUMENT,COMMERCIAL,,,,1374.6,,1288.69,1683.89,
NUCLEAR ANTIGEN ANITBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.13,44.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR LIP FULL THICKNESS VERMILI,40650,CPT,450,RC,,OUTPATIENT,,,901.62,360.648,BLUE CROSS ANTHEM,COMMERCIAL,,,,721.296,OTHER,676.2,883.6,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR LIP FULL THICKNESS VERMILI,40650,CPT,450,RC,,OUTPATIENT,,,901.62,360.648,MONUMENT,COMMERCIAL,,,,721.3,,676.2,883.6,
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.13,44.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR LIP FULL THKNS>ONE-HALF HE,40654,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.4,653.9,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR LIP FULL THKNS>ONE-HALF HE,40654,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.4,653.9,
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,34.13,44.59,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF MOUTH,40800,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF MOUTH,40800,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
Z CUTANEOUS IMMUNOFLUOR AB IGG,8625591,CPT,300,RC,91,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,101.81,133.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,OUTPATIENT,,,1663.6,665.44,BLUE CROSS ANTHEM,COMMERCIAL,,,,1330.88,OTHER,1247.7,1630.3,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,OUTPATIENT,,,1663.6,665.44,MONUMENT,COMMERCIAL,,,,1330.9,,1247.7,1630.3,
IMMUNOASSAY ANALYTE-QUANT,8625691,CPT,300,RC,91,OUTPATIENT,,,138.5,55.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,103.88,135.73,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR FLOOR MTH AND/OR TONGUE,41250,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR FLOOR MTH AND/OR TONGUE,41250,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
STREPTOCOCCUS PNEUM IGG 23 SER,8631759,CPT,300,RC,59,OUTPATIENT,,,72.25,28.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.19,70.81,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"TONGUE, FLOOR OF MOUTH UNLISTE",41599,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,533.8,OTHER,500.44,653.91,PERCENT OF CHARGES BASED ON HCPCS CODE
"TONGUE, FLOOR OF MOUTH UNLISTE",41599,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,MONUMENT,COMMERCIAL,,,,533.8,,500.44,653.91,
Z STREPTOCOCCUS PHEUM IGG 7SER,8631759,CPT,300,RC,59,OUTPATIENT,,,426.75,170.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,320.06,418.22,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF GUM,41800,CPT,450,RC,,OUTPATIENT,,,589,235.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,471.2,OTHER,441.75,577.22,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF GUM,41800,CPT,450,RC,,OUTPATIENT,,,589,235.6,MONUMENT,COMMERCIAL,,,,471.2,,441.75,577.22,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF TONSIL ABSCESS,42700,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF TONSIL ABSCESS,42700,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY PHARYNX,42809,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,BLUE CROSS ANTHEM,COMMERCIAL,,,,430.872,OTHER,331.88,433.65,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY PHARYNX,42809,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,MONUMENT,COMMERCIAL,,,,354,,331.88,433.65,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,BLUE CROSS ANTHEM,COMMERCIAL,,,,1653.464,OTHER,499.31,652.44,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,MONUMENT,COMMERCIAL,,,,532.6,,499.31,652.44,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INCISION OF RECTAL,46040,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,BLUE CROSS ANTHEM,COMMERCIAL,,,,1653.464,OTHER,580.13,758.03,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION OF RECTAL,46040,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,MONUMENT,COMMERCIAL,,,,618.8,,580.13,758.03,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
I&D PERIANAL ABSCESS SUPERFCL,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,BLUE CROSS ANTHEM,COMMERCIAL,,,,1265.496,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
I&D PERIANAL ABSCESS SUPERFCL,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.5,29.4,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE EXT HEM GROUPS 2+,46250,CPT,450,RC,,OUTPATIENT,,,5432.66,2173.064,BLUE CROSS ANTHEM,COMMERCIAL,,,,4346.128,OTHER,4074.5,5324,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE EXT HEM GROUPS 2+,46250,CPT,450,RC,,OUTPATIENT,,,5432.66,2173.064,MONUMENT,COMMERCIAL,,,,4346.1,,4074.5,5324,
NEUTRALIZATION TEST VIRAL,8638291,CPT,300,RC,91,OUTPATIENT,,,132.5,53,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,99.38,129.85,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EXC OF THROMBOSED HEMORRD EXTR,46320,CPT,450,RC,,OUTPATIENT,,,2397.5,959,BLUE CROSS ANTHEM,COMMERCIAL,,,,1918,OTHER,1798.13,2349.55,PERCENT OF CHARGES BASED ON HCPCS CODE
EXC OF THROMBOSED HEMORRD EXTR,46320,CPT,450,RC,,OUTPATIENT,,,2397.5,959,MONUMENT,COMMERCIAL,,,,1918,,1798.13,2349.55,
Z SYPHILIS AB IGM,8659259,CPT,300,RC,59,OUTPATIENT,,,67,26.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,50.25,65.66,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ANOSCOPY REMOVE FOR BODY,46608,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,BLUE CROSS ANTHEM,COMMERCIAL,,,,1265.496,OTHER,750,980,PERCENT OF CHARGES BASED ON HCPCS CODE
ANOSCOPY REMOVE FOR BODY,46608,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,MONUMENT,COMMERCIAL,,,,800,,750,980,
Z BARTONELLA HENSELAE IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABD PARACENTESIS W/O IMAGING,49082,CPT,450,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,710.63,928.55,PERCENT OF CHARGES BASED ON HCPCS CODE
ABD PARACENTESIS W/O IMAGING,49082,CPT,450,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,758,,710.63,928.55,
Z BARTONELLA QUINTANA IGG,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ABD PARACENTESIS W/IMAG GUIDAN,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,BLUE CROSS ANTHEM,COMMERCIAL,,,,1290.928,OTHER,710.63,928.55,PERCENT OF CHARGES BASED ON HCPCS CODE
ABD PARACENTESIS W/IMAG GUIDAN,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,MONUMENT,COMMERCIAL,,,,758,,710.63,928.55,
Z BARTONELLA QUINTANA IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN BL W/CATH INSERTION,51102,CPT,350,RC,,OUTPATIENT,,,3738.02,1495.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,2990.416,OTHER,2803.5,3663.3,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN BL W/CATH INSERTION,51102,CPT,350,RC,,OUTPATIENT,,,3738.02,1495.208,MONUMENT,COMMERCIAL,,,,2990.4,,2803.5,3663.3,
BLASTOMYCES AB,8661291,CPT,300,RC,91,OUTPATIENT,,,80.5,32.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,60.38,78.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US URINE CAPACITY MEASURE,51798,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,497.2,OTHER,466.13,609.07,PERCENT OF CHARGES BASED ON HCPCS CODE
US URINE CAPACITY MEASURE,51798,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,MONUMENT,COMMERCIAL,,,,497.2,,466.13,609.07,
BRUCELLA AB SCREEN CONFIRM,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.94,71.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INCISION AND DRAINAGE SCROTUM,54700,CPT,450,RC,,OUTPATIENT,,,975,390,BLUE CROSS ANTHEM,COMMERCIAL,,,,780,OTHER,731.25,955.5,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISION AND DRAINAGE SCROTUM,54700,CPT,450,RC,,OUTPATIENT,,,975,390,MONUMENT,COMMERCIAL,,,,780,,731.25,955.5,
BRUCELLA AB,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,54.94,71.79,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF GLAND,56420,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF GLAND,56420,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
Z CANDIDA ANTIBODY IGM,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.5,103.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INTRO ANY HEMOSTATIC AGENT,57180,CPT,450,RC,,OUTPATIENT,,,577.5,231,BLUE CROSS ANTHEM,COMMERCIAL,,,,462,OTHER,433.13,565.95,PERCENT OF CHARGES BASED ON HCPCS CODE
INTRO ANY HEMOSTATIC AGENT,57180,CPT,450,RC,,OUTPATIENT,,,577.5,231,MONUMENT,COMMERCIAL,,,,462,,433.13,565.95,
Z CANDIDA ANTIBODY IGA,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,79.5,103.88,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR VAGINA/PERINEUM,57210,CPT,450,RC,,OUTPATIENT,,,6049.04,2419.616,BLUE CROSS ANTHEM,COMMERCIAL,,,,4839.232,OTHER,4536.8,5928.1,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR VAGINA/PERINEUM,57210,CPT,450,RC,,OUTPATIENT,,,6049.04,2419.616,MONUMENT,COMMERCIAL,,,,4839.2,,4536.8,5928.1,
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE INTRAUTERINE DEVICE,58301,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,BLUE CROSS ANTHEM,COMMERCIAL,,,,448.824,OTHER,282.38,368.97,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE INTRAUTERINE DEVICE,58301,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,MONUMENT,COMMERCIAL,,,,301.2,,282.38,368.97,
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
LUMBAR PUNCTURE SPINAL,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,687.75,898.66,PERCENT OF CHARGES BASED ON HCPCS CODE
LUMBAR PUNCTURE SPINAL,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,733.6,,687.75,898.66,
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.81,35.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"INJECTION, EPIDURAL PATCH",62273,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,120.94,158.03,PERCENT OF CHARGES BASED ON HCPCS CODE
"INJECTION, EPIDURAL PATCH",62273,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,26.81,35.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N BLOCK INJ TRIGEMINAL,64400,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
N BLOCK INJ TRIGEMINAL,64400,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
Z COCCIDIOIDES AB IGG BY IMMUN,8663591,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N BLOCK INJ FACIAL,64402,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
N BLOCK INJ FACIAL,64402,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
Z Q FEVER AB IGM,8663891,CPT,300,RC,91,OUTPATIENT,,,65,26,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,48.75,63.7,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N BLOCK INJ OCCIPITAL,64405,CPT,361,RC,,OUTPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,427.6,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
N BLOCK INJ OCCIPITAL,64405,CPT,361,RC,,OUTPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
EBV IGM,8666591,CPT,300,RC,91,OUTPATIENT,,,44.25,17.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,33.19,43.37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BILATERAL N BLOCK INJ OCCIPITA,6445050,CPT,450,RC,50,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,801.75,1047.62,PERCENT OF CHARGES BASED ON HCPCS CODE
BILATERAL N BLOCK INJ OCCIPITA,6445050,CPT,450,RC,50,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,855.2,,801.75,1047.62,
FUNGUS ANTIBODY ADD'L,8667191,CPT,300,RC,91,OUTPATIENT,,,111,44.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,83.25,108.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ ANES/SCIATIC NERVE SINGLE,64445,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,454.88,594.37,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ ANES/SCIATIC NERVE SINGLE,64445,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,485.2,,454.88,594.37,
Z GIARDIA LAMBLIA AB IGA,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,485.2,OTHER,454.88,594.37,PERCENT OF CHARGES BASED ON HCPCS CODE
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,MONUMENT,COMMERCIAL,,,,485.2,,454.88,594.37,
Z GIARDIA LAMBLIA AB IGM,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,36.56,47.78,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N BLOCK INJ PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,485.2,OTHER,454.88,594.37,PERCENT OF CHARGES BASED ON HCPCS CODE
N BLOCK INJ PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,MONUMENT,COMMERCIAL,,,,485.2,,454.88,594.37,
Z HELICOBACTER PYLORI IGA,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
N BLOCK INJ PERIPHERAL BILAT,64450,CPT,361,RC,,OUTPATIENT,,,1298.5,519.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1038.8,OTHER,973.9,1272.5,PERCENT OF CHARGES BASED ON HCPCS CODE
N BLOCK INJ PERIPHERAL BILAT,64450,CPT,361,RC,,OUTPATIENT,,,1298.5,519.4,MONUMENT,COMMERCIAL,,,,1038.8,,973.9,1272.5,
Z HELICOBACTER PYLORI IGM,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45,58.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
NERVE BLOCK UNLISTED,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,BLUE CROSS ANTHEM,COMMERCIAL,,,,422.416,OTHER,396,517.5,PERCENT OF CHARGES BASED ON HCPCS CODE
NERVE BLOCK UNLISTED,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,MONUMENT,COMMERCIAL,,,,422.4,,396,517.5,
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY EYE EXTERNAL,65205,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.8,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY EYE EXTERNAL,65205,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL FOREIGN BODY CORNEAL,65220,CPT,450,RC,,OUTPATIENT,,,707.75,283.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,566.2,OTHER,530.81,693.6,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL FOREIGN BODY CORNEAL,65220,CPT,450,RC,,OUTPATIENT,,,707.75,283.1,MONUMENT,COMMERCIAL,,,,566.2,,530.81,693.6,
Z HISTOPLASMA ANTIBODY,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,22.88,29.89,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY CORNEAL W/SLI,65222,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.8,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY CORNEAL W/SLI,65222,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
Z INFLUENZA VIRUS ANTIBODY IGM,8671059,CPT,300,RC,59,OUTPATIENT,,,47.75,19.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,35.81,46.8,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE FOREIGN BODY FROM EYE,65235,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.8,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE FOREIGN BODY FROM EYE,65235,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
MYCOPLASMA PNEUMONIAE IGM,8673891,CPT,300,RC,91,OUTPATIENT,,,98,39.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,73.5,96.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF EYELID ABCESS,67700,CPT,450,RC,,OUTPATIENT,,,563.64,225.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.912,OTHER,422.7,552.4,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF EYELID ABCESS,67700,CPT,450,RC,,OUTPATIENT,,,563.64,225.456,MONUMENT,COMMERCIAL,,,,450.9,,422.7,552.4,
PARVOVIRUS B19 AG IGG,8674791,CPT,300,RC,91,OUTPATIENT,,,53,21.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39.75,51.94,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CANTHOTOMY,67715,CPT,450,RC,,OUTPATIENT,,,2205,882,BLUE CROSS ANTHEM,COMMERCIAL,,,,1764,OTHER,1653.75,2160.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CANTHOTOMY,67715,CPT,450,RC,,OUTPATIENT,,,2205,882,MONUMENT,COMMERCIAL,,,,1764,,1653.75,2160.9,
Z SPOTTED FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.81,54.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REPAIR EYELID WOUND,67935,CPT,450,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
REPAIR EYELID WOUND,67935,CPT,450,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
Z TYPHUS FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,41.81,54.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE FOREIGN BODY EYELID,67938,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,555.8,OTHER,521.06,680.86,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE FOREIGN BODY EYELID,67938,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,MONUMENT,COMMERCIAL,,,,555.8,,521.06,680.86,
Z VIRUS IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAIN EXTERNAL EAR LESION,69000,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,400.88,523.81,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAIN EXTERNAL EAR LESION,69000,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
Z DENGUE FEVER IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,162,64.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,121.5,158.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM FOREIGN BODY EAR,69200,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,226.6,OTHER,212.44,277.59,PERCENT OF CHARGES BASED ON HCPCS CODE
REM FOREIGN BODY EAR,69200,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,MONUMENT,COMMERCIAL,,,,226.6,,212.44,277.59,
HANTA VIRUS IGM,8679091,CPT,300,RC,91,OUTPATIENT,,,108.75,43.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,81.56,106.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOREIGN BODY REMOVAL EAR W/GA,69205,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,226.6,OTHER,212.44,277.59,PERCENT OF CHARGES BASED ON HCPCS CODE
FOREIGN BODY REMOVAL EAR W/GA,69205,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,MONUMENT,COMMERCIAL,,,,226.6,,212.44,277.59,
Z POST DAT,8688091,CPT,300,RC,91,OUTPATIENT,,,110.94,44.376,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,55.69,72.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,115.84,46.336,BLUE CROSS ANTHEM,COMMERCIAL,,,,92.672,OTHER,86.9,113.5,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,115.84,46.336,MONUMENT,COMMERCIAL,,,,92.7,,86.9,113.5,
CULTURE BLOOD MULTIPLE SITES,8704059,CPT,306,RC,59,OUTPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159,207.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REM IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,226.6,OTHER,212.44,277.59,PERCENT OF CHARGES BASED ON HCPCS CODE
REM IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,MONUMENT,COMMERCIAL,,,,226.6,,212.44,277.59,
CULTURE BLOOD,8704091,CPT,306,RC,91,OUTPATIENT,,,212,84.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,159,207.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BEDSIDE ULTRASOUND OF THE EYES,7651250,CPT,450,RC,50,OUTPATIENT,,,943,377.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,754.4,OTHER,707.25,924.14,PERCENT OF CHARGES BASED ON HCPCS CODE
BEDSIDE ULTRASOUND OF THE EYES,7651250,CPT,450,RC,50,OUTPATIENT,,,943,377.2,MONUMENT,COMMERCIAL,,,,754.4,,707.25,924.14,
Z CULTURE FECES W/ISO PRE EXAM,8704691,CPT,306,RC,91,OUTPATIENT,,,27.25,10.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,20.44,26.71,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BEDSIDE ULTRASOUND OF THE EYE,76512,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,377.2,OTHER,353.63,462.07,PERCENT OF CHARGES BASED ON HCPCS CODE
BEDSIDE ULTRASOUND OF THE EYE,76512,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,MONUMENT,COMMERCIAL,,,,377.2,,353.63,462.07,
Z ANAEROBIC SENSITIVITY,8718191,CPT,306,RC,91,OUTPATIENT,,,101.75,40.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,76.31,99.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,OUTPATIENT,,,795,318,BLUE CROSS ANTHEM,COMMERCIAL,,,,636,OTHER,457.69,598.05,PERCENT OF CHARGES BASED ON HCPCS CODE
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,OUTPATIENT,,,795,318,MONUMENT,COMMERCIAL,,,,488.2,,457.69,598.05,
Z MACROBROTH DILUTION EA AGENT,8718859,CPT,300,RC,59,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US CHEST REAL TIME W/IMAGE DOC,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,318.8,OTHER,298.88,390.53,PERCENT OF CHARGES BASED ON HCPCS CODE
US CHEST REAL TIME W/IMAGE DOC,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,MONUMENT,COMMERCIAL,,,,318.8,,298.88,390.53,
Z MACROBROTH DILUTION EA PLATE,8718891,CPT,300,RC,91,OUTPATIENT,,,62.25,24.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,46.69,61.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US BREAST LIMITED UNILAT,76642,CPT,402,RC,,OUTPATIENT,,,196.25,78.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,157,OTHER,147.19,192.33,PERCENT OF CHARGES BASED ON HCPCS CODE
US BREAST LIMITED UNILAT,76642,CPT,402,RC,,OUTPATIENT,,,196.25,78.5,MONUMENT,COMMERCIAL,,,,157,,147.19,192.33,
Z LEGIONELLA SMEAR,8730091,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,28.31,37,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BEDSIDE US ABDOMEN, COMPLETE",76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,484.4,OTHER,454.13,593.39,PERCENT OF CHARGES BASED ON HCPCS CODE
"BEDSIDE US ABDOMEN, COMPLETE",76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,MONUMENT,COMMERCIAL,,,,484.4,,454.13,593.39,
SHIGA TOXIN 2,8742759,CPT,300,RC,59,OUTPATIENT,,,41.5,16.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,31.13,40.67,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BEDSIDE ABDOMEN, LIMITED",76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,377.2,OTHER,353.63,462.07,PERCENT OF CHARGES BASED ON HCPCS CODE
"BEDSIDE ABDOMEN, LIMITED",76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,MONUMENT,COMMERCIAL,,,,377.2,,353.63,462.07,
Z INFLUENZA A H1N1 BY PCR,8779891,CPT,300,RC,91,OUTPATIENT,,,225.75,90.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,169.31,221.24,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"US RETROPERITONEAL, LIMITED",76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,446.8,OTHER,418.88,547.33,PERCENT OF CHARGES BASED ON HCPCS CODE
"US RETROPERITONEAL, LIMITED",76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,MONUMENT,COMMERCIAL,,,,446.8,,418.88,547.33,
Z FLOW CYTOMETRY EA ADD'L WBC,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BEDSIDE US, PREGNANT UTERUS",76815,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,377.2,OTHER,353.63,462.07,PERCENT OF CHARGES BASED ON HCPCS CODE
"BEDSIDE US, PREGNANT UTERUS",76815,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,MONUMENT,COMMERCIAL,,,,377.2,,353.63,462.07,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PELVIC LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,511.4,OTHER,479.44,626.47,PERCENT OF CHARGES BASED ON HCPCS CODE
PELVIC LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,MONUMENT,COMMERCIAL,,,,511.4,,479.44,626.47,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BEDSIDE US,LIMITED NONVAS EXTR",76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.8,OTHER,207.94,271.71,PERCENT OF CHARGES BASED ON HCPCS CODE
"BEDSIDE US,LIMITED NONVAS EXTR",76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,MONUMENT,COMMERCIAL,,,,221.8,,207.94,271.71,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US GUIDANCE NEEDLE PLCMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,733.4,OTHER,687.56,898.42,PERCENT OF CHARGES BASED ON HCPCS CODE
US GUIDANCE NEEDLE PLCMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,MONUMENT,COMMERCIAL,,,,733.4,,687.56,898.42,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BURN SUPPLIES,459002,CDM,,,,INPATIENT,,,1710.5,684.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1556.56,OTHER,1282.88,1676.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BURN SUPPLIES,459002,CDM,,,,INPATIENT,,,1710.5,684.2,MONUMENT,COMMERCIAL,,,,1368.4,,1282.88,1676.29,
BURN SUPPLIES,459002,CDM,,,,INPATIENT,,,1710.5,684.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1282.88,,1282.88,1676.29,
INJ INTER ARTERIAL,96373,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,137.06,179.1,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ INTER ARTERIAL,96373,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,146.2,,137.06,179.1,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ THER/PROPH/DIAG SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,157,62.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,125.6,OTHER,117.75,153.86,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ THER/PROPH/DIAG SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,157,62.8,MONUMENT,COMMERCIAL,,,,125.6,,117.75,153.86,
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,563.75,225.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,422.81,552.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
GASTRIC LAVAGE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,BLUE CROSS ANTHEM,COMMERCIAL,,,,421.672,OTHER,273,356.72,PERCENT OF CHARGES BASED ON HCPCS CODE
GASTRIC LAVAGE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,MONUMENT,COMMERCIAL,,,,291.2,,273,356.72,
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OPHTHALMOLOGICAL EXAM AND EVAL,92002,CPT,450,RC,,OUTPATIENT,,,270,108,BLUE CROSS ANTHEM,COMMERCIAL,,,,216,OTHER,202.5,264.6,PERCENT OF CHARGES BASED ON HCPCS CODE
OPHTHALMOLOGICAL EXAM AND EVAL,92002,CPT,450,RC,,OUTPATIENT,,,270,108,MONUMENT,COMMERCIAL,,,,216,,202.5,264.6,
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DIAGNOSTIC NASOPHARYNGOSCOPY,92511,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.8,OTHER,592.31,773.96,PERCENT OF CHARGES BASED ON HCPCS CODE
DIAGNOSTIC NASOPHARYNGOSCOPY,92511,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,MONUMENT,COMMERCIAL,,,,631.8,,592.31,773.96,
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84.94,110.99,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIAC ARREST CPR,92950,CPT,450,RC,,OUTPATIENT,,,998,399.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,798.4,OTHER,748.5,978.04,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIAC ARREST CPR,92950,CPT,450,RC,,OUTPATIENT,,,998,399.2,MONUMENT,COMMERCIAL,,,,798.4,,748.5,978.04,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CARDIOVERSION ELECTIVE,92960,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1185.2,OTHER,1111.13,1451.87,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOVERSION ELECTIVE,92960,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,MONUMENT,COMMERCIAL,,,,1185.2,,1111.13,1451.87,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"TRANSTHORACIC ECHO, LIMITED",93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,385.2,OTHER,361.13,471.87,PERCENT OF CHARGES BASED ON HCPCS CODE
"TRANSTHORACIC ECHO, LIMITED",93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,MONUMENT,COMMERCIAL,,,,385.2,,361.13,471.87,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US LE ART;UNILAT OR LIMITED,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,429.2,OTHER,402.38,525.77,PERCENT OF CHARGES BASED ON HCPCS CODE
US LE ART;UNILAT OR LIMITED,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,MONUMENT,COMMERCIAL,,,,429.2,,402.38,525.77,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
US VENOUS LIMITED - BEDSIDE,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,742.8,OTHER,696.38,909.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US VENOUS LIMITED - BEDSIDE,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,MONUMENT,COMMERCIAL,,,,742.8,,696.38,909.93,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IV PUSH SAME DRUG,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH SAME DRUG,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
IRRIG DRUG DELIVERY DEVICE,96523,CPT,260,RC,,OUTPATIENT,,,172,68.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.6,OTHER,129,168.56,PERCENT OF CHARGES BASED ON HCPCS CODE
IRRIG DRUG DELIVERY DEVICE,96523,CPT,260,RC,,OUTPATIENT,,,172,68.8,MONUMENT,COMMERCIAL,,,,137.6,,129,168.56,
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ACTIVE WOUND CARE <20CM,97597,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,168.75,220.5,PERCENT OF CHARGES BASED ON HCPCS CODE
ACTIVE WOUND CARE <20CM,97597,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,180,,168.75,220.5,
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,450,RC,,OUTPATIENT,,,340,136,BLUE CROSS ANTHEM,COMMERCIAL,,,,272,OTHER,255,333.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,450,RC,,OUTPATIENT,,,340,136,MONUMENT,COMMERCIAL,,,,272,,255,333.2,
CYTOGENETICS - DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOD SED SAME PHYS/QHP 5/>YRS,99152,CPT,761,RC,,OUTPATIENT,,,650,260,BLUE CROSS ANTHEM,COMMERCIAL,,,,520,OTHER,487.5,637,PERCENT OF CHARGES BASED ON HCPCS CODE
MOD SED SAME PHYS/QHP 5/>YRS,99152,CPT,761,RC,,OUTPATIENT,,,650,260,MONUMENT,COMMERCIAL,,,,520,,487.5,637,
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,84,109.76,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOD SED SAME PHYS/QHP EA,99153,CPT,761,RC,,OUTPATIENT,,,340,136,BLUE CROSS ANTHEM,COMMERCIAL,,,,272,OTHER,255,333.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MOD SED SAME PHYS/QHP EA,99153,CPT,761,RC,,OUTPATIENT,,,340,136,MONUMENT,COMMERCIAL,,,,272,,255,333.2,
Z CYTOGENETICS ANALYSIS,8827591,CPT,310,RC,91,OUTPATIENT,,,311.5,124.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,233.63,305.27,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOD SED OTH PHYS/QHP 5>YRS,99156,CPT,450,RC,,OUTPATIENT,,,335,134,BLUE CROSS ANTHEM,COMMERCIAL,,,,268,OTHER,251.3,328.3,PERCENT OF CHARGES BASED ON HCPCS CODE
MOD SED OTH PHYS/QHP 5>YRS,99156,CPT,450,RC,,OUTPATIENT,,,335,134,MONUMENT,COMMERCIAL,,,,268,,251.3,328.3,
Z DIRECT IMMUNOFLOUR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.63,58.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MOD SED OTHER PHYS/QHP EA,99157,CPT,450,RC,,OUTPATIENT,,,189.5,75.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,151.6,OTHER,142.1,185.7,PERCENT OF CHARGES BASED ON HCPCS CODE
MOD SED OTHER PHYS/QHP EA,99157,CPT,450,RC,,OUTPATIENT,,,189.5,75.8,MONUMENT,COMMERCIAL,,,,151.6,,142.1,185.7,
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.63,58.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ER ACUITY 1 W/O MODIFIER,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,225,OTHER,210.94,275.63,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 1 W/O MODIFIER,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,MONUMENT,COMMERCIAL,,,,225,,210.94,275.63,
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.63,58.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ER ACUITY 2 W/O MODIFIER,99282,CPT,450,RC,,OUTPATIENT,,,371.25,148.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,297,OTHER,278.44,363.83,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 2 W/O MODIFIER,99282,CPT,450,RC,,OUTPATIENT,,,371.25,148.5,MONUMENT,COMMERCIAL,,,,225,,278.44,363.83,
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.63,58.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ER ACUITY 3 W/O MODIFIER,99283,CPT,450,RC,,OUTPATIENT,,,461.62,184.648,BLUE CROSS ANTHEM,COMMERCIAL,,,,369.296,OTHER,325.88,425.81,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 3 W/O MODIFIER,99283,CPT,450,RC,,OUTPATIENT,,,461.62,184.648,MONUMENT,COMMERCIAL,,,,225,,325.88,425.81,
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,44.63,58.31,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ER ACUITY 4 W/O MODIFIER,99284,CPT,450,RC,,OUTPATIENT,,,820.25,328.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,656.2,OTHER,615.19,803.85,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 4 W/O MODIFIER,99284,CPT,450,RC,,OUTPATIENT,,,820.25,328.1,MONUMENT,COMMERCIAL,,,,225,,615.19,803.85,
Z IMMUNOFLUORESCENT STUDY,8834791,CPT,310,RC,91,OUTPATIENT,,,315.75,126.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,236.81,309.44,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ER ACUITY 5 W/O MODIFIER,99285,CPT,450,RC,,OUTPATIENT,,,1448.5,579.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1158.8,OTHER,1086.38,1419.53,PERCENT OF CHARGES BASED ON HCPCS CODE
ER ACUITY 5 W/O MODIFIER,99285,CPT,450,RC,,OUTPATIENT,,,1448.5,579.4,MONUMENT,COMMERCIAL,,,,225,,1086.38,1419.53,
Z UROVYSION DETECTION BLAD CA,8836891,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,146.25,191.1,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BI-PAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,527.2,OTHER,494.25,645.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BI-PAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,MONUMENT,COMMERCIAL,,,,527.2,,494.25,645.82,
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,551.25,720.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ETCO2 FIRST DAY,94770,CPT,460,RC,,OUTPATIENT,,,222.75,89.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.2,OTHER,167.06,218.3,PERCENT OF CHARGES BASED ON HCPCS CODE
ETCO2 FIRST DAY,94770,CPT,460,RC,,OUTPATIENT,,,222.75,89.1,MONUMENT,COMMERCIAL,,,,178.2,,167.06,218.3,
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,551.25,720.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BI-PAP FIRST DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,527.2,OTHER,494.25,645.82,PERCENT OF CHARGES BASED ON HCPCS CODE
BI-PAP FIRST DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,MONUMENT,COMMERCIAL,,,,527.2,,494.25,645.82,
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,551.25,720.3,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
OXIMETRY ONCE DAILY,94760,CPT,460,RC,,OUTPATIENT,,,96.25,38.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,77,OTHER,72.19,94.33,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY ONCE DAILY,94760,CPT,460,RC,,OUTPATIENT,,,96.25,38.5,MONUMENT,COMMERCIAL,,,,77,,72.19,94.33,
LIVING WITH PAIN (GROUP CLASS),9150000,CDM,,,,OUTPATIENT,,,120,48,UNITED HEALTH,UNITED COMMERCIAL,,,,102,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY MULTIPLES DAILY,94761,CPT,460,RC,,OUTPATIENT,,,275.5,110.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,220.4,OTHER,206.63,269.99,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY MULTIPLES DAILY,94761,CPT,460,RC,,OUTPATIENT,,,275.5,110.2,MONUMENT,COMMERCIAL,,,,220.4,,206.63,269.99,
ER ACUITY 2,9928225,CPT,450,RC,25,OUTPATIENT,,,371.25,148.5,UNITED HEALTH,UNITED COMMERCIAL,,,CASE RATE,550,CASE RATE,278.44,363.83,CALCULATION BASED ON HCPCS/CPT CODE FOR A FLAT RATE OR A PERCENTAGE
PEAK FLOW MONITORING,4600043,CDM,270,RC,,INPATIENT,,,124.5,49.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.3,OTHER,93.38,122.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PEAK FLOW MONITORING,4600043,CDM,270,RC,,INPATIENT,,,124.5,49.8,MONUMENT,COMMERCIAL,,,,99.6,,93.38,122.01,
PEAK FLOW MONITORING,4600043,CDM,270,RC,,INPATIENT,,,124.5,49.8,UNITED HEALTH,UNITED COMMERCIAL,,,,93.38,,93.38,122.01,
PFT  SPIROMETRY  PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,259.2,OTHER,243,317.52,PERCENT OF CHARGES BASED ON HCPCS CODE
PFT  SPIROMETRY  PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,MONUMENT,COMMERCIAL,,,,259.2,,243,317.52,
ER ACUITY 3,9928325,CPT,450,RC,25,OUTPATIENT,,,461.62,184.648,UNITED HEALTH,UNITED COMMERCIAL,,,CASE RATE,1700,CASE RATE,325.88,425.81,CALCULATION BASED ON HCPCS/CPT CODE FOR A FLAT RATE OR A PERCENTAGE
SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,259.2,OTHER,243,317.52,PERCENT OF CHARGES BASED ON HCPCS CODE
SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,MONUMENT,COMMERCIAL,,,,259.2,,243,317.52,
ER ACUITY 4,9928425,CPT,450,RC,25,OUTPATIENT,,,820.25,328.1,UNITED HEALTH,UNITED COMMERCIAL,,,CASE RATE,2800,CASE RATE,615.19,803.85,CALCULATION BASED ON HCPCS/CPT CODE FOR A FLAT RATE OR A PERCENTAGE
SPIROMETRY PRE/POST BRDIAL,94060,CPT,460,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
SPIROMETRY PRE/POST BRDIAL,94060,CPT,460,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
ER ACUITY 5,9928525,CPT,450,RC,25,OUTPATIENT,,,1448.5,579.4,UNITED HEALTH,UNITED COMMERCIAL,,,CASE RATE,3800,CASE RATE,1086.38,1419.53,CALCULATION BASED ON HCPCS/CPT CODE FOR A FLAT RATE OR A PERCENTAGE
PFT SPIROMETRY PRE/POST BRDIA,94060,CPT,460,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
PFT SPIROMETRY PRE/POST BRDIA,94060,CPT,460,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
SYPHILIS TOTAL AB,0064U,CPT,300,RC,,OUTPATIENT,,,120,48,UNITED HEALTH,UNITED COMMERCIAL,,,,102,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSPASM PROVOCATION EVAL,94070,CPT,460,RC,,OUTPATIENT,,,874.25,349.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,699.4,OTHER,655.69,856.77,PERCENT OF CHARGES BASED ON HCPCS CODE
BRONCHOSPASM PROVOCATION EVAL,94070,CPT,460,RC,,OUTPATIENT,,,874.25,349.7,MONUMENT,COMMERCIAL,,,,699.4,,655.69,856.77,
BREAST ASPIRATION LT 1 SITE,19000LT,CPT,361,RC,LT,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
PFT  LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,534.8,OTHER,501.38,655.13,PERCENT OF CHARGES BASED ON HCPCS CODE
PFT  LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,MONUMENT,COMMERCIAL,,,,534.8,,501.38,655.13,
BREAST ASPIRATION RT 1 SITE,19000RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
PFT  DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,269.2,OTHER,252.38,329.77,PERCENT OF CHARGES BASED ON HCPCS CODE
PFT  DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,MONUMENT,COMMERCIAL,,,,269.2,,252.38,329.77,
US BREAST ASPIRATION LT2 SITES,19001LT,CPT,361,RC,LT,OUTPATIENT,,,768,307.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,576,752.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
VITALOR SCREENING,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.52,OTHER,107.44,140.39,PERCENT OF CHARGES BASED ON HCPCS CODE
VITALOR SCREENING,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,MONUMENT,COMMERCIAL,,,,114.6,,107.44,140.39,
BREAST ASPIRATION RT 2 SITES,19001RT,CPT,361,RC,RT,OUTPATIENT,,,768,307.2,UNITED HEALTH,UNITED COMMERCIAL,,,,652.8,OTHER,576,752.64,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY NOCTURNAL STUDY,94762,CPT,460,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,160.31,209.48,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY NOCTURNAL STUDY,94762,CPT,460,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,171,,160.31,209.48,
STEREO CORE BX LT,19081LT,CPT,401,RC,LT,OUTPATIENT,,,2904.5,1161.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2468.825,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY WITH AMBULATION,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,BLUE CROSS ANTHEM,COMMERCIAL,,,,154,OTHER,144.38,188.65,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY WITH AMBULATION,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,MONUMENT,COMMERCIAL,,,,154,,144.38,188.65,
STEREO CORE BX RT,19081RT,CPT,401,RC,RT,OUTPATIENT,,,2904.5,1161.8,UNITED HEALTH,UNITED COMMERCIAL,,,,2468.825,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.5,315.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.6,OTHER,592.13,773.71,PERCENT OF CHARGES BASED ON HCPCS CODE
INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.5,315.8,MONUMENT,COMMERCIAL,,,,631.6,,592.13,773.71,
STEREO 2ND LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
CARDIOPULMONARY RESUSCITATION,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,BLUE CROSS ANTHEM,COMMERCIAL,,,,798,OTHER,748.13,977.55,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIOPULMONARY RESUSCITATION,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,MONUMENT,COMMERCIAL,,,,798,,748.13,977.55,
STEREO 3RD LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
CARDIAC EVENT MONITER SETUP,93270,CPT,480,RC,,OUTPATIENT,,,412,164.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,329.6,OTHER,309,403.76,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIAC EVENT MONITER SETUP,93270,CPT,480,RC,,OUTPATIENT,,,412,164.8,MONUMENT,COMMERCIAL,,,,329.6,,309,403.76,
STEREO 2ND LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
VENTILATION RESCUE BREATHING,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,BLUE CROSS ANTHEM,COMMERCIAL,,,,798,OTHER,748.13,977.55,PERCENT OF CHARGES BASED ON HCPCS CODE
VENTILATION RESCUE BREATHING,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,MONUMENT,COMMERCIAL,,,,798,,748.13,977.55,
STEREO 3RD LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2183.65,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
ECHO 3D/M MODE & COLOR DOPPLER,C8929,HCPCS,480,RC,,INPATIENT,,,2595.5,1038.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2361.91,OTHER,1946.63,2543.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ECHO 3D/M MODE & COLOR DOPPLER,C8929,HCPCS,480,RC,,INPATIENT,,,2595.5,1038.2,MONUMENT,COMMERCIAL,,,,2076.4,,1946.63,2543.59,
ECHO 3D/M MODE & COLOR DOPPLER,C8929,HCPCS,480,RC,,INPATIENT,,,2595.5,1038.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1946.63,,1946.63,2543.59,
GRADED EXERCISE BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,929,OTHER,870.94,1138.03,PERCENT OF CHARGES BASED ON HCPCS CODE
GRADED EXERCISE BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,MONUMENT,COMMERCIAL,,,,929,,870.94,1138.03,
BX BREAST 1ST LESION LT,19085LT,CPT,610,RC,LT,OUTPATIENT,,,3207.25,1282.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2726.1625,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
GRADED EXERCISE TEST,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,929,OTHER,870.94,1138.03,PERCENT OF CHARGES BASED ON HCPCS CODE
GRADED EXERCISE TEST,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,MONUMENT,COMMERCIAL,,,,929,,870.94,1138.03,
BX BREAST 1ST LESION RT,19085RT,CPT,610,RC,RT,OUTPATIENT,,,3207.25,1282.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2726.1625,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
GXT STD THREADMILL WALKING,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,929,OTHER,870.94,1138.03,PERCENT OF CHARGES BASED ON HCPCS CODE
GXT STD THREADMILL WALKING,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,MONUMENT,COMMERCIAL,,,,929,,870.94,1138.03,
BX BREAST ADD LESION LT,19086LT,CPT,610,RC,LT,OUTPATIENT,,,2441.25,976.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2075.0625,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
PHARM STRESS TEST BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,929,OTHER,870.94,1138.03,PERCENT OF CHARGES BASED ON HCPCS CODE
PHARM STRESS TEST BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,MONUMENT,COMMERCIAL,,,,929,,870.94,1138.03,
BX BREAST ADD LESION RT,19086RT,CPT,610,RC,RT,OUTPATIENT,,,2441.25,976.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2075.0625,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
PULMONARY STRESS TESTING 6 MIN,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,84.56,110.5,PERCENT OF CHARGES BASED ON HCPCS CODE
PULMONARY STRESS TESTING 6 MIN,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,90.2,,84.56,110.5,
US BIOPSY BREAST LT 1ST LESION,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2076.4,OTHER,1946.63,2543.59,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,MONUMENT,COMMERCIAL,,,,2076.4,,1946.63,2543.59,
US BIOPSY BREAST LT 2 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AE PFT SPIROMETRY PRE/POST BRD,94060,CPT,460,RC,,OUTPATIENT,,,600,240,BLUE CROSS ANTHEM,COMMERCIAL,,,,480,OTHER,450,588,PERCENT OF CHARGES BASED ON HCPCS CODE
AE PFT SPIROMETRY PRE/POST BRD,94060,CPT,460,RC,,OUTPATIENT,,,600,240,MONUMENT,COMMERCIAL,,,,480,,450,588,
US BIOPSY BREAST LT 3 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO 2D/M MODE&COLOR DOP W/C,C8929,HCPCS,480,RC,,BOTH,,,2595.5,1038.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2361.91,OTHER,1946.63,2543.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ECHO 2D/M MODE&COLOR DOP W/C,C8929,HCPCS,480,RC,,BOTH,,,2595.5,1038.2,MONUMENT,COMMERCIAL,,,,2076.4,,1946.63,2543.59,
ECHO 2D/M MODE&COLOR DOP W/C,C8929,HCPCS,480,RC,,BOTH,,,2595.5,1038.2,UNITED HEALTH,UNITED COMMERCIAL,,,,1946.63,,1946.63,2543.59,
AE MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
AE MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
US BIOPSY BREAST RT 1 LESION,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AE MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
AE MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
US BIOPSY BREAST RT 2 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1440.6,OTHER,1350.56,1764.74,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,MONUMENT,COMMERCIAL,,,,1440.6,,1350.56,1764.74,
US BIOPSY BREAST RT 3 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,240,OTHER,1018.5,1330.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO 2D/M MODE LIMITED,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,385.2,OTHER,361.13,471.87,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE LIMITED,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,MONUMENT,COMMERCIAL,,,,385.2,,361.13,471.87,
STERO 2ND LESION LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2076.4,OTHER,1946.63,2543.59,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,MONUMENT,COMMERCIAL,,,,2076.4,,1946.63,2543.59,
MAMMOTOME BIOPSY LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,1520.81,1987.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1440.6,OTHER,1350.56,1764.74,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,MONUMENT,COMMERCIAL,,,,1440.6,,1350.56,1764.74,
STERO 3RD LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE LIMITED STUDY,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,385.2,OTHER,361.13,471.87,PERCENT OF CHARGES BASED ON HCPCS CODE
ECHO 2D/M MODE LIMITED STUDY,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,MONUMENT,COMMERCIAL,,,,385.2,,361.13,471.87,
MAMMOTOME BIOPSY RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,1520.81,1987.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
STRESS ECHO TECHNICAL,93350,CPT,480,RC,,OUTPATIENT,,,1572.25,628.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1257.8,OTHER,1179.19,1540.81,PERCENT OF CHARGES BASED ON HCPCS CODE
STRESS ECHO TECHNICAL,93350,CPT,480,RC,,OUTPATIENT,,,1572.25,628.9,MONUMENT,COMMERCIAL,,,,1257.8,,1179.19,1540.81,
MAMMOTOME BIOPSY 2ND LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,1520.81,1987.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
AE NEB MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,103.31,135,PERCENT OF CHARGES BASED ON HCPCS CODE
AE NEB MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,110.2,,103.31,135,
BX BREAST VAC ASSIST R 2 SITES,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1723.5875,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
AE NEB SUBSEQUENT MED AEROSOL,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
AE NEB SUBSEQUENT MED AEROSOL,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
NEEDLE PLACEMENT 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1068.45,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
AE PEAK FLOW MONITORING,4830104,CDM,270,RC,,INPATIENT,,,124.5,49.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.3,OTHER,93.38,122.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AE PEAK FLOW MONITORING,4830104,CDM,270,RC,,INPATIENT,,,124.5,49.8,MONUMENT,COMMERCIAL,,,,99.6,,93.38,122.01,
AE PEAK FLOW MONITORING,4830104,CDM,270,RC,,INPATIENT,,,124.5,49.8,UNITED HEALTH,UNITED COMMERCIAL,,,,93.38,,93.38,122.01,
AE PFT SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,259.2,OTHER,243,317.52,PERCENT OF CHARGES BASED ON HCPCS CODE
AE PFT SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,MONUMENT,COMMERCIAL,,,,259.2,,243,317.52,
PERQ DEV BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2846.75,1138.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2419.7375,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
AE PFT LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,534.8,OTHER,501.38,655.13,PERCENT OF CHARGES BASED ON HCPCS CODE
AE PFT LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,MONUMENT,COMMERCIAL,,,,534.8,,501.38,655.13,
PERQ DEVICE BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
AE PFT DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,269.2,OTHER,252.38,329.77,PERCENT OF CHARGES BASED ON HCPCS CODE
AE PFT DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,MONUMENT,COMMERCIAL,,,,269.2,,252.38,329.77,
BREAST NEEDLE LOC LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2173.25,869.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1847.2625,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION EA ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION EA ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
PERQ DEV BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2846.75,1138.7,UNITED HEALTH,UNITED COMMERCIAL,,,,2419.7375,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL I,96360,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,472.4,OTHER,442.88,578.69,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION INITIAL LEVEL I,96360,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,MONUMENT,COMMERCIAL,,,,472.4,,442.88,578.69,
PERQ DEVICE BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL II,96360,CPT,450,RC,,OUTPATIENT,,,522.5,209,BLUE CROSS ANTHEM,COMMERCIAL,,,,418,OTHER,391.88,512.05,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION INITIAL LEVEL II,96360,CPT,450,RC,,OUTPATIENT,,,522.5,209,MONUMENT,COMMERCIAL,,,,418,,391.88,512.05,
NEEDLE PLACEMENT 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1068.45,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL III,96360,CPT,450,RC,,OUTPATIENT,,,532.25,212.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,425.8,OTHER,399.19,521.61,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION INITIAL LEVEL III,96360,CPT,450,RC,,OUTPATIENT,,,532.25,212.9,MONUMENT,COMMERCIAL,,,,425.8,,399.19,521.61,
NEEDLE PLACEMENT 2ND RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,UNITED HEALTH,UNITED COMMERCIAL,,,,1053.7365,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION SETUP,5100040,CDM,,,,INPATIENT,,,193.75,77.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,176.31,OTHER,145.31,189.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINOR EXCISION SETUP,5100040,CDM,,,,INPATIENT,,,193.75,77.5,MONUMENT,COMMERCIAL,,,,155,,145.31,189.88,
MINOR EXCISION SETUP,5100040,CDM,,,,INPATIENT,,,193.75,77.5,UNITED HEALTH,UNITED COMMERCIAL,,,,145.31,,145.31,189.88,
MINOR WOUND DEBRIDEMENT,5100050,CDM,,,,INPATIENT,,,177.5,71,BLUE CROSS ANTHEM,COMMERCIAL,,,,161.53,OTHER,133.13,173.95,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MINOR WOUND DEBRIDEMENT,5100050,CDM,,,,INPATIENT,,,177.5,71,MONUMENT,COMMERCIAL,,,,142,,133.13,173.95,
MINOR WOUND DEBRIDEMENT,5100050,CDM,,,,INPATIENT,,,177.5,71,UNITED HEALTH,UNITED COMMERCIAL,,,,133.13,,133.13,173.95,
PICC LINE INSERTION,36489,CPT,361,RC,,OUTPATIENT,,,839.5,335.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,671.6,OTHER,629.63,822.71,PERCENT OF CHARGES BASED ON HCPCS CODE
PICC LINE INSERTION,36489,CPT,361,RC,,OUTPATIENT,,,839.5,335.8,MONUMENT,COMMERCIAL,,,,671.6,,629.63,822.71,
BREAST NEEDLE LOC RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2173.25,869.3,UNITED HEALTH,UNITED COMMERCIAL,,,,1847.2625,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
STERILE DRESSING,5100080,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STERILE DRESSING,5100080,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
STERILE DRESSING,5100080,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
EVAL & MGMT CLINICAL VISIT,G0463,HCPCS,510,RC,,BOTH,,,232,92.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,211.12,OTHER,126.94,165.87,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EVAL & MGMT CLINICAL VISIT,G0463,HCPCS,510,RC,,BOTH,,,232,92.8,MONUMENT,COMMERCIAL,,,,135.4,,126.94,165.87,
EVAL & MGMT CLINICAL VISIT,G0463,HCPCS,510,RC,,BOTH,,,232,92.8,UNITED HEALTH,UNITED COMMERCIAL,,,,126.94,,126.94,165.87,
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,INPATIENT,,,15,6,BLUE CROSS ANTHEM,COMMERCIAL,,,,13.65,OTHER,11.3,14.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,INPATIENT,,,15,6,MONUMENT,COMMERCIAL,,,,12,,11.3,14.7,
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,INPATIENT,,,15,6,UNITED HEALTH,UNITED COMMERCIAL,,,,11.3,,11.3,14.7,
SCHOOL/CAMP PHY LEVEL 1,P99901,HCPCS,516,RC,,OUTPATIENT,,,35,14,BLUE CROSS ANTHEM,COMMERCIAL,,,,28,OTHER,26.25,34.3,PERCENT OF CHARGES BASED ON HCPCS CODE
SCHOOL/CAMP PHY LEVEL 1,P99901,HCPCS,516,RC,,OUTPATIENT,,,35,14,MONUMENT,COMMERCIAL,,,,28,,26.25,34.3,
NEEDLE PLACEMENT 2ND LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
DOT PHYSICAL,P99904,HCPCS,516,RC,,OUTPATIENT,,,170,68,BLUE CROSS ANTHEM,COMMERCIAL,,,,136,OTHER,127.5,166.6,PERCENT OF CHARGES BASED ON HCPCS CODE
DOT PHYSICAL,P99904,HCPCS,516,RC,,OUTPATIENT,,,170,68,MONUMENT,COMMERCIAL,,,,136,,127.5,166.6,
NEEDLE PLACEMENT 4TH LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
"CLINDAMYCIN PHOSP, 300MG INJ",S0077,HCPCS,,,,OUTPATIENT,,,22,8.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.6,OTHER,16.5,21.56,PERCENT OF CHARGES BASED ON HCPCS CODE
"CLINDAMYCIN PHOSP, 300MG INJ",S0077,HCPCS,,,,OUTPATIENT,,,22,8.8,MONUMENT,COMMERCIAL,,,,17.6,,16.5,21.56,
PERQ DEVICE BREAST EA IMAGE LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG,S0119,HCPCS,,,,OUTPATIENT,,,39,15.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,31.2,OTHER,29.25,38.22,PERCENT OF CHARGES BASED ON HCPCS CODE
ONDANSETRON 4MG,S0119,HCPCS,,,,OUTPATIENT,,,39,15.6,MONUMENT,COMMERCIAL,,,,31.2,,29.25,38.22,
NEEDLE PLACEMENT 3RD RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
SPLINT DIGIT,S8450,HCPCS,516,RC,,OUTPATIENT,,,5,2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4,OTHER,3.75,4.9,PERCENT OF CHARGES BASED ON HCPCS CODE
SPLINT DIGIT,S8450,HCPCS,516,RC,,OUTPATIENT,,,5,2,MONUMENT,COMMERCIAL,,,,4,,3.75,4.9,
NEEDLE PLACEMENT 4TH RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,UNITED HEALTH,UNITED COMMERCIAL,,,,235.6625,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 1 MG,Q0162,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
ONDANSETRON 1 MG,Q0162,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
PERQ DEVICE BREAST EA IMAGE RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,2350.25,940.1,UNITED HEALTH,UNITED COMMERCIAL,,,,1997.7125,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
STEREOTACTIC NDLE LOC LT,19290LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1068.45,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
"ALBUTEROL, INHALATION SOLUTION",J7613,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
"ALBUTEROL, INHALATION SOLUTION",J7613,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
STEREOTACTIC NDLE LOC RT,19290RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1068.45,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
PR PREDNISONE IMMEDIATE RELEAS,J7512,HCPCS,516,RC,,OUTPATIENT,,,0.05,0.02,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.04,OTHER,0.04,0.05,PERCENT OF CHARGES BASED ON HCPCS CODE
PR PREDNISONE IMMEDIATE RELEAS,J7512,HCPCS,516,RC,,OUTPATIENT,,,0.05,0.02,MONUMENT,COMMERCIAL,,,,0.04,,0.04,0.05,
DRAIN/INJECT JOINT/BURSA LT,20605LT,CPT,361,RC,LT,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE ORAL,J7506,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
PREDNISONE ORAL,J7506,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
DRAIN/INJECT JOINT/BURSA,20605RT,CPT,320,RC,RT,OUTPATIENT,,,590.5,236.2,UNITED HEALTH,UNITED COMMERCIAL,,,,501.925,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 250CC BAG,J7050,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
NORMAL SALINE 250CC BAG,J7050,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
INJ/DRAIN MAJOR JOINT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,662.75,265.1,UNITED HEALTH,UNITED COMMERCIAL,,,,563.3375,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 1000CC BAG,J7030,HCPCS,516,RC,,OUTPATIENT,,,5,2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4,OTHER,3.75,4.9,PERCENT OF CHARGES BASED ON HCPCS CODE
NORMAL SALINE 1000CC BAG,J7030,HCPCS,516,RC,,OUTPATIENT,,,5,2,MONUMENT,COMMERCIAL,,,,4,,3.75,4.9,
SHOULDER INJECT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,520.55,208.22,UNITED HEALTH,UNITED COMMERCIAL,,,,442.4675,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
TRIAMCINOLONE ACETONIDE INJ,J3301,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3.2,OTHER,3,3.92,PERCENT OF CHARGES BASED ON HCPCS CODE
TRIAMCINOLONE ACETONIDE INJ,J3301,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,MONUMENT,COMMERCIAL,,,,3.2,,3,3.92,
INJ/DRAIN MAJOR JOINT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,662.75,265.1,UNITED HEALTH,UNITED COMMERCIAL,,,,563.3375,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2930,HCPCS,516,RC,,OUTPATIENT,,,9,3.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,7.2,OTHER,6.75,8.82,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLPREDNISOLONE INJECTION,J2930,HCPCS,516,RC,,OUTPATIENT,,,9,3.6,MONUMENT,COMMERCIAL,,,,7.2,,6.75,8.82,
SHOULDER INJECT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,520.55,208.22,UNITED HEALTH,UNITED COMMERCIAL,,,,442.4675,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2920,HCPCS,516,RC,,OUTPATIENT,,,6,2.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,4.8,OTHER,4.5,5.88,PERCENT OF CHARGES BASED ON HCPCS CODE
METHYLPREDNISOLONE INJECTION,J2920,HCPCS,516,RC,,OUTPATIENT,,,6,2.4,MONUMENT,COMMERCIAL,,,,4.8,,4.5,5.88,
HIP INJECT FOR MR ARTHRO LT,27093LT,CPT,320,RC,LT,OUTPATIENT,,,685,274,UNITED HEALTH,UNITED COMMERCIAL,,,,582.25,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE HCL INJECTION,J2550,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3.2,OTHER,3,3.92,PERCENT OF CHARGES BASED ON HCPCS CODE
PROMETHAZINE HCL INJECTION,J2550,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,MONUMENT,COMMERCIAL,,,,3.2,,3,3.92,
HIP INJECT FOR MRI ARTHRO RT,27093RT,CPT,320,RC,RT,OUTPATIENT,,,685,274,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,187.5,245,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ONDANSETRON HCL INJECTION,J2405,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
ONDANSETRON HCL INJECTION,J2405,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
KNEE INJECT LT,27369LT,CPT,361,RC,LT,OUTPATIENT,,,357,142.8,UNITED HEALTH,UNITED COMMERCIAL,,,,303.45,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC TROMETHAMINE INJ,J1885,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1.6,OTHER,1.5,1.96,PERCENT OF CHARGES BASED ON HCPCS CODE
KETOROLAC TROMETHAMINE INJ,J1885,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,MONUMENT,COMMERCIAL,,,,1.6,,1.5,1.96,
KNEE INJECT RT,27369RT,CPT,361,RC,RT,OUTPATIENT,,,357,142.8,UNITED HEALTH,UNITED COMMERCIAL,,,,303.45,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE HCL INJECTIO,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1.6,OTHER,1.5,1.96,PERCENT OF CHARGES BASED ON HCPCS CODE
DIPHENHYDRAMINE HCL INJECTIO,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,MONUMENT,COMMERCIAL,,,,1.6,,1.5,1.96,
ANKLE INJECTION LT,27648LT,CPT,320,RC,LT,OUTPATIENT,,,343.75,137.5,UNITED HEALTH,UNITED COMMERCIAL,,,,292.1875,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE SODIUM PHOS,J1100,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,0.8,OTHER,0.75,0.98,PERCENT OF CHARGES BASED ON HCPCS CODE
DEXAMETHASONE SODIUM PHOS,J1100,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,MONUMENT,COMMERCIAL,,,,0.8,,0.75,0.98,
ANKLE INJECTION RT,27648RT,CPT,320,RC,RT,OUTPATIENT,,,343.75,137.5,UNITED HEALTH,UNITED COMMERCIAL,,,,292.1875,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
ROCEPHIN INJ,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1.6,OTHER,1.5,1.96,PERCENT OF CHARGES BASED ON HCPCS CODE
ROCEPHIN INJ,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,MONUMENT,COMMERCIAL,,,,1.6,,1.5,1.96,
MRI TMJ W/O CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2525.06,3299.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PENICILLIN G BENZATHINE INJ,J0561,HCPCS,516,RC,,OUTPATIENT,,,20,8,BLUE CROSS ANTHEM,COMMERCIAL,,,,16,OTHER,15,19.6,PERCENT OF CHARGES BASED ON HCPCS CODE
PENICILLIN G BENZATHINE INJ,J0561,HCPCS,516,RC,,OUTPATIENT,,,20,8,MONUMENT,COMMERCIAL,,,,16,,15,19.6,
MRI TMJ W/WO CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2525.06,3299.42,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PENG BENZATHINE/PROCAINE INJ,J0558,HCPCS,516,RC,,OUTPATIENT,,,15,6,BLUE CROSS ANTHEM,COMMERCIAL,,,,12,OTHER,11.25,14.7,PERCENT OF CHARGES BASED ON HCPCS CODE
PENG BENZATHINE/PROCAINE INJ,J0558,HCPCS,516,RC,,OUTPATIENT,,,15,6,MONUMENT,COMMERCIAL,,,,12,,11.25,14.7,
CT HEAD W/CONTRAST,70460QQ,CPT,350,RC,QQ,OUTPATIENT,,,1877.5,751,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1408.13,1839.95,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"REMOVE FOREIGN BODY, SIM",10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,294,384.16,PERCENT OF CHARGES BASED ON HCPCS CODE
"REMOVE FOREIGN BODY, SIM",10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,313.6,,294,384.16,
CT HEAD W/WO CONTRAST,70470QQ,CPT,350,RC,QQ,OUTPATIENT,,,2113.75,845.5,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1585.31,2071.48,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
PUNCTURE DRAINAGE OF LESION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,251.25,328.3,PERCENT OF CHARGES BASED ON HCPCS CODE
PUNCTURE DRAINAGE OF LESION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,268,,251.25,328.3,
CT IAC/ORB/SELLA W/CONTRAST,70481QQ,CPT,350,RC,QQ,OUTPATIENT,,,2050.75,820.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1538.06,2009.74,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"REMOVAL OF NAIL PLATE, SINGLE",11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,189.75,247.94,PERCENT OF CHARGES BASED ON HCPCS CODE
"REMOVAL OF NAIL PLATE, SINGLE",11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,202.4,,189.75,247.94,
CT IAC/ORB/SELLA W/WO CONTRAST,70482QQ,CPT,350,RC,QQ,OUTPATIENT,,,2516,1006.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1887,2465.68,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR SF WOUND TR 2.5CM/<,12001,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,172.5,225.4,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR SF WOUND TR 2.5CM/<,12001,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,184,,172.5,225.4,
CT MAXILLO FACIAL W/O CONTRAST,70486QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR SF WOUND TRNK 2.6-7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,210.75,275.38,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR SF WOUND TRNK 2.6-7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,224.8,,210.75,275.38,
CT MAXILLO FACIAL W/CONTRAST,70487QQ,CPT,350,RC,QQ,OUTPATIENT,,,2224.5,889.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1668.38,2180.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR SF WOUND FA 2.5 CM/<,12011,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,211.5,276.36,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR SF WOUND FA 2.5 CM/<,12011,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,225.6,,211.5,276.36,
CT SOFT TISSUE NECK W/CONTRAST,70491QQ,CPT,350,RC,QQ,OUTPATIENT,,,1684.25,673.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1263.19,1650.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
RPR SF WOUNDS FA 5.1-7.5 CM,12014,CPT,450,RC,,OUTPATIENT,,,365,146,BLUE CROSS ANTHEM,COMMERCIAL,,,,292,OTHER,273.75,357.7,PERCENT OF CHARGES BASED ON HCPCS CODE
RPR SF WOUNDS FA 5.1-7.5 CM,12014,CPT,450,RC,,OUTPATIENT,,,365,146,MONUMENT,COMMERCIAL,,,,292,,273.75,357.7,
CT SOFT TISSUE NCK W/WO (NEWW),70492QQ,CPT,350,RC,QQ,OUTPATIENT,,,2228.5,891.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1671.38,2183.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"LAYER CLOSURE OF WOUNDS, HAND",12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,BLUE CROSS ANTHEM,COMMERCIAL,,,,551.448,OTHER,464.25,606.62,PERCENT OF CHARGES BASED ON HCPCS CODE
"LAYER CLOSURE OF WOUNDS, HAND",12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,MONUMENT,COMMERCIAL,,,,495.2,,464.25,606.62,
CT ANGIO HEAD W/CONTRAST,70496QQ,CPT,350,RC,QQ,OUTPATIENT,,,2275,910,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1706.25,2229.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
"BURN TREATMENT W/O ANES, SM",16020,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,BLUE CROSS ANTHEM,COMMERCIAL,,,,286.296,OTHER,158.25,206.78,PERCENT OF CHARGES BASED ON HCPCS CODE
"BURN TREATMENT W/O ANES, SM",16020,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,MONUMENT,COMMERCIAL,,,,168.8,,158.25,206.78,
CT CAROTID ANGIO (CAAN),70498QQ,CPT,350,RC,QQ,OUTPATIENT,,,1908,763.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1431,1869.84,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,BLUE CROSS ANTHEM,COMMERCIAL,,,,991.752,OTHER,503.25,657.58,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,MONUMENT,COMMERCIAL,,,,536.8,,503.25,657.58,
MRI ST NECK W/CONTRAST,70542QQ,CPT,610,RC,QQ,OUTPATIENT,,,3914.5,1565.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2935.88,3836.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLY FOREARM SPLINT,29125,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,124.5,162.68,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLY FOREARM SPLINT,29125,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,132.8,,124.5,162.68,
RIBS-UNILAT/PA CHEST 3 VWS LT,71101LT,CPT,320,RC,LT,OUTPATIENT,,,431.75,172.7,UNITED HEALTH,UNITED COMMERCIAL,,,,366.9875,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
APPLICATION OF FINGER SPLINT,29130,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,78.75,102.9,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION OF FINGER SPLINT,29130,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,84,,78.75,102.9,
CT CHEST ANGIO,71275QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1512.38,1976.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
APPLICATION LOWER LEG SPLINT,29515,CPT,450,RC,,OUTPATIENT,,,281.39,112.556,BLUE CROSS ANTHEM,COMMERCIAL,,,,225.112,OTHER,139.5,182.28,PERCENT OF CHARGES BASED ON HCPCS CODE
APPLICATION LOWER LEG SPLINT,29515,CPT,450,RC,,OUTPATIENT,,,281.39,112.556,MONUMENT,COMMERCIAL,,,,148.8,,139.5,182.28,
CT CERVICAL SPINE W/O CONTRAST,72125QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ROUTINE VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,8,3.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,6.4,OTHER,6,7.84,PERCENT OF CHARGES BASED ON HCPCS CODE
ROUTINE VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,8,3.2,MONUMENT,COMMERCIAL,,,,6.4,,6,7.84,
CT THORACIC SPINE W/O CONTRAST,72128QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1592.25,2080.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
DRAINAGE OF ANAL ABSCESS,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,BLUE CROSS ANTHEM,COMMERCIAL,,,,1265.496,OTHER,393,513.52,PERCENT OF CHARGES BASED ON HCPCS CODE
DRAINAGE OF ANAL ABSCESS,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,MONUMENT,COMMERCIAL,,,,419.2,,393,513.52,
CT THORACIC SPINE W/CONTRAST,72129QQ,CPT,350,RC,QQ,OUTPATIENT,,,2478.5,991.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1858.88,2428.93,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INCISE EXTERNAL HEMORRHOID,46083,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,424.368,OTHER,342,446.88,PERCENT OF CHARGES BASED ON HCPCS CODE
INCISE EXTERNAL HEMORRHOID,46083,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,MONUMENT,COMMERCIAL,,,,364.8,,342,446.88,
CT LUMBAR SPINE W/O CONTRAST,72131QQ,CPT,350,RC,QQ,OUTPATIENT,,,1831.5,732.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1373.63,1794.87,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
INJ NERVE BLOCK PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,155.25,202.86,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ NERVE BLOCK PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,165.6,,155.25,202.86,
CT PELVIS W/CONTRAST,72193QQ,CPT,350,RC,QQ,OUTPATIENT,,,1871,748.4,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1403.25,1833.58,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
CLEAR OUTER EAR CANAL,69200,CPT,450,RC,,OUTPATIENT,,,318,127.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,254.4,OTHER,238.5,311.64,PERCENT OF CHARGES BASED ON HCPCS CODE
CLEAR OUTER EAR CANAL,69200,CPT,450,RC,,OUTPATIENT,,,318,127.2,MONUMENT,COMMERCIAL,,,,254.4,,238.5,311.64,
CT PELVIS W/WO CONTRAST,72194QQ,CPT,350,RC,QQ,OUTPATIENT,,,2135.75,854.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1601.81,2093.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
REMOVE IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,127,50.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.6,OTHER,95.25,124.46,PERCENT OF CHARGES BASED ON HCPCS CODE
REMOVE IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,127,50.8,MONUMENT,COMMERCIAL,,,,101.6,,95.25,124.46,
CLAVICLE LT,73000LT,CPT,320,RC,LT,OUTPATIENT,,,260.5,104.2,UNITED HEALTH,UNITED COMMERCIAL,,,,221.425,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,300,RC,,OUTPATIENT,,,17.92,7.168,BLUE CROSS ANTHEM,COMMERCIAL,,,,14.336,OTHER,13.4,17.6,PERCENT OF CHARGES BASED ON HCPCS CODE
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,300,RC,,OUTPATIENT,,,17.92,7.168,MONUMENT,COMMERCIAL,,,,14.3,,13.4,17.6,
CLAVICLE RT,73000RT,CPT,320,RC,RT,OUTPATIENT,,,260.5,104.2,UNITED HEALTH,UNITED COMMERCIAL,,,,221.425,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
URINALYSIS COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,9,3.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,7.2,OTHER,6.8,8.8,PERCENT OF CHARGES BASED ON HCPCS CODE
URINALYSIS COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,9,3.6,MONUMENT,COMMERCIAL,,,,7.2,,6.8,8.8,
SCAPULA LT,73010LT,CPT,320,RC,LT,OUTPATIENT,,,258.75,103.5,UNITED HEALTH,UNITED COMMERCIAL,,,,219.9375,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
"URINALYSIS, NON AUTOMATED",81002,CPT,307,RC,,OUTPATIENT,,,9,3.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,7.2,OTHER,6.75,8.82,PERCENT OF CHARGES BASED ON HCPCS CODE
"URINALYSIS, NON AUTOMATED",81002,CPT,307,RC,,OUTPATIENT,,,9,3.6,MONUMENT,COMMERCIAL,,,,7.2,,6.75,8.82,
SCAPULA RT,73010RT,CPT,320,RC,RT,OUTPATIENT,,,258.75,103.5,UNITED HEALTH,UNITED COMMERCIAL,,,,219.9375,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
URINE PREGNANCY TEST,81025,CPT,300,RC,,OUTPATIENT,,,22,8.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.6,OTHER,16.5,21.56,PERCENT OF CHARGES BASED ON HCPCS CODE
URINE PREGNANCY TEST,81025,CPT,300,RC,,OUTPATIENT,,,22,8.8,MONUMENT,COMMERCIAL,,,,17.6,,16.5,21.56,
SHOULDER 1 VIEW LT,73020LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
UR ALBUMIN SEMIQUANTITATIVE,82044,CPT,,,,OUTPATIENT,,,16,6.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.8,OTHER,12,15.7,PERCENT OF CHARGES BASED ON HCPCS CODE
UR ALBUMIN SEMIQUANTITATIVE,82044,CPT,,,,OUTPATIENT,,,16,6.4,MONUMENT,COMMERCIAL,,,,12.8,,12,15.7,
SHOULDER 1 VIEW RT,73020RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,OUTPATIENT,,,11,4.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,8.8,OTHER,8.3,10.8,PERCENT OF CHARGES BASED ON HCPCS CODE
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,OUTPATIENT,,,11,4.4,MONUMENT,COMMERCIAL,,,,8.8,,8.3,10.8,
SHOULDER 2 OR MORE VIEWS LT,73030LT,CPT,320,RC,LT,OUTPATIENT,,,348.5,139.4,UNITED HEALTH,UNITED COMMERCIAL,,,,296.225,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TEST,82950,CPT,301,RC,,OUTPATIENT,,,16,6.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,12.8,OTHER,12,15.7,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE TEST,82950,CPT,301,RC,,OUTPATIENT,,,16,6.4,MONUMENT,COMMERCIAL,,,,12.8,,12,15.7,
SHOULDER 2 OR MORE VIEWS RT,73030RT,CPT,320,RC,RT,OUTPATIENT,,,348.5,139.4,UNITED HEALTH,UNITED COMMERCIAL,,,,296.225,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE BLOOD TEST,82962,CPT,300,RC,,OUTPATIENT,,,6.56,2.624,BLUE CROSS ANTHEM,COMMERCIAL,,,,5.248,OTHER,4.5,5.88,PERCENT OF CHARGES BASED ON HCPCS CODE
GLUCOSE BLOOD TEST,82962,CPT,300,RC,,OUTPATIENT,,,6.56,2.624,MONUMENT,COMMERCIAL,,,,4.8,,4.5,5.88,
SHOULDER ARTHROGRAM LT,73040LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,UNITED HEALTH,UNITED COMMERCIAL,,,,681.0625,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,33,13.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,26.4,OTHER,24.8,32.3,PERCENT OF CHARGES BASED ON HCPCS CODE
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,33,13.2,MONUMENT,COMMERCIAL,,,,26.4,,24.8,32.3,
SHOULDER ARTHROGRAM RT,73040RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,UNITED HEALTH,UNITED COMMERCIAL,,,,681.0625,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,13,5.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,10.4,OTHER,9.8,12.7,PERCENT OF CHARGES BASED ON HCPCS CODE
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,13,5.2,MONUMENT,COMMERCIAL,,,,10.4,,9.8,12.7,
HUMERUS AP/LAT LT,73060LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
SMEAR WET MOUNT SALINE/INK,87210,CPT,300,RC,,OUTPATIENT,,,15,6,BLUE CROSS ANTHEM,COMMERCIAL,,,,12,OTHER,11.3,14.7,PERCENT OF CHARGES BASED ON HCPCS CODE
SMEAR WET MOUNT SALINE/INK,87210,CPT,300,RC,,OUTPATIENT,,,15,6,MONUMENT,COMMERCIAL,,,,12,,11.3,14.7,
HUMERUS AP/LAT RT,73060RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA DNA AMP PROBE,87502,CPT,306,RC,,OUTPATIENT,,,117,46.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.6,OTHER,87.8,114.7,PERCENT OF CHARGES BASED ON HCPCS CODE
INFLUENZA DNA AMP PROBE,87502,CPT,306,RC,,OUTPATIENT,,,117,46.8,MONUMENT,COMMERCIAL,,,,93.6,,87.8,114.7,
ELBOW 2 VIEWS LT,73070LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,UNITED HEALTH,UNITED COMMERCIAL,,,,181.6875,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
RSV DNA/RNA AMP PROBE,87634,CPT,300,RC,,OUTPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.6,OTHER,72.8,95.1,PERCENT OF CHARGES BASED ON HCPCS CODE
RSV DNA/RNA AMP PROBE,87634,CPT,300,RC,,OUTPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.8,95.1,
ELBOW 2 VIEWS RT,73070RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,UNITED HEALTH,UNITED COMMERCIAL,,,,181.6875,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,87635,CPT,300,RC,,OUTPATIENT,,,100.2,40.08,BLUE CROSS ANTHEM,COMMERCIAL,,,,80.16,OTHER,75.2,98.2,PERCENT OF CHARGES BASED ON HCPCS CODE
COVID19 SARS2 RNA QUAL RT PCR,87635,CPT,300,RC,,OUTPATIENT,,,100.2,40.08,MONUMENT,COMMERCIAL,,,,80.2,,75.2,98.2,
ELBOW 3 VIEWS LT,73080LT,CPT,320,RC,LT,OUTPATIENT,,,317,126.8,UNITED HEALTH,UNITED COMMERCIAL,,,,269.45,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,54,21.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,43.2,OTHER,40.5,52.9,PERCENT OF CHARGES BASED ON HCPCS CODE
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,54,21.6,MONUMENT,COMMERCIAL,,,,43.2,,40.5,52.9,
ELBOW 3 VIEWS RT,73080RT,CPT,320,RC,RT,OUTPATIENT,,,317,126.8,UNITED HEALTH,UNITED COMMERCIAL,,,,269.45,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,98,39.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.4,OTHER,73.5,96,PERCENT OF CHARGES BASED ON HCPCS CODE
DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,98,39.2,MONUMENT,COMMERCIAL,,,,78.4,,73.5,96,
ELBOW ARTHROGRAM LT,73085LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,UNITED HEALTH,UNITED COMMERCIAL,,,,681.0625,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
"INFCT ANTIGEN, INFLUENZA",87804,CPT,300,RC,,OUTPATIENT,,,41,16.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,32.8,OTHER,30.75,40.18,PERCENT OF CHARGES BASED ON HCPCS CODE
"INFCT ANTIGEN, INFLUENZA",87804,CPT,300,RC,,OUTPATIENT,,,41,16.4,MONUMENT,COMMERCIAL,,,,32.8,,30.75,40.18,
ELBOW ARTHROGRAM RT,73085RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,UNITED HEALTH,UNITED COMMERCIAL,,,,681.0625,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
"INFCTS ANTIGN, STREPTOCOCCUS A",87880,CPT,300,RC,,OUTPATIENT,,,47,18.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,37.6,OTHER,35.25,46.06,PERCENT OF CHARGES BASED ON HCPCS CODE
"INFCTS ANTIGN, STREPTOCOCCUS A",87880,CPT,300,RC,,OUTPATIENT,,,47,18.8,MONUMENT,COMMERCIAL,,,,37.6,,35.25,46.06,
FOREARM AP/LAT LT,73090LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,UNITED HEALTH,UNITED COMMERCIAL,,,,265.625,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
"IMMUN ADMIN 1 VAC, SNGL/COMBO",90471,CPT,761,RC,,OUTPATIENT,,,123.52,49.408,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.816,OTHER,48,62.72,PERCENT OF CHARGES BASED ON HCPCS CODE
"IMMUN ADMIN 1 VAC, SNGL/COMBO",90471,CPT,761,RC,,OUTPATIENT,,,123.52,49.408,MONUMENT,COMMERCIAL,,,,51.2,,48,62.72,
FOREARM AP/LAT RT,73090RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,UNITED HEALTH,UNITED COMMERCIAL,,,,265.625,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
TD VACCINE NO PRSRV 7/> IM,90714,CPT,516,RC,,OUTPATIENT,,,53,21.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,42.4,OTHER,39.75,51.94,PERCENT OF CHARGES BASED ON HCPCS CODE
TD VACCINE NO PRSRV 7/> IM,90714,CPT,516,RC,,OUTPATIENT,,,53,21.2,MONUMENT,COMMERCIAL,,,,42.4,,39.75,51.94,
WRIST 2 VIEWS LT,73100LT,CPT,320,RC,LT,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,137.0625,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
TDAP IMMUNIZATION,90715,CPT,516,RC,,OUTPATIENT,,,79,31.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.2,OTHER,59.25,77.42,PERCENT OF CHARGES BASED ON HCPCS CODE
TDAP IMMUNIZATION,90715,CPT,516,RC,,OUTPATIENT,,,79,31.6,MONUMENT,COMMERCIAL,,,,63.2,,59.25,77.42,
WRIST 2 VIEWS RT,73100RT,CPT,320,RC,RT,OUTPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,137.0625,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,OUTPATIENT,,,22,8.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,17.6,OTHER,16.5,21.6,PERCENT OF CHARGES BASED ON HCPCS CODE
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,OUTPATIENT,,,22,8.8,MONUMENT,COMMERCIAL,,,,17.6,,16.5,21.6,
WRIST LT,73110LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,35.25,46.06,PERCENT OF CHARGES BASED ON HCPCS CODE
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,37.6,,35.25,46.06,
WRIST RT,73110RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION INITIAL;31-60 MINS,96360,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,110.25,144.06,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION INITIAL;31-60 MINS,96360,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,117.6,,110.25,144.06,
WRIST ARTHRO LT,73115LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADDT'L HR,96361,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.784,OTHER,29.25,38.22,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION EA ADDT'L HR,96361,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,MONUMENT,COMMERCIAL,,,,31.2,,29.25,38.22,
WRIST ARTHRO RT,73115RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
"INJ, THERAPEUTIC OR DIAGNOSTIC",96372,CPT,260,RC,,OUTPATIENT,,,123.52,49.408,BLUE CROSS ANTHEM,COMMERCIAL,,,,98.816,OTHER,48,62.72,PERCENT OF CHARGES BASED ON HCPCS CODE
"INJ, THERAPEUTIC OR DIAGNOSTIC",96372,CPT,260,RC,,OUTPATIENT,,,123.52,49.408,MONUMENT,COMMERCIAL,,,,51.2,,48,62.72,
HAND 2 VIEWS LT,73120LT,CPT,320,RC,LT,OUTPATIENT,,,217.19,86.876,UNITED HEALTH,UNITED COMMERCIAL,,,,184.6115,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SINGLE OR INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,BLUE CROSS ANTHEM,COMMERCIAL,,,,324.488,OTHER,108.75,142.1,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH SINGLE OR INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
HAND 2 VIEWS RT,73120RT,CPT,320,RC,RT,OUTPATIENT,,,217.19,86.876,UNITED HEALTH,UNITED COMMERCIAL,,,,184.6115,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA NEW ADDT'L DRUGS,96375,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,BLUE CROSS ANTHEM,COMMERCIAL,,,,63.784,OTHER,42.75,55.86,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH EA NEW ADDT'L DRUGS,96375,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,MONUMENT,COMMERCIAL,,,,45.6,,42.75,55.86,
HAND 3 VIEWS LT,73130LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW",99201,CPT,516,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, NEW",99201,CPT,516,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
HAND 3 VIEWS RT,73130RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
OFFICE/OP VISIT NEW,99202,CPT,516,RC,,OUTPATIENT,,,190,76,BLUE CROSS ANTHEM,COMMERCIAL,,,,152,OTHER,142.5,186.2,PERCENT OF CHARGES BASED ON HCPCS CODE
OFFICE/OP VISIT NEW,99202,CPT,516,RC,,OUTPATIENT,,,190,76,MONUMENT,COMMERCIAL,,,,152,,142.5,186.2,
FINGER 2ND DIGIT LT,73140F1,CPT,320,RC,F1,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99203,CPT,516,RC,,OUTPATIENT,,,277,110.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,221.6,OTHER,207.75,271.46,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, NEW, MOD",99203,CPT,516,RC,,OUTPATIENT,,,277,110.8,MONUMENT,COMMERCIAL,,,,221.6,,207.75,271.46,
FINGER 3RD DIGIT LT,73140F2,CPT,320,RC,F2,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99204,CPT,516,RC,,OUTPATIENT,,,421,168.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,336.8,OTHER,315.75,412.58,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, NEW, MOD",99204,CPT,516,RC,,OUTPATIENT,,,421,168.4,MONUMENT,COMMERCIAL,,,,336.8,,315.75,412.58,
FINGER 4TH DIGIT LT,73140F3,CPT,320,RC,F3,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MIN",99211,CPT,510,RC,,OUTPATIENT,,,51,20.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,40.8,OTHER,38.25,49.98,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, EST, MIN",99211,CPT,510,RC,,OUTPATIENT,,,51,20.4,MONUMENT,COMMERCIAL,,,,40.8,,38.25,49.98,
FINGER 5TH DIGIT LT,73140F4,CPT,320,RC,F4,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT EST, LOW",99212,CPT,510,RC,,OUTPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,89.6,OTHER,84,109.76,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT EST, LOW",99212,CPT,510,RC,,OUTPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.76,
FINGER THUMB RT,73140F5,CPT,320,RC,F5,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST MOD",99213,CPT,510,RC,,OUTPATIENT,,,185,74,BLUE CROSS ANTHEM,COMMERCIAL,,,,148,OTHER,138.75,181.3,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, EST MOD",99213,CPT,510,RC,,OUTPATIENT,,,185,74,MONUMENT,COMMERCIAL,,,,148,,138.75,181.3,
FINGER 2ND DIGIT RT,73140F6,CPT,320,RC,F6,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MOD",99214,CPT,510,RC,,OUTPATIENT,,,274,109.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,219.2,OTHER,205.5,268.52,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, EST, MOD",99214,CPT,510,RC,,OUTPATIENT,,,274,109.6,MONUMENT,COMMERCIAL,,,,219.2,,205.5,268.52,
FINGER 3RD DIGIT RT,73140F7,CPT,320,RC,F7,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, HIGH",99215,CPT,510,RC,,OUTPATIENT,,,371,148.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,296.8,OTHER,278.25,363.58,PERCENT OF CHARGES BASED ON HCPCS CODE
"OFFICE/OP VISIT, EST, HIGH",99215,CPT,510,RC,,OUTPATIENT,,,371,148.4,MONUMENT,COMMERCIAL,,,,296.8,,278.25,363.58,
FINGER 4TH DIGIT RT,73140F8,CPT,320,RC,F8,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
SLEEP STAGING <6 YRS,95782,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3119.6,OTHER,2924.63,3821.51,PERCENT OF CHARGES BASED ON HCPCS CODE
SLEEP STAGING <6 YRS,95782,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,MONUMENT,COMMERCIAL,,,,3119.6,,2924.63,3821.51,
FINGER 5TH DIGIT RT,73140F9,CPT,320,RC,F9,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
"SS, CPAP STAGING <6 YRS",95783,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3439.2,OTHER,3224.25,4213.02,PERCENT OF CHARGES BASED ON HCPCS CODE
"SS, CPAP STAGING <6 YRS",95783,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,MONUMENT,COMMERCIAL,,,,3439.2,,3224.25,4213.02,
FINGER THUMB LT,73140FA,CPT,320,RC,FA,OUTPATIENT,,,233.75,93.5,UNITED HEALTH,UNITED COMMERCIAL,,,,198.6875,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
MULTI SLEEP LATENCY TEST,95805,CPT,740,RC,,OUTPATIENT,,,4094.5,1637.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3275.6,OTHER,3070.88,4012.61,PERCENT OF CHARGES BASED ON HCPCS CODE
MULTI SLEEP LATENCY TEST,95805,CPT,740,RC,,OUTPATIENT,,,4094.5,1637.8,MONUMENT,COMMERCIAL,,,,3275.6,,3070.88,4012.61,
CT UPPER EXTREMITY W/O LT,73200LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
SLEEP STUDY UNATTENDED,95806,CPT,740,RC,,OUTPATIENT,,,278.15,111.26,BLUE CROSS ANTHEM,COMMERCIAL,,,,222.52,OTHER,206.25,269.5,PERCENT OF CHARGES BASED ON HCPCS CODE
SLEEP STUDY UNATTENDED,95806,CPT,740,RC,,OUTPATIENT,,,278.15,111.26,MONUMENT,COMMERCIAL,,,,220,,206.25,269.5,
CT UPPER EXTREMITY W/O CONT RT,73200RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POLYSOMNOGRAM STAGING,95810,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3119.6,OTHER,2924.63,3821.51,PERCENT OF CHARGES BASED ON HCPCS CODE
POLYSOMNOGRAM STAGING,95810,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,MONUMENT,COMMERCIAL,,,,3119.6,,2924.63,3821.51,
CT UPPER EXTREMITY W/O RT,73200RTQQ,CPT,350,RC,RTQQ,OUTPATIENT,,,1934.25,773.7,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1450.69,1895.57,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POLYSOMNOGRAM CPAP-STAGING,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3439.2,OTHER,3224.25,4213.02,PERCENT OF CHARGES BASED ON HCPCS CODE
POLYSOMNOGRAM CPAP-STAGING,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,MONUMENT,COMMERCIAL,,,,3439.2,,3224.25,4213.02,
CT UPPER EXTREMITY W/CONT LT,73201LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
POLYSOMNOGRAM W/CPAP,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,3439.2,OTHER,3224.25,4213.02,PERCENT OF CHARGES BASED ON HCPCS CODE
POLYSOMNOGRAM W/CPAP,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,MONUMENT,COMMERCIAL,,,,3439.2,,3224.25,4213.02,
CT UPPER EXTREMITY W/CONT LT,73201LTQQ,CPT,350,RC,LTQQ,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
ELECTROENCEPHALOGRAM,95816,CPT,740,RC,,OUTPATIENT,,,1063,425.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,850.4,OTHER,797.25,1041.74,PERCENT OF CHARGES BASED ON HCPCS CODE
ELECTROENCEPHALOGRAM,95816,CPT,740,RC,,OUTPATIENT,,,1063,425.2,MONUMENT,COMMERCIAL,,,,850.4,,797.25,1041.74,
CT UPPER EXTREMITY W/CONT RT,73201QQ,CPT,350,RC,QQ,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
EEG ALL NIGHT RECORDING,95827,CPT,740,RC,,OUTPATIENT,,,3742.25,1496.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2993.8,OTHER,2806.69,3667.41,PERCENT OF CHARGES BASED ON HCPCS CODE
EEG ALL NIGHT RECORDING,95827,CPT,740,RC,,OUTPATIENT,,,3742.25,1496.9,MONUMENT,COMMERCIAL,,,,2993.8,,2806.69,3667.41,
CT UPPER EXTREMITY W/WO LT,73202LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1030.5,1346.52,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2686.4,OTHER,2518.5,3290.84,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,MONUMENT,COMMERCIAL,,,,2686.4,,2518.5,3290.84,
UPPER EXTREMITY W/WO RT,73202RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,UNITED HEALTH,UNITED COMMERCIAL,,,,1167.9,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST LT W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,BLUE CROSS ANTHEM,COMMERCIAL,,,,2627.63,OTHER,2165.63,2829.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRI BREAST LT W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,MONUMENT,COMMERCIAL,,,,2310,,2165.63,2829.75,
MRI BREAST LT W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,UNITED HEALTH,UNITED COMMERCIAL,,,,2165.63,,2165.63,2829.75,
MRI BREAST RT  W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,BLUE CROSS ANTHEM,COMMERCIAL,,,,2627.63,OTHER,2165.63,2829.75,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRI BREAST RT  W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,MONUMENT,COMMERCIAL,,,,2310,,2165.63,2829.75,
MRI BREAST RT  W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,UNITED HEALTH,UNITED COMMERCIAL,,,,2165.63,,2165.63,2829.75,
MRI BREAST BILATERAL W/WO,C8908,HCPCS,610,RC,,BOTH,,,4059.25,1623.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,3693.92,OTHER,3044.44,3978.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRI BREAST BILATERAL W/WO,C8908,HCPCS,610,RC,,BOTH,,,4059.25,1623.7,MONUMENT,COMMERCIAL,,,,3247.4,,3044.44,3978.07,
MRI BREAST BILATERAL W/WO,C8908,HCPCS,610,RC,,BOTH,,,4059.25,1623.7,UNITED HEALTH,UNITED COMMERCIAL,,,,3044.44,,3044.44,3978.07,
MRI BREAST BILAT W/O CONTRAST,77047,CPT,610,RC,,OUTPATIENT,,,3180,1272,BLUE CROSS ANTHEM,COMMERCIAL,,,,2544,OTHER,2385,3116.4,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI BREAST BILAT W/O CONTRAST,77047,CPT,610,RC,,OUTPATIENT,,,3180,1272,MONUMENT,COMMERCIAL,,,,2544,,2385,3116.4,
UPPER EXT ANGIO LEFT,73206LT,CPT,350,RC,LT,OUTPATIENT,,,2069.75,827.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1759.2875,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB W/WO BILATERAL,7371850,CPT,610,RC,50,OUTPATIENT,,,3675,1470,BLUE CROSS ANTHEM,COMMERCIAL,,,,2940,OTHER,2756.25,3601.5,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB/FIB W/WO BILATERAL,7371850,CPT,610,RC,50,OUTPATIENT,,,3675,1470,MONUMENT,COMMERCIAL,,,,2940,,2756.25,3601.5,
UPPER EXT ANGIO RIGHT,73206RT,CPT,350,RC,RT,OUTPATIENT,,,2069.75,827.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1759.2875,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI FOREARM WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRACHIAL PLEXUS W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI HAND WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRACHIAL PLEXUS W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI HUMERUS WO/CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRACHIAL PLEXUS W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI UPEXT NON JT W/O CONT LT,73218LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
MRI UPEXT NON JT W/O CONT RT,73218QQ,CPT,610,RC,QQ,OUTPATIENT,,,2752.5,1101,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2064.38,2697.45,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
MRI FOREARM W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR BILATERAL W/WO,7372050,CPT,610,RC,50,OUTPATIENT,,,4811.25,1924.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,3849,OTHER,3608.44,4715.03,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR BILATERAL W/WO,7372050,CPT,610,RC,50,OUTPATIENT,,,4811.25,1924.5,MONUMENT,COMMERCIAL,,,,3849,,3608.44,4715.03,
MRI HAND W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FEMUR BILATERAL W/O,7371850,CPT,610,RC,50,OUTPATIENT,,,3526,1410.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2820.8,OTHER,2644.5,3455.48,PERCENT OF CHARGES BASED ON HCPCS CODE
FEMUR BILATERAL W/O,7371850,CPT,610,RC,50,OUTPATIENT,,,3526,1410.4,MONUMENT,COMMERCIAL,,,,2820.8,,2644.5,3455.48,
MRI HUMERUS W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
TIB/FIB BILATERAL W/O,7372050,CPT,610,RC,50,OUTPATIENT,,,3400,1360,BLUE CROSS ANTHEM,COMMERCIAL,,,,2720,OTHER,2550,3332,PERCENT OF CHARGES BASED ON HCPCS CODE
TIB/FIB BILATERAL W/O,7372050,CPT,610,RC,50,OUTPATIENT,,,3400,1360,MONUMENT,COMMERCIAL,,,,2720,,2550,3332,
MRI UPEXT NON JT W/CONT LT,73219LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CHEST W/O CONTRAST,71550,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2686.4,OTHER,2518.5,3290.84,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CHEST W/O CONTRAST,71550,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,MONUMENT,COMMERCIAL,,,,2686.4,,2518.5,3290.84,
MRI UPEXT NON JT W/CONT RT,73219QQ,CPT,610,RC,QQ,OUTPATIENT,,,3140,1256,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2355,3077.2,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CERVICAL SPINE W/WO CONTRT,72156,CPT,610,RC,,OUTPATIENT,,,3765.75,1506.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3012.6,OTHER,2824.31,3690.44,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CERVICAL SPINE W/WO CONTRT,72156,CPT,610,RC,,OUTPATIENT,,,3765.75,1506.3,MONUMENT,COMMERCIAL,,,,3012.6,,2824.31,3690.44,
MRI FOREARM W/WO LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CERVICAL SPINE W/CONTRAST,72142,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CERVICAL SPINE W/CONTRAST,72142,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
MRI HAND W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CERVICAL SPINE W/O CONTRST,72141,CPT,610,RC,,OUTPATIENT,,,2808.25,1123.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2246.6,OTHER,2106.19,2752.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CERVICAL SPINE W/O CONTRST,72141,CPT,610,RC,,OUTPATIENT,,,2808.25,1123.3,MONUMENT,COMMERCIAL,,,,2246.6,,2106.19,2752.09,
MRI HUMERUS W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FACE NECK ORBIT W CONTRAST,70542,CPT,610,RC,,OUTPATIENT,,,3577.75,1431.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,2862.2,OTHER,2683.31,3506.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FACE NECK ORBIT W CONTRAST,70542,CPT,610,RC,,OUTPATIENT,,,3577.75,1431.1,MONUMENT,COMMERCIAL,,,,2862.2,,2683.31,3506.2,
MRI UPEXT NON JT W/WO CONT LT,73220LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MR GUIDANCE FOR NEEDLE PLACE,77021,CPT,610,RC,,OUTPATIENT,,,2378.75,951.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1903,OTHER,1784.06,2331.18,PERCENT OF CHARGES BASED ON HCPCS CODE
MR GUIDANCE FOR NEEDLE PLACE,77021,CPT,610,RC,,OUTPATIENT,,,2378.75,951.5,MONUMENT,COMMERCIAL,,,,1903,,1784.06,2331.18,
MRI UPEXT NON JT W/WO CONT RT,73220QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FACE/NECK/OR WO CONTRAST,70540,CPT,610,RC,,OUTPATIENT,,,3169.5,1267.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2535.6,OTHER,2377.13,3106.11,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FACE/NECK/OR WO CONTRAST,70540,CPT,610,RC,,OUTPATIENT,,,3169.5,1267.8,MONUMENT,COMMERCIAL,,,,2535.6,,2377.13,3106.11,
MRI WRIST WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FOOT W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
MRI ELBOW WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FOOT W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
MRI SHOULDER WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FOOT WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI UPEXT JT W/O CONT LT,73221LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2800,1120,BLUE CROSS ANTHEM,COMMERCIAL,,,,2240,OTHER,2100,2744,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2800,1120,MONUMENT,COMMERCIAL,,,,2240,,2100,2744,
MRI UPEXT JT W/O CONT RT,73221QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364,945.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773,2316.72,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,2800,1120,BLUE CROSS ANTHEM,COMMERCIAL,,,,2240,OTHER,2100,2744,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,2800,1120,MONUMENT,COMMERCIAL,,,,2240,,2100,2744,
MRI ELBOW W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI SHOULDER W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
MRI WRIST W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FEMUR W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
MRI UPEXT JT W/CONT LT,73222LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FEMUR WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI UPEXT JT W/CONT RT,73222QQ,CPT,610,RC,QQ,OUTPATIENT,,,2720.5,1088.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2040.38,2666.09,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI ANKLE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
MRI ELBOW W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI ANKLE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI SHOULDER W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI ANKLE W/O CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/O CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
MRI WRIST W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
MRI UPEXT JT W/WO CONT LT,73223LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI UPEXT JT W/WO CONT RT,73223QQ,CPT,610,RC,QQ,OUTPATIENT,,,3382,1352.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2536.5,3314.36,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/O CONT RT,73721RT,CPT,610,RC,RT,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/O CONT RT,73721RT,CPT,610,RC,RT,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
HIP 1 VIEW LEFT,73501LT,CPT,320,RC,LT,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,,127.5,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/CONT RT,73722,CPT,610,RC,,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP W/CONT RT,73722,CPT,610,RC,,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
HIP 1 VIEW RIGHT,73501RT,CPT,320,RC,RT,OUTPATIENT,,,150,60,UNITED HEALTH,UNITED COMMERCIAL,,,,127.5,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
OR HIP LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,639.5,255.8,UNITED HEALTH,UNITED COMMERCIAL,,,,543.575,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP WO CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
HIP 2 VIEW LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,UNITED HEALTH,UNITED COMMERCIAL,,,,265.625,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
HIP 2 VIEW RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,UNITED HEALTH,UNITED COMMERCIAL,,,,265.625,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
OR HIP RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,639.5,255.8,UNITED HEALTH,UNITED COMMERCIAL,,,,543.575,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
HIP ARTHROGRAM LT,73525LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
HIP ARTHROGRAM RT,73525RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
FEMUR 2 VIEWS LT,73552LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,,212.5,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS WO/CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS WO/CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
FEMUR 2 VIEWS RT,73552RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,,212.5,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
KNEE 2 VIEWS LT,73560LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
KNEE 2 VIEWS RT,73560RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
KNEE 3 VIEWS LT,73562LT,CPT,320,RC,LT,OUTPATIENT,,,375,150,UNITED HEALTH,UNITED COMMERCIAL,,,,318.75,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
KNEE 3 VIEWS RT,73562RT,CPT,320,RC,RT,OUTPATIENT,,,375,150,UNITED HEALTH,UNITED COMMERCIAL,,,,318.75,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
KNEE 4 VIEWS LT,73564LT,CPT,320,RC,LT,OUTPATIENT,,,440.75,176.3,UNITED HEALTH,UNITED COMMERCIAL,,,,374.6375,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
KNEE 4 VIEWS RT,73564RT,CPT,320,RC,RT,OUTPATIENT,,,440.75,176.3,UNITED HEALTH,UNITED COMMERCIAL,,,,374.6375,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
KNEE ARTHROGRAPHY LT,73580LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST BILATERAL W/WO,7322350,CPT,610,RC,50,OUTPATIENT,,,5700,2280,BLUE CROSS ANTHEM,COMMERCIAL,,,,4560,OTHER,4275,5586,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST BILATERAL W/WO,7322350,CPT,610,RC,50,OUTPATIENT,,,5700,2280,MONUMENT,COMMERCIAL,,,,4560,,4275,5586,
KNEE ARTHROGRAPHY RT,73580RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
TIB/FIB LT,73590LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,,212.5,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
TIB/FIB RT,73590RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,UNITED HEALTH,UNITED COMMERCIAL,,,,212.5,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
ANKLE 2 VIEWS LT,73600LT,CPT,320,RC,LT,OUTPATIENT,,,218,87.2,UNITED HEALTH,UNITED COMMERCIAL,,,,185.3,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
ANKLE 2 VIEWS RT,73600RT,CPT,320,RC,RT,OUTPATIENT,,,218,87.2,UNITED HEALTH,UNITED COMMERCIAL,,,,185.3,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
MRI HAND WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
ANKLE 3 VIEWS LT,73610LT,CPT,320,RC,LT,OUTPATIENT,,,320.25,128.1,UNITED HEALTH,UNITED COMMERCIAL,,,,272.2125,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
ANKLE 3 VIEWS RT,73610RT,CPT,320,RC,RT,OUTPATIENT,,,320.25,128.1,UNITED HEALTH,UNITED COMMERCIAL,,,,272.2125,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
HAND W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6504.75,2601.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,5203.8,OTHER,4878.56,6374.66,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6504.75,2601.9,MONUMENT,COMMERCIAL,,,,5203.8,,4878.56,6374.66,
ANKLE ARTHROGRAM LT,73615LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
HAND W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,5402.25,2160.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,4321.8,OTHER,4051.69,5294.21,PERCENT OF CHARGES BASED ON HCPCS CODE
HAND W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,5402.25,2160.9,MONUMENT,COMMERCIAL,,,,4321.8,,4051.69,5294.21,
ANKLE ARTHROGRAM RT,73615RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UNITED HEALTH,UNITED COMMERCIAL,,,,623.662,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/WO CONTRAST,70553,CPT,610,RC,,OUTPATIENT,,,3674.75,1469.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2939.8,OTHER,2756.06,3601.26,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HEAD W/WO CONTRAST,70553,CPT,610,RC,,OUTPATIENT,,,3674.75,1469.9,MONUMENT,COMMERCIAL,,,,2939.8,,2756.06,3601.26,
FOOT 2 VIEWS LT,73620LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,UNITED HEALTH,UNITED COMMERCIAL,,,,181.6875,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW,77084,CPT,610,RC,,OUTPATIENT,,,2587.5,1035,BLUE CROSS ANTHEM,COMMERCIAL,,,,2070,OTHER,1940.63,2535.75,PERCENT OF CHARGES BASED ON HCPCS CODE
BONE MARROW,77084,CPT,610,RC,,OUTPATIENT,,,2587.5,1035,MONUMENT,COMMERCIAL,,,,2070,,1940.63,2535.75,
FOOT 2 VIEWS RT,73620RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,UNITED HEALTH,UNITED COMMERCIAL,,,,181.6875,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,3071.75,1228.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2457.4,OTHER,2303.81,3010.32,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HEAD W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,3071.75,1228.7,MONUMENT,COMMERCIAL,,,,2457.4,,2303.81,3010.32,
FOOT 3 VIEWS LT,73630LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/O CONTRAST,70551,CPT,610,RC,,OUTPATIENT,,,2888.5,1155.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2310.8,OTHER,2166.38,2830.73,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HEAD W/O CONTRAST,70551,CPT,610,RC,,OUTPATIENT,,,2888.5,1155.4,MONUMENT,COMMERCIAL,,,,2310.8,,2166.38,2830.73,
FOOT 3 VIEWS RT,73630RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
HEEL CALCANEOUS LT,73650LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
HEEL CALCANEOUS RT,73650RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UNITED HEALTH,UNITED COMMERCIAL,,,,287.0875,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ANKLE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
TOE 2ND DIGIT LT,73660T1,CPT,320,RC,T1,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
TOE 3RD DIGIT LT,73660T2,CPT,320,RC,T2,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
TOE 4TH DIGIT LT,73660T3,CPT,320,RC,T3,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ELBOW W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
TOE 5TH DIGIT LT,73660T4,CPT,320,RC,T4,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
TOE GREAT RT,73660T5,CPT,320,RC,T5,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
TOE 2ND DIGIT RT,73660T6,CPT,320,RC,T6,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
TOE 3RD DIGIT RT,73660T7,CPT,320,RC,T7,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
TOE 4TH DIGIT RT,73660T8,CPT,320,RC,T8,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOREARM W/WO LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
TOE 5TH DIGIT RT,73660T9,CPT,320,RC,T9,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
TOE GREAT LT,73660TA,CPT,320,RC,TA,OUTPATIENT,,,245.5,98.2,UNITED HEALTH,UNITED COMMERCIAL,,,,208.675,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
CT LOWER EXT W/O CONT RT,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1190.81,1556,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FOOT WO CONT BI,7371850,CPT,610,RC,50,OUTPATIENT,,,5046,2018.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,4036.8,OTHER,3784.5,4945.08,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT WO CONT BI,7371850,CPT,610,RC,50,OUTPATIENT,,,5046,2018.4,MONUMENT,COMMERCIAL,,,,4036.8,,3784.5,4945.08,
CT PELVIS/HIP FRACTURE,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1190.81,1556,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FOOT W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FOOT W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1827.94,2388.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
FOOT W/WO CONT BI,7372050,CPT,610,RC,50,OUTPATIENT,,,6848.75,2739.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5479,OTHER,5136.56,6711.78,PERCENT OF CHARGES BASED ON HCPCS CODE
FOOT W/WO CONT BI,7372050,CPT,610,RC,50,OUTPATIENT,,,6848.75,2739.5,MONUMENT,COMMERCIAL,,,,5479,,5136.56,6711.78,
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1827.94,2388.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI FEMUR W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FEMUR W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
CT LOWER EXTREMITY W/CONT RT,73701QQ,CPT,350,RC,QQ,OUTPATIENT,,,2437.25,974.9,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1827.94,2388.51,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HAND W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
MRI FEMUR WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HAND WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI FOOT WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HAND W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HAND W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI TIB/FIB WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HIP W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
MRI LOEXT NON JT W/O CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HIP WO CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP WO CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
MRI LOEXT NON JT W/WO CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HIP W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HIP W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI LOEXT NON JT W/O CONT LT,73718RTQQ,CPT,610,RC,RTQQ,OUTPATIENT,,,2523,1009.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1892.25,2472.54,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HUMERUS W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
MRI FOOT W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HUMERUS WO/CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS WO/CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI TIB/FIB W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2100,2744,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI HUMERUS W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI HUMERUS W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI LOEXT NON JT W/CONT LT,73719LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
MRI LOEXT NON JT W/CONT RT,73719QQ,CPT,610,RC,QQ,OUTPATIENT,,,2837.5,1135,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2128.13,2780.75,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
MRI FOOT W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI KNEE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI KNEE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI FEMUR W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT JT W/CONTRAST,73722QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364.5,945.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.6,OTHER,1773.38,2317.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT JT W/CONTRAST,73722QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364.5,945.8,MONUMENT,COMMERCIAL,,,,1891.6,,1773.38,2317.21,
MRI TIB/FIB W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2100,2744,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT JT W/WO CONT LT,73723LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT JT W/WO CONT LT,73723LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MRI LOEXT NON JT W/WO CONT LT,73720LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3424.5,1369.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2568.38,3356.01,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT NON JT W/O CONT LT,73718RTQQ,CPT,610,RC,RTQQ,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/O CONT LT,73718RTQQ,CPT,610,RC,RTQQ,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI ANKLE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT NON JT W/CONT LT,73719LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/CONT LT,73719LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
MRI HIP WO CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT NON JT W/O CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/O CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI KNEE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT NON JT W/WO CONT LT,73720LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/WO CONT LT,73720LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
MRI HIP WO,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT JT W/O CONTRAST,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1723.6,OTHER,1615.88,2111.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT JT W/O CONTRAST,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,MONUMENT,COMMERCIAL,,,,1723.6,,1615.88,2111.41,
MRI LOEXT JT W/O CONTRAST,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO LOEXT W/CONT LT,C8912LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/CONT LT,C8912LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/CONT LT,C8912LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
MRA ANGIO LOEXT W/O CONT LT,C8913LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/O CONT LT,C8913LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/O CONT LT,C8913LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
MRA ANGIO LOEXT W/WO CONT LT,C8914LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/WO CONT LT,C8914LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/WO CONT LT,C8914LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
MRI SHOULDER W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
MRI KNEE W/O CONT RT,73721RT,CPT,610,RC,RT,OUTPATIENT,,,2154.5,861.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1615.88,2111.41,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SHOULDER WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
MRI ANKLE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SHOULDER W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SHOULDER W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
MRI HIP W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,BLUE CROSS ANTHEM,COMMERCIAL,,,,2240,OTHER,2100,2744,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,MONUMENT,COMMERCIAL,,,,2240,,2100,2744,
MRI KNEE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2018.4,OTHER,1892.25,2472.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,MONUMENT,COMMERCIAL,,,,2018.4,,1892.25,2472.54,
MRI LOEXT JT W/CONTRAST,73722QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI TIB/FIB W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,BLUE CROSS ANTHEM,COMMERCIAL,,,,2240,OTHER,2100,2744,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TIB/FIB W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,MONUMENT,COMMERCIAL,,,,2240,,2100,2744,
MRI ANKLE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI WHOLE BODY LIM 1-4 AREAS,76498,CPT,610,RC,,OUTPATIENT,,,3496,1398.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2796.8,OTHER,2622,3426.1,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WHOLE BODY LIM 1-4 AREAS,76498,CPT,610,RC,,OUTPATIENT,,,3496,1398.4,MONUMENT,COMMERCIAL,,,,2796.8,,2622,3426.1,
MRI KNEE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,1773.38,2317.21,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LUMBAR SPINE W/WO CONTRAST,72158,CPT,610,RC,,OUTPATIENT,,,3560.75,1424.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2848.6,OTHER,2670.56,3489.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LUMBAR SPINE W/WO CONTRAST,72158,CPT,610,RC,,OUTPATIENT,,,3560.75,1424.3,MONUMENT,COMMERCIAL,,,,2848.6,,2670.56,3489.54,
MRI ANKLE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO UPEXT W/CONT LT,C8934LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/CONT LT,C8934LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/CONT LT,C8934LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRA ANGIO UPEXT W/O CONT LT,C8935LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/O CONT LT,C8935LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/O CONT LT,C8935LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRA ANGIO UPEXT W/WO CONT LT,C8936LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/WO CONT LT,C8936LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/WO CONT LT,C8936LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRI WRIST W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
MRI HIP W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LUMBAR SPINE W/CONTRAST,72149,CPT,610,RC,,OUTPATIENT,,,3350.75,1340.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.6,OTHER,2513.06,3283.74,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LUMBAR SPINE W/CONTRAST,72149,CPT,610,RC,,OUTPATIENT,,,3350.75,1340.3,MONUMENT,COMMERCIAL,,,,2680.6,,2513.06,3283.74,
MRI KNEE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI WRIST W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI WRIST W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
MRI LOEXT JT W/WO CONT LT,73723LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LUMBAR SPINE W/O CONTRAST,72148,CPT,610,RC,,OUTPATIENT,,,2931.5,1172.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2345.2,OTHER,2198.63,2872.87,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LUMBAR SPINE W/O CONTRAST,72148,CPT,610,RC,,OUTPATIENT,,,2931.5,1172.6,MONUMENT,COMMERCIAL,,,,2345.2,,2198.63,2872.87,
MRI LOEXT JT W/WO CONT RT,73723QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO HEAD W/O CONTRAST,70544,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2313.8,OTHER,2169.19,2834.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO HEAD W/O CONTRAST,70544,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,MONUMENT,COMMERCIAL,,,,2313.8,,2169.19,2834.41,
MRI ANKLE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO LOEXT W/CONT RT,C8912,HCPCS,610,RC,,BOTH,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/CONT RT,C8912,HCPCS,610,RC,,BOTH,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/CONT RT,C8912,HCPCS,610,RC,,BOTH,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
MRI SCAPULA W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI KNEE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SCAPULA W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
MRI HIP W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1750,OTHER,2512.88,3283.49,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SCAPULA W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
CT ABD ANGIO (CTAA),74175QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1512.38,1976.17,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SCAPULA W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
CT ABD & PELVIS W/O CONTRAST,74176QQ,CPT,350,RC,QQ,OUTPATIENT,,,3079.5,1231.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2309.63,3017.91,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SCAPULA W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
CT ABD & PELVIS W/WO CONTRAST,74178QQ,CPT,350,RC,QQ,OUTPATIENT,,,4262.75,1705.1,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,3197.06,4177.5,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI SCAPULA W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI SCAPULA W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1123.5,1468.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MR ANGIO PELVIS W/O & W/DYE,72198,CPT,610,RC,,OUTPATIENT,,,2625,1050,BLUE CROSS ANTHEM,COMMERCIAL,,,,2100,OTHER,1968.75,2572.5,PERCENT OF CHARGES BASED ON HCPCS CODE
MR ANGIO PELVIS W/O & W/DYE,72198,CPT,610,RC,,OUTPATIENT,,,2625,1050,MONUMENT,COMMERCIAL,,,,2100,,1968.75,2572.5,
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,1123.5,1468.04,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANG LWR EXT W OR W/O DYE,73725,CPT,610,RC,,OUTPATIENT,,,1837.5,735,BLUE CROSS ANTHEM,COMMERCIAL,,,,1470,OTHER,1378.13,1800.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANG LWR EXT W OR W/O DYE,73725,CPT,610,RC,,OUTPATIENT,,,1837.5,735,MONUMENT,COMMERCIAL,,,,1470,,1378.13,1800.75,
CT ABD/PELVIS ANGIO W/RUNOFF,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2626.13,3431.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO ABDOMEN W/WO CONTRST,C8902,HCPCS,610,RC,,INPATIENT,,,2312,924.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2103.92,OTHER,1734,2265.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO ABDOMEN W/WO CONTRST,C8902,HCPCS,610,RC,,INPATIENT,,,2312,924.8,MONUMENT,COMMERCIAL,,,,1849.6,,1734,2265.76,
MRA ANGIO ABDOMEN W/WO CONTRST,C8902,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1734,,1734,2265.76,
MRA ANGIO NECK W/O CONTRAST,70547,CPT,610,RC,,OUTPATIENT,,,2223,889.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1778.4,OTHER,1667.25,2178.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO NECK W/O CONTRAST,70547,CPT,610,RC,,OUTPATIENT,,,2223,889.2,MONUMENT,COMMERCIAL,,,,1778.4,,1667.25,2178.54,
CT EXTREMITY ANGIO,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,2626.13,3431.47,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRA ANGIO NECK W/CONTRAST,70548,CPT,610,RC,,OUTPATIENT,,,2434.25,973.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1947.4,OTHER,1825.69,2385.57,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO NECK W/CONTRAST,70548,CPT,610,RC,,OUTPATIENT,,,2434.25,973.7,MONUMENT,COMMERCIAL,,,,1947.4,,1825.69,2385.57,
VENOGRAM UNILATERAL LT,75820LT,CPT,320,RC,LT,OUTPATIENT,,,2802.66,1121.064,UNITED HEALTH,UNITED COMMERCIAL,,,,2382.261,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/WO CONTRAST,70549,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2313.8,OTHER,2169.19,2834.41,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO NECK W/WO CONTRAST,70549,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,MONUMENT,COMMERCIAL,,,,2313.8,,2169.19,2834.41,
VENOGRAM UNILATERAL RT,75820RT,CPT,320,RC,RT,OUTPATIENT,,,2802.66,1121.064,UNITED HEALTH,UNITED COMMERCIAL,,,,2382.261,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3085.8,OTHER,2892.94,3780.11,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,MONUMENT,COMMERCIAL,,,,3085.8,,2892.94,3780.11,
DEXA HIP (R),76075RT,CPT,320,RC,RT,OUTPATIENT,,,62.75,25.1,UNITED HEALTH,UNITED COMMERCIAL,,,,53.3375,OTHER,47.06,61.5,PERCENT OF TOTAL BILLED CHARGES
MRI TMJ W/O CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2693.4,OTHER,2525.06,3299.42,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TMJ W/O CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,MONUMENT,COMMERCIAL,,,,2693.4,,2525.06,3299.42,
CT SINUS  W/O LIMITED,76380QQ,CPT,350,RC,QQ,OUTPATIENT,,,776.5,310.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,1500,OTHER,582.38,760.97,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI THORACIC SPINE W/WO CONTRT,72157,CPT,610,RC,,OUTPATIENT,,,3352.25,1340.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2681.8,OTHER,2514.19,3285.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI THORACIC SPINE W/WO CONTRT,72157,CPT,610,RC,,OUTPATIENT,,,3352.25,1340.9,MONUMENT,COMMERCIAL,,,,2681.8,,2514.19,3285.21,
BREAST COMPLETE LT,76641LT,CPT,402,RC,LT,OUTPATIENT,,,293.5,117.4,UNITED HEALTH,UNITED COMMERCIAL,,,,249.475,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/CONTRAST,72147,CPT,610,RC,,OUTPATIENT,,,3108,1243.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2486.4,OTHER,2331,3045.84,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI THORACIC SPINE W/CONTRAST,72147,CPT,610,RC,,OUTPATIENT,,,3108,1243.2,MONUMENT,COMMERCIAL,,,,2486.4,,2331,3045.84,
BREAST COMPLETE RT,76641RT,CPT,402,RC,RT,OUTPATIENT,,,293.5,117.4,UNITED HEALTH,UNITED COMMERCIAL,,,,249.475,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/O CONTRST,72146,CPT,610,RC,,OUTPATIENT,,,2931,1172.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,2344.8,OTHER,2198.25,2872.38,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI THORACIC SPINE W/O CONTRST,72146,CPT,610,RC,,OUTPATIENT,,,2931,1172.4,MONUMENT,COMMERCIAL,,,,2344.8,,2198.25,2872.38,
BREAST LIMITED LT,76642LT,CPT,402,RC,LT,OUTPATIENT,,,196.25,78.5,UNITED HEALTH,UNITED COMMERCIAL,,,,166.8125,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT RT,73222QQ,CPT,610,RC,QQ,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/CONT RT,73222QQ,CPT,610,RC,QQ,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
BREAST LIMITED RT,76642RT,CPT,402,RC,RT,OUTPATIENT,,,196.25,78.5,UNITED HEALTH,UNITED COMMERCIAL,,,,166.8125,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT LT,73222LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2720.5,1088.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2176.4,OTHER,2040.38,2666.09,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/CONT LT,73222LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2720.5,1088.2,MONUMENT,COMMERCIAL,,,,2176.4,,2040.38,2666.09,
STEREOTACTIC NDLE LOC (LT) 3RD,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT RT,73221QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/O CONT RT,73221QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
STEREOTACTIC NDLE LOC LT,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT LT,73221LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2364,945.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,1891.2,OTHER,1773,2316.72,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/O CONT LT,73221LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2364,945.6,MONUMENT,COMMERCIAL,,,,1891.2,,1773,2316.72,
STEREOTACTIC NDLE LOC (LT) 2ND,77031LT59,CPT,320,RC,LT59,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/CONTRAST,70545,CPT,610,RC,,OUTPATIENT,,,3099,1239.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,2479.2,OTHER,2324.25,3037.02,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO HEAD W/CONTRAST,70545,CPT,610,RC,,OUTPATIENT,,,3099,1239.6,MONUMENT,COMMERCIAL,,,,2479.2,,2324.25,3037.02,
STEREOTACTIC NDLE LOC RT,77031RT,CPT,320,RC,RT,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/WO CONTRAST,70546,CPT,610,RC,,OUTPATIENT,,,3173,1269.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2538.4,OTHER,2379.75,3109.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO HEAD W/WO CONTRAST,70546,CPT,610,RC,,OUTPATIENT,,,3173,1269.2,MONUMENT,COMMERCIAL,,,,2538.4,,2379.75,3109.54,
STEREOTACTIC NDLE LOC RT 2ND,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/CONTRAST,71551,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3016.2,OTHER,2827.69,3694.85,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CHEST W/CONTRAST,71551,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,MONUMENT,COMMERCIAL,,,,3016.2,,2827.69,3694.85,
STEREOTACTIC NDLE LOC RT 3RD,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1473.6875,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/WO CONTRAST,71552,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3176.6,OTHER,2978.06,3891.34,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CHEST W/WO CONTRAST,71552,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,MONUMENT,COMMERCIAL,,,,3176.6,,2978.06,3891.34,
MAMM DUCTOGRAM SGL LT,77053LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,564.94,738.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI LOEXT JT W/WO CONT RT,73723QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT JT W/WO CONT RT,73723QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
MAMM DUCTOGRAM SGL RT,77053RT,CPT,320,RC,RT,OUTPATIENT,,,753.25,301.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,564.94,738.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,BLUE CROSS ANTHEM,COMMERCIAL,,,,2784,OTHER,2610,3410.4,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,MONUMENT,COMMERCIAL,,,,2784,,2610,3410.4,
MAMM DUCTOGRAM MULT LT,77054LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,564.94,738.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3928.2,OTHER,3682.69,4812.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,MONUMENT,COMMERCIAL,,,,3928.2,,3682.69,4812.05,
MAMM DUCTOGRAM MULT RT,77054RT,CPT,401,RC,RT,OUTPATIENT,,,753.25,301.3,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,564.94,738.19,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI UPEXT NON JT W/O CONT RT,73218QQ,CPT,610,RC,QQ,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/O CONT RT,73218QQ,CPT,610,RC,QQ,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
DIGITAL MAMM UNILAT LT DIAG,77065LT,CPT,401,RC,LT,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI UPEXT NON JT W/O CONT LT,73218LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/O CONT LT,73218LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
DIGITAL MAMM UNILAT RT DIAG,77065RT,CPT,401,RC,RT,OUTPATIENT,,,193,77.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,141,OTHER,144.75,189.14,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI UPEXT NON JT W/CONT RT,73219QQ,CPT,610,RC,QQ,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/CONT RT,73219QQ,CPT,610,RC,QQ,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
DIGITAL MAM UNI LT SCREEN,77067LT52,CPT,403,RC,LT52,OUTPATIENT,,,202.2,80.88,UNITED HEALTH,UNITED COMMERCIAL,,,,171.87,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/CONT LT,73219LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/CONT LT,73219LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
DIGITAL MAM UNI RT SCREEN,77067RT52,CPT,403,RC,RT52,OUTPATIENT,,,202.2,80.88,UNITED HEALTH,UNITED COMMERCIAL,,,,171.87,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT RT,73220QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/WO CONT RT,73220QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
DEXA HIPS/PELVIS/SPINE,77080XU,CPT,320,RC,XU,OUTPATIENT,,,428,171.2,UNITED HEALTH,UNITED COMMERCIAL,,,,363.8,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT LT,73220LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT NON JT W/WO CONT LT,73220LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
PET SCAN LIMITED INITIAL,78814PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT RT,73223QQ,CPT,610,RC,QQ,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/WO CONT RT,73223QQ,CPT,610,RC,QQ,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
PET SCAN LIMITED SUBSEQUENT,78814PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT LT,73223LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3382,1352.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2705.6,OTHER,2536.5,3314.36,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI UPEXT JT W/WO CONT LT,73223LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3382,1352.8,MONUMENT,COMMERCIAL,,,,2705.6,,2536.5,3314.36,
PET SCAN SKULL TO THIGH INITAL,78815PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/CONTRAST,74182,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3016.2,OTHER,2827.69,3694.85,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ABDOMEN W/CONTRAST,74182,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,MONUMENT,COMMERCIAL,,,,3016.2,,2827.69,3694.85,
PET SCAN SKULL-THIGH SUBSEQUET,78815PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/WO CONTRAST,74183,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,3176.6,OTHER,2978.06,3891.34,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ABDOMEN W/WO CONTRAST,74183,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,MONUMENT,COMMERCIAL,,,,3176.6,,2978.06,3891.34,
PET SCAN WHOLE BODY INITIAL,78816PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19085RT,CPT,610,RC,RT,OUTPATIENT,,,3207.25,1282.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2565.8,OTHER,2405.44,3143.11,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION RT,19085RT,CPT,610,RC,RT,OUTPATIENT,,,3207.25,1282.9,MONUMENT,COMMERCIAL,,,,2565.8,,2405.44,3143.11,
PET SCAN WHOLE BODY SUBSEQUENT,78816PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UNITED HEALTH,UNITED COMMERCIAL,,,,7107.7,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19085LT,CPT,610,RC,LT,OUTPATIENT,,,3207.25,1282.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2565.8,OTHER,2405.44,3143.11,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION LT,19085LT,CPT,610,RC,LT,OUTPATIENT,,,3207.25,1282.9,MONUMENT,COMMERCIAL,,,,2565.8,,2405.44,3143.11,
Z ALLERGEN GRASS PANEL I,86003 91,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,27.38,35.77,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION RT,19086RT,CPT,610,RC,RT,OUTPATIENT,,,2441.25,976.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1953,OTHER,1830.94,2392.43,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION RT,19086RT,CPT,610,RC,RT,OUTPATIENT,,,2441.25,976.5,MONUMENT,COMMERCIAL,,,,1953,,1830.94,2392.43,
Z ENA SSB,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION LT,19086LT,CPT,610,RC,LT,OUTPATIENT,,,2441.25,976.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1953,OTHER,1830.94,2392.43,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION LT,19086LT,CPT,610,RC,LT,OUTPATIENT,,,2441.25,976.5,MONUMENT,COMMERCIAL,,,,1953,,1830.94,2392.43,
Z ENA SM,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION BI,1908550,CPT,610,RC,50,OUTPATIENT,,,3589.75,1435.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2871.8,OTHER,2692.31,3517.96,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION BI,1908550,CPT,610,RC,50,OUTPATIENT,,,3589.75,1435.9,MONUMENT,COMMERCIAL,,,,2871.8,,2692.31,3517.96,
Z ENA RNP,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST ADD LESION BI,1908650,CPT,610,RC,50,OUTPATIENT,,,2823.75,1129.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2259,OTHER,2117.81,2767.28,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST ADD LESION BI,1908650,CPT,610,RC,50,OUTPATIENT,,,2823.75,1129.5,MONUMENT,COMMERCIAL,,,,2259,,2117.81,2767.28,
Z ENA SCL 70,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
BX BREAST 1ST LESION UNI,19085,CPT,610,RC,,OUTPATIENT,,,4345,1738,BLUE CROSS ANTHEM,COMMERCIAL,,,,3476,OTHER,3258.75,4258.1,PERCENT OF CHARGES BASED ON HCPCS CODE
BX BREAST 1ST LESION UNI,19085,CPT,610,RC,,OUTPATIENT,,,4345,1738,MONUMENT,COMMERCIAL,,,,3476,,3258.75,4258.1,
Z ENA JO1,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,45.38,59.29,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CLAVICLE W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
ANTIBIOTIC SENSITIVITY  MIC,87186XU,CPT,306,RC,XU,OUTPATIENT,,,118,47.2,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,88.5,115.64,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CLAVICLE W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,BLUE CROSS ANTHEM,COMMERCIAL,,,,2202,OTHER,2064.38,2697.45,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,MONUMENT,COMMERCIAL,,,,2202,,2064.38,2697.45,
Z INFLUENZA A,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CLAVICLE W/WO RT,73218,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/WO RT,73218,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
Z INFLUENZA B,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,UNITED HEALTH,UNITED COMMERCIAL,,,PER VISIT OUTPATIENT,180,OTHER,39,50.96,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MRI CLAVICLE W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,2680.4,OTHER,2512.88,3283.49,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,MONUMENT,COMMERCIAL,,,,2680.4,,2512.88,3283.49,
SPEECH/LANG/AUD/VOICE TX,92507GN,CPT,440,RC,GN,OUTPATIENT,,,316,126.4,UNITED HEALTH,UNITED COMMERCIAL,,,,268.6,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
SPEECH GROUPS THERAPY,92508GN,CPT,443,RC,GN,OUTPATIENT,,,161.5,64.6,UNITED HEALTH,UNITED COMMERCIAL,,,,137.275,OTHER,121.13,158.27,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,BLUE CROSS ANTHEM,COMMERCIAL,,,,2512,OTHER,2355,3077.2,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI CLAVICLE W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,MONUMENT,COMMERCIAL,,,,2512,,2355,3077.2,
EVAL OF SPEECH FLUENCY,92521GN,CPT,444,RC,GN,OUTPATIENT,,,277.46,110.984,UNITED HEALTH,UNITED COMMERCIAL,,,,235.841,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,3446.8,OTHER,3231.38,4222.33,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,MONUMENT,COMMERCIAL,,,,3446.8,,3231.38,4222.33,
EVAL OF SPEECH SOUND PROD,92522GN,CPT,444,RC,GN,OUTPATIENT,,,182,72.8,UNITED HEALTH,UNITED COMMERCIAL,,,,154.7,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,5360.6,OTHER,5025.56,6566.74,PERCENT OF CHARGES BASED ON HCPCS CODE
ANKLE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,MONUMENT,COMMERCIAL,,,,5360.6,,5025.56,6566.74,
SPEECH/LANG/AUD/VOICE EVAL,92523GN,CPT,444,RC,GN,OUTPATIENT,,,261.33,104.532,UNITED HEALTH,UNITED COMMERCIAL,,,,222.1305,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
KNEE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,3446.8,OTHER,3231.38,4222.33,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,MONUMENT,COMMERCIAL,,,,3446.8,,3231.38,4222.33,
EVAL OF SPEECH SND W/EVAL LANG,92523GN,CPT,444,RC,GN,OUTPATIENT,,,477.2,190.88,UNITED HEALTH,UNITED COMMERCIAL,,,,405.62,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
KNEE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,5360.6,OTHER,5025.56,6566.74,PERCENT OF CHARGES BASED ON HCPCS CODE
KNEE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,MONUMENT,COMMERCIAL,,,,5360.6,,5025.56,6566.74,
BEHAVIORAL ANALYSIS OF VOICE,92524GN,CPT,444,RC,GN,OUTPATIENT,,,226.82,90.728,UNITED HEALTH,UNITED COMMERCIAL,,,,192.797,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
HIP W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,3446.8,OTHER,3231.38,4222.33,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,MONUMENT,COMMERCIAL,,,,3446.8,,3231.38,4222.33,
SP SWALLOWING/ORAL TREATMENT,92526GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,UNITED HEALTH,UNITED COMMERCIAL,,,,260.1,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
HIP W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,5360.6,OTHER,5025.56,6566.74,PERCENT OF CHARGES BASED ON HCPCS CODE
HIP W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,MONUMENT,COMMERCIAL,,,,5360.6,,5025.56,6566.74,
TRMT OF SWALLOWING DYSFUNCTION,92526GN,CPT,440,RC,GN,OUTPATIENT,,,175.92,70.368,UNITED HEALTH,UNITED COMMERCIAL,,,,149.532,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,4727.5,1891,BLUE CROSS ANTHEM,COMMERCIAL,,,,3782,OTHER,3545.63,4632.95,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,4727.5,1891,MONUMENT,COMMERCIAL,,,,3782,,3545.63,4632.95,
VOICE PROSTHETIC EVA,92597GN,CPT,444,RC,GN,OUTPATIENT,,,167.25,66.9,UNITED HEALTH,UNITED COMMERCIAL,,,,142.1625,OTHER,125.44,163.91,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6763.25,2705.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,5410.6,OTHER,5072.44,6627.99,PERCENT OF CHARGES BASED ON HCPCS CODE
SHOULDER W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6763.25,2705.3,MONUMENT,COMMERCIAL,,,,5410.6,,5072.44,6627.99,
EVAL FOR SPEECH DEVICE 1 HR,92607GN,CPT,444,RC,GN,OUTPATIENT,,,260.32,104.128,UNITED HEALTH,UNITED COMMERCIAL,,,,221.272,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
WRIST BILAT W/O MRI,73221,CPT,610,RC,,OUTPATIENT,,,3408.64,1363.456,BLUE CROSS ANTHEM,COMMERCIAL,,,,2726.912,OTHER,2556.5,3340.5,PERCENT OF CHARGES BASED ON HCPCS CODE
WRIST BILAT W/O MRI,73221,CPT,610,RC,,OUTPATIENT,,,3408.64,1363.456,MONUMENT,COMMERCIAL,,,,2726.9,,2556.5,3340.5,
EVAL FOR SPEECH DEVICE ADDL,92608GN,CPT,444,RC,GN,OUTPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,99.875,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/CONT RT,C8934,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/CONT RT,C8934,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/CONT RT,C8934,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRA ANGIO UPEXT W/WO CONT RT,C8936,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/WO CONT RT,C8936,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/WO CONT RT,C8936,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRA ANGIO ABD W/O CONTRAST,C8901,HCPCS,610,RC,,INPATIENT,,,2312,924.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2103.92,OTHER,1734,2265.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO ABD W/O CONTRAST,C8901,HCPCS,610,RC,,INPATIENT,,,2312,924.8,MONUMENT,COMMERCIAL,,,,1849.6,,1734,2265.76,
MRA ANGIO ABD W/O CONTRAST,C8901,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1734,,1734,2265.76,
MRA ANGIO ABD W/CONTRAST,C8900,HCPCS,610,RC,,INPATIENT,,,2312,924.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2103.92,OTHER,1734,2265.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO ABD W/CONTRAST,C8900,HCPCS,610,RC,,INPATIENT,,,2312,924.8,MONUMENT,COMMERCIAL,,,,1849.6,,1734,2265.76,
MRA ANGIO ABD W/CONTRAST,C8900,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1734,,1734,2265.76,
MRA ANGIO CHEST W/CONTRAST,C8909,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1665.07,OTHER,1372.31,1793.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO CHEST W/CONTRAST,C8909,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,MONUMENT,COMMERCIAL,,,,1463.8,,1372.31,1793.16,
MRA ANGIO CHEST W/CONTRAST,C8909,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1372.31,,1372.31,1793.16,
MRA ANGIO CHEST W/WO CONTRAST,C8911,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1665.07,OTHER,1372.31,1793.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO CHEST W/WO CONTRAST,C8911,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,MONUMENT,COMMERCIAL,,,,1463.8,,1372.31,1793.16,
MRA ANGIO CHEST W/WO CONTRAST,C8911,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1372.31,,1372.31,1793.16,
MRA ANGIO LOEXT W/O CONT RT,C8913,HCPCS,610,RC,,BOTH,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/O CONT RT,C8913,HCPCS,610,RC,,BOTH,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/O CONT RT,C8913,HCPCS,610,RC,,BOTH,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
MRI TMJ W/WO CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,2693.4,OTHER,2525.06,3299.42,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI TMJ W/WO CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,MONUMENT,COMMERCIAL,,,,2693.4,,2525.06,3299.42,
SPEECH GENERATING DEVICE SERV,92609GN,CPT,440,RC,GN,OUTPATIENT,,,242.25,96.9,UNITED HEALTH,UNITED COMMERCIAL,,,,205.9125,OTHER,181.69,237.41,PERCENT OF TOTAL BILLED CHARGES
MRI ST NECK W/CONTRAST,70542QQ,CPT,610,RC,QQ,OUTPATIENT,,,3914.5,1565.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3131.6,OTHER,2935.88,3836.21,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI ST NECK W/CONTRAST,70542QQ,CPT,610,RC,QQ,OUTPATIENT,,,3914.5,1565.8,MONUMENT,COMMERCIAL,,,,3131.6,,2935.88,3836.21,
EVAL SWALLOWING FUNCTION,92610GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,UNITED HEALTH,UNITED COMMERCIAL,,,,260.1,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
MRI FACE/NECK/ORBIT W/WO,70543,CPT,610,RC,,OUTPATIENT,,,4389.75,1755.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3511.8,OTHER,3292.31,4301.96,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI FACE/NECK/ORBIT W/WO,70543,CPT,610,RC,,OUTPATIENT,,,4389.75,1755.9,MONUMENT,COMMERCIAL,,,,3511.8,,3292.31,4301.96,
DUPLEX PELVIC OUTFLOW,93976QQ,CPT,,,QQ,OUTPATIENT,,,529.5,211.8,UNITED HEALTH,UNITED COMMERCIAL,,,,450.075,OTHER,397.13,518.91,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,4124.5,1649.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,3299.6,OTHER,3093.38,4042.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI PITUITARY/IAC W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,4124.5,1649.8,MONUMENT,COMMERCIAL,,,,3299.6,,3093.38,4042.01,
MUSCLE TESTING EXTREMITY,95831GP,CPT,420,RC,GP,OUTPATIENT,,,54.25,21.7,UNITED HEALTH,UNITED COMMERCIAL,,,,46.1125,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/WO CONTRST,70553,CPT,610,RC,,OUTPATIENT,,,5173,2069.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,4138.4,OTHER,3879.75,5069.54,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI PITUITARY/IAC W/WO CONTRST,70553,CPT,610,RC,,OUTPATIENT,,,5173,2069.2,MONUMENT,COMMERCIAL,,,,4138.4,,3879.75,5069.54,
MUSCLE TESTING MANUAL HAND,95832GO,CPT,430,RC,GO,OUTPATIENT,,,112.5,45,UNITED HEALTH,UNITED COMMERCIAL,,,,95.625,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/O CONTRAST,C8910,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1665.07,OTHER,1372.31,1793.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO CHEST W/O CONTRAST,C8910,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,MONUMENT,COMMERCIAL,,,,1463.8,,1372.31,1793.16,
MRA ANGIO CHEST W/O CONTRAST,C8910,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1372.31,,1372.31,1793.16,
MRA ANGIO PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,BLUE CROSS ANTHEM,COMMERCIAL,,,,2784,OTHER,2610,3410.4,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,MONUMENT,COMMERCIAL,,,,2784,,2610,3410.4,
MUSCLE TESTING-HAND,95832GP,CPT,420,RC,GP,OUTPATIENT,,,118.25,47.3,UNITED HEALTH,UNITED COMMERCIAL,,,,100.5125,OTHER,88.69,115.89,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3085.8,OTHER,2892.94,3780.11,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,MONUMENT,COMMERCIAL,,,,3085.8,,2892.94,3780.11,
MUSCLE TESTING EXCLUDE HANDS,95833GP,CPT,420,RC,GP,OUTPATIENT,,,79.5,31.8,UNITED HEALTH,UNITED COMMERCIAL,,,,67.575,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3928.2,OTHER,3682.69,4812.05,PERCENT OF CHARGES BASED ON HCPCS CODE
MRA ANGIO PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,MONUMENT,COMMERCIAL,,,,3928.2,,3682.69,4812.05,
MUSCLE TESTING INCLUDE HANDS,95834GP,CPT,420,RC,GP,OUTPATIENT,,,106,42.4,UNITED HEALTH,UNITED COMMERCIAL,,,,90.1,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/O CONT RT,C8935,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3332.65,OTHER,2746.69,3589.01,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO UPEXT W/O CONT RT,C8935,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,MONUMENT,COMMERCIAL,,,,2929.8,,2746.69,3589.01,
MRA ANGIO UPEXT W/O CONT RT,C8935,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UNITED HEALTH,UNITED COMMERCIAL,,,,2746.69,,2746.69,3589.01,
MRI LOEXT NON JT W/WO CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,3424.5,1369.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2739.6,OTHER,2568.38,3356.01,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/WO CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,3424.5,1369.8,MONUMENT,COMMERCIAL,,,,2739.6,,2568.38,3356.01,
ASSESSMENT OF APHASIA PER HR,96105GN,CPT,442,RC,GN,OUTPATIENT,,,291.25,116.5,UNITED HEALTH,UNITED COMMERCIAL,,,,247.5625,OTHER,218.44,285.43,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/CONT RT,73719QQ,CPT,610,RC,QQ,OUTPATIENT,,,2837.5,1135,BLUE CROSS ANTHEM,COMMERCIAL,,,,2270,OTHER,2128.13,2780.75,PERCENT OF CHARGES BASED ON HCPCS CODE
MRI LOEXT NON JT W/CONT RT,73719QQ,CPT,610,RC,QQ,OUTPATIENT,,,2837.5,1135,MONUMENT,COMMERCIAL,,,,2270,,2128.13,2780.75,
STD COGNITIVE TEST PER HR,96125GN,CPT,444,RC,GN,OUTPATIENT,,,350.25,140.1,UNITED HEALTH,UNITED COMMERCIAL,,,,297.7125,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/WO CONT RT,C8914,HCPCS,610,RC,,INPATIENT,,,1864.75,745.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1696.92,OTHER,1398.56,1827.46,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MRA ANGIO LOEXT W/WO CONT RT,C8914,HCPCS,610,RC,,INPATIENT,,,1864.75,745.9,MONUMENT,COMMERCIAL,,,,1491.8,,1398.56,1827.46,
MRA ANGIO LOEXT W/WO CONT RT,C8914,HCPCS,610,RC,,INPATIENT,,,1864.75,745.9,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.56,,1398.56,1827.46,
LOCM (180 MG IODINE),Q9946,HCPCS,636,RC,,INPATIENT,,,103,41.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.73,OTHER,77.25,100.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOCM (180 MG IODINE),Q9946,HCPCS,636,RC,,INPATIENT,,,103,41.2,MONUMENT,COMMERCIAL,,,,82.4,,77.25,100.94,
LOCM (180 MG IODINE),Q9946,HCPCS,636,RC,,INPATIENT,,,103,41.2,UNITED HEALTH,UNITED COMMERCIAL,,,,77.25,,77.25,100.94,
LOCM (320 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,379.25,151.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,345.12,OTHER,284.44,371.67,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOCM (320 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,379.25,151.7,MONUMENT,COMMERCIAL,,,,303.4,,284.44,371.67,
LOCM (320 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,379.25,151.7,UNITED HEALTH,UNITED COMMERCIAL,,,,284.44,,284.44,371.67,
LOCM (350 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,103,41.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,93.73,OTHER,77.25,100.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOCM (350 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,103,41.2,MONUMENT,COMMERCIAL,,,,82.4,,77.25,100.94,
LOCM (350 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,103,41.2,UNITED HEALTH,UNITED COMMERCIAL,,,,77.25,,77.25,100.94,
TECHNETIUM TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,196.25,78.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.59,OTHER,147.2,192.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TECHNETIUM TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,196.25,78.5,MONUMENT,COMMERCIAL,,,,157,,147.2,192.3,
TECHNETIUM TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,196.25,78.5,UNITED HEALTH,UNITED COMMERCIAL,,,,147.2,,147.2,192.3,
GLADOLINIUM,A9579,HCPCS,636,RC,,INPATIENT,,,271.25,108.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,246.84,OTHER,203.44,265.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
GLADOLINIUM,A9579,HCPCS,636,RC,,INPATIENT,,,271.25,108.5,MONUMENT,COMMERCIAL,,,,217,,203.44,265.83,
GLADOLINIUM,A9579,HCPCS,636,RC,,INPATIENT,,,271.25,108.5,UNITED HEALTH,UNITED COMMERCIAL,,,,203.44,,203.44,265.83,
FDG F-18 INITIAL,A9552PI,HCPCS,343,RC,PI,INPATIENT,,,1320.75,528.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1201.88,OTHER,990.56,1294.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FDG F-18 INITIAL,A9552PI,HCPCS,343,RC,PI,INPATIENT,,,1320.75,528.3,MONUMENT,COMMERCIAL,,,,1056.6,,990.56,1294.34,
FDG F-18 INITIAL,A9552PI,HCPCS,343,RC,PI,INPATIENT,,,1320.75,528.3,UNITED HEALTH,UNITED COMMERCIAL,,,,990.56,,990.56,1294.34,
FDG F-18 SUB,A9552PS,HCPCS,343,RC,PS,INPATIENT,,,1320.75,528.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1201.88,OTHER,990.56,1294.34,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FDG F-18 SUB,A9552PS,HCPCS,343,RC,PS,INPATIENT,,,1320.75,528.3,MONUMENT,COMMERCIAL,,,,1056.6,,990.56,1294.34,
FDG F-18 SUB,A9552PS,HCPCS,343,RC,PS,INPATIENT,,,1320.75,528.3,UNITED HEALTH,UNITED COMMERCIAL,,,,990.56,,990.56,1294.34,
RECOVERY ROOM + .5 HR,7100010,CDM,,,,INPATIENT,,,150.75,60.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,137.18,OTHER,113.06,147.74,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM + .5 HR,7100010,CDM,,,,INPATIENT,,,150.75,60.3,MONUMENT,COMMERCIAL,,,,120.6,,113.06,147.74,
RECOVERY ROOM + .5 HR,7100010,CDM,,,,INPATIENT,,,150.75,60.3,UNITED HEALTH,UNITED COMMERCIAL,,,,113.06,,113.06,147.74,
RECOVERY ROOM-GENERAL,7100070,CDM,,,,INPATIENT,,,860,344,BLUE CROSS ANTHEM,COMMERCIAL,,,,782.6,OTHER,645,842.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM-GENERAL,7100070,CDM,,,,INPATIENT,,,860,344,MONUMENT,COMMERCIAL,,,,688,,645,842.8,
RECOVERY ROOM-GENERAL,7100070,CDM,,,,INPATIENT,,,860,344,UNITED HEALTH,UNITED COMMERCIAL,,,,645,,645,842.8,
RECOVERY ROOM-LOCAL,7100080,CDM,,,,INPATIENT,,,439,175.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,399.49,OTHER,329.25,430.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM-LOCAL,7100080,CDM,,,,INPATIENT,,,439,175.6,MONUMENT,COMMERCIAL,,,,351.2,,329.25,430.22,
RECOVERY ROOM-LOCAL,7100080,CDM,,,,INPATIENT,,,439,175.6,UNITED HEALTH,UNITED COMMERCIAL,,,,329.25,,329.25,430.22,
RECOVERY ROOM-REGIONAL,7100090,CDM,,,,INPATIENT,,,553,221.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,503.23,OTHER,414.75,541.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM-REGIONAL,7100090,CDM,,,,INPATIENT,,,553,221.2,MONUMENT,COMMERCIAL,,,,442.4,,414.75,541.94,
RECOVERY ROOM-REGIONAL,7100090,CDM,,,,INPATIENT,,,553,221.2,UNITED HEALTH,UNITED COMMERCIAL,,,,414.75,,414.75,541.94,
DELIVERY/RECOVERY 1,7200010,CDM,,,,INPATIENT,,,1865,746,BLUE CROSS ANTHEM,COMMERCIAL,,,,1697.15,OTHER,1398.75,1827.7,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DELIVERY/RECOVERY 1,7200010,CDM,,,,INPATIENT,,,1865,746,MONUMENT,COMMERCIAL,,,,1492,,1398.75,1827.7,
DELIVERY/RECOVERY 1,7200010,CDM,,,,INPATIENT,,,1865,746,UNITED HEALTH,UNITED COMMERCIAL,,,,1398.75,,1398.75,1827.7,
DELIVERY/RECOVERY 2,7200012,CDM,,,,INPATIENT,,,3997.75,1599.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,3637.95,OTHER,2998.31,3917.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
DELIVERY/RECOVERY 2,7200012,CDM,,,,INPATIENT,,,3997.75,1599.1,MONUMENT,COMMERCIAL,,,,3198.2,,2998.31,3917.8,
DELIVERY/RECOVERY 2,7200012,CDM,,,,INPATIENT,,,3997.75,1599.1,UNITED HEALTH,UNITED COMMERCIAL,,,,2998.31,,2998.31,3917.8,
PRECIP DELIVERY,7200014,CDM,,,,INPATIENT,,,896.25,358.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,815.59,OTHER,672.19,878.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PRECIP DELIVERY,7200014,CDM,,,,INPATIENT,,,896.25,358.5,MONUMENT,COMMERCIAL,,,,717,,672.19,878.33,
PRECIP DELIVERY,7200014,CDM,,,,INPATIENT,,,896.25,358.5,UNITED HEALTH,UNITED COMMERCIAL,,,,672.19,,672.19,878.33,
CS PREOP,7200016,CDM,,,,INPATIENT,,,297.25,118.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,270.5,OTHER,222.94,291.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CS PREOP,7200016,CDM,,,,INPATIENT,,,297.25,118.9,MONUMENT,COMMERCIAL,,,,237.8,,222.94,291.31,
CS PREOP,7200016,CDM,,,,INPATIENT,,,297.25,118.9,UNITED HEALTH,UNITED COMMERCIAL,,,,222.94,,222.94,291.31,
OB DOPPLER,7200018,CDM,,,,INPATIENT,,,204.5,81.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,186.1,OTHER,153.38,200.41,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB DOPPLER,7200018,CDM,,,,INPATIENT,,,204.5,81.8,MONUMENT,COMMERCIAL,,,,163.6,,153.38,200.41,
OB DOPPLER,7200018,CDM,,,,INPATIENT,,,204.5,81.8,UNITED HEALTH,UNITED COMMERCIAL,,,,153.38,,153.38,200.41,
EFM/PER DAY,7200020,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
EFM/PER DAY,7200020,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
EFM/PER DAY,7200020,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,214.31,,214.31,280.04,
BABY CHECK AND EVAL,99211,CPT,510,RC,,OUTPATIENT,,,102,40.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,81.6,OTHER,76.5,99.96,PERCENT OF CHARGES BASED ON HCPCS CODE
BABY CHECK AND EVAL,99211,CPT,510,RC,,OUTPATIENT,,,102,40.8,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
MOIST HEAT THERAPY,97010GP,CPT,420,RC,GP,OUTPATIENT,,,65.5,26.2,UNITED HEALTH,UNITED COMMERCIAL,,,,55.675,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
FHM INTERNAL FSE,7200030,CDM,,,,INPATIENT,,,394.75,157.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.22,OTHER,296.06,386.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FHM INTERNAL FSE,7200030,CDM,,,,INPATIENT,,,394.75,157.9,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
FHM INTERNAL FSE,7200030,CDM,,,,INPATIENT,,,394.75,157.9,UNITED HEALTH,UNITED COMMERCIAL,,,,296.06,,296.06,386.86,
INFUSION THERAPY,96365,CPT,260,RC,,OUTPATIENT,,,496.25,198.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,397,OTHER,372.19,486.33,PERCENT OF CHARGES BASED ON HCPCS CODE
INFUSION THERAPY,96365,CPT,260,RC,,OUTPATIENT,,,496.25,198.5,MONUMENT,COMMERCIAL,,,,397,,372.19,486.33,
TRACTION - MECHANICAL,97012GP,CPT,420,RC,GP,OUTPATIENT,,,91.25,36.5,UNITED HEALTH,UNITED COMMERCIAL,,,,77.5625,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
NIPPLE STIM (INCLUDES EFM),7200034,CDM,,,,INPATIENT,,,424.25,169.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,386.07,OTHER,318.19,415.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NIPPLE STIM (INCLUDES EFM),7200034,CDM,,,,INPATIENT,,,424.25,169.7,MONUMENT,COMMERCIAL,,,,339.4,,318.19,415.77,
NIPPLE STIM (INCLUDES EFM),7200034,CDM,,,,INPATIENT,,,424.25,169.7,UNITED HEALTH,UNITED COMMERCIAL,,,,318.19,,318.19,415.77,
OCT (INCLUDES EFM),59020,CPT,720,RC,,OUTPATIENT,,,670,268,BLUE CROSS ANTHEM,COMMERCIAL,,,,536,OTHER,502.5,656.6,PERCENT OF CHARGES BASED ON HCPCS CODE
OCT (INCLUDES EFM),59020,CPT,720,RC,,OUTPATIENT,,,670,268,MONUMENT,COMMERCIAL,,,,536,,502.5,656.6,
PARAFFIN BATH,97018GP,CPT,420,RC,GP,OUTPATIENT,,,72.5,29,UNITED HEALTH,UNITED COMMERCIAL,,,,61.625,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
VERSION (INCLUDES EFM),59412,CPT,720,RC,,OUTPATIENT,,,2396,958.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,1916.8,OTHER,1797,2348.08,PERCENT OF CHARGES BASED ON HCPCS CODE
VERSION (INCLUDES EFM),59412,CPT,720,RC,,OUTPATIENT,,,2396,958.4,MONUMENT,COMMERCIAL,,,,1916.8,,1797,2348.08,
WHIRLPOOL,97022GP,CPT,420,RC,GP,OUTPATIENT,,,222.75,89.1,UNITED HEALTH,UNITED COMMERCIAL,,,,189.3375,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
IUPC,7200042,CDM,,,,INPATIENT,,,739.25,295.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,672.72,OTHER,554.44,724.47,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IUPC,7200042,CDM,,,,INPATIENT,,,739.25,295.7,MONUMENT,COMMERCIAL,,,,591.4,,554.44,724.47,
IUPC,7200042,CDM,,,,INPATIENT,,,739.25,295.7,UNITED HEALTH,UNITED COMMERCIAL,,,,554.44,,554.44,724.47,
INJ THER/PROPH/DIAG  SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.4,OTHER,142.88,186.69,PERCENT OF CHARGES BASED ON HCPCS CODE
INJ THER/PROPH/DIAG  SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,MONUMENT,COMMERCIAL,,,,152.4,,142.88,186.69,
INFRARED THERAPY,97026GO,CPT,430,RC,GO,OUTPATIENT,,,30.25,12.1,UNITED HEALTH,UNITED COMMERCIAL,,,,25.7125,OTHER,22.69,29.65,PERCENT OF TOTAL BILLED CHARGES
INJECTION PROCEDURE,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,152.4,OTHER,142.88,186.69,PERCENT OF CHARGES BASED ON HCPCS CODE
INJECTION PROCEDURE,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,MONUMENT,COMMERCIAL,,,,152.4,,142.88,186.69,
INFRARED THERAPY,97026GP,CPT,420,RC,GP,OUTPATIENT,,,32,12.8,UNITED HEALTH,UNITED COMMERCIAL,,,,27.2,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
NST/EFM,59025,CPT,720,RC,,OUTPATIENT,,,445.25,178.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,356.2,OTHER,333.94,436.35,PERCENT OF CHARGES BASED ON HCPCS CODE
NST/EFM,59025,CPT,720,RC,,OUTPATIENT,,,445.25,178.1,MONUMENT,COMMERCIAL,,,,356.2,,333.94,436.35,
ELE STIMULATION ATTENDED 15MIN,97032GO,CPT,430,RC,GO,OUTPATIENT,,,90.5,36.2,UNITED HEALTH,UNITED COMMERCIAL,,,,76.925,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
NURSE ATTENDED TRANSFER,7200120,CDM,,,,INPATIENT,,,334.5,133.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,304.4,OTHER,250.88,327.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NURSE ATTENDED TRANSFER,7200120,CDM,,,,INPATIENT,,,334.5,133.8,MONUMENT,COMMERCIAL,,,,267.6,,250.88,327.81,
NURSE ATTENDED TRANSFER,7200120,CDM,,,,INPATIENT,,,334.5,133.8,UNITED HEALTH,UNITED COMMERCIAL,,,,250.88,,250.88,327.81,
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,OUTPATIENT,,,2927.25,1170.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2341.8,OTHER,2195.44,2868.71,PERCENT OF CHARGES BASED ON HCPCS CODE
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,OUTPATIENT,,,2927.25,1170.9,MONUMENT,COMMERCIAL,,,,2341.8,,2195.44,2868.71,
ELEC STIMULATION ATTENDED/15 M,97032GP,CPT,420,RC,GP,OUTPATIENT,,,133.25,53.3,UNITED HEALTH,UNITED COMMERCIAL,,,,113.2625,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
INFUSION THERAPY EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.6,OTHER,73.69,96.29,PERCENT OF CHARGES BASED ON HCPCS CODE
INFUSION THERAPY EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
IONTOPHORESIS 15 MINS,97033GO,CPT,430,RC,GO,OUTPATIENT,,,129.25,51.7,UNITED HEALTH,UNITED COMMERCIAL,,,,109.8625,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
OB IM/SQ VACCINE,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,115.2,OTHER,108,141.1,PERCENT OF CHARGES BASED ON HCPCS CODE
OB IM/SQ VACCINE,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.1,
IONTOPHORESIS 15 MINS,97033GP,CPT,420,RC,GP,OUTPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,,115.3875,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,OUTPATIENT,,,5697.98,2279.192,BLUE CROSS ANTHEM,COMMERCIAL,,,,4558.384,OTHER,4273.5,5584,PERCENT OF CHARGES BASED ON HCPCS CODE
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,OUTPATIENT,,,5697.98,2279.192,MONUMENT,COMMERCIAL,,,,4558.4,,4273.5,5584,
ULTRASOUND THERAPY 15 MINS,97035GO,CPT,430,RC,GO,OUTPATIENT,,,80.25,32.1,UNITED HEALTH,UNITED COMMERCIAL,,,,68.2125,OTHER,60.19,78.65,PERCENT OF TOTAL BILLED CHARGES
IV PUSH NEW MED ADDON,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH NEW MED ADDON,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
ULTRASOUND THERAPY 15 MINS,97035GP,CPT,420,RC,GP,OUTPATIENT,,,113.9,45.56,UNITED HEALTH,UNITED COMMERCIAL,,,,96.815,OTHER,63.38,82.81,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SAME MED ADDON,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH SAME MED ADDON,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
THERAPEUTIC EXERCISES/15 MIN,97110GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,UNITED HEALTH,UNITED COMMERCIAL,,,,91.8,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION (INITIAL),96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,358.4,OTHER,336,439.04,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION (INITIAL),96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,MONUMENT,COMMERCIAL,,,,358.4,,336,439.04,
THERAPEUTIC EXERCISE 15 MINS,97110GP,CPT,420,RC,GP,OUTPATIENT,,,146.94,58.776,UNITED HEALTH,UNITED COMMERCIAL,,,,124.899,OTHER,85.13,111.23,PERCENT OF TOTAL BILLED CHARGES
SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,BLUE CROSS ANTHEM,COMMERCIAL,,,,110,OTHER,103.13,134.75,PERCENT OF CHARGES BASED ON HCPCS CODE
SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,MONUMENT,COMMERCIAL,,,,110,,103.13,134.75,
NEUROMUSCULAR RE-EDUC/15 MIN,97112GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,UNITED HEALTH,UNITED COMMERCIAL,,,,91.8,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.4,OTHER,88.5,115.64,PERCENT OF CHARGES BASED ON HCPCS CODE
IV HYDRATION ADD'L HR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,MONUMENT,COMMERCIAL,,,,94.4,,88.5,115.64,
NEUROMUSCULAR RE ED,97112GP,CPT,420,RC,GP,OUTPATIENT,,,142,56.8,UNITED HEALTH,UNITED COMMERCIAL,,,,120.7,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
OB THER/DIAG CONCURRENT INF,96368,CPT,450,RC,,OUTPATIENT,,,132.25,52.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,105.8,OTHER,99.2,129.6,PERCENT OF CHARGES BASED ON HCPCS CODE
OB THER/DIAG CONCURRENT INF,96368,CPT,450,RC,,OUTPATIENT,,,132.25,52.9,MONUMENT,COMMERCIAL,,,,105.8,,99.2,129.6,
AQUATIC THERAPY / 15 MIN,97113GO,CPT,430,RC,GO,OUTPATIENT,,,88.25,35.3,UNITED HEALTH,UNITED COMMERCIAL,,,,75.0125,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.1,214.4,PERCENT OF CHARGES BASED ON HCPCS CODE
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.1,214.4,
AQUATIC THERAPY - INDIV/15 MN,97113GP,CPT,420,RC,GP,OUTPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,78.8375,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
LABOR,7210002,CDM,,,,INPATIENT,,,1247.25,498.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1135,OTHER,935.44,1222.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LABOR,7210002,CDM,,,,INPATIENT,,,1247.25,498.9,MONUMENT,COMMERCIAL,,,,997.8,,935.44,1222.31,
LABOR,7210002,CDM,,,,INPATIENT,,,1247.25,498.9,UNITED HEALTH,UNITED COMMERCIAL,,,,935.44,,935.44,1222.31,
MATERNAL RESUSCITATION,7210010,CDM,,,,INPATIENT,,,399.75,159.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,363.77,OTHER,299.81,391.76,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MATERNAL RESUSCITATION,7210010,CDM,,,,INPATIENT,,,399.75,159.9,MONUMENT,COMMERCIAL,,,,319.8,,299.81,391.76,
MATERNAL RESUSCITATION,7210010,CDM,,,,INPATIENT,,,399.75,159.9,UNITED HEALTH,UNITED COMMERCIAL,,,,299.81,,299.81,391.76,
AMNIOCENTESIS PROCEDURE,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,BLUE CROSS ANTHEM,COMMERCIAL,,,,1009.992,OTHER,446.25,583.1,PERCENT OF CHARGES BASED ON HCPCS CODE
AMNIOCENTESIS PROCEDURE,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,MONUMENT,COMMERCIAL,,,,476,,446.25,583.1,
GAIT TRAINING / 15 MIN,97116GP,CPT,420,RC,GP,OUTPATIENT,,,131.45,52.58,UNITED HEALTH,UNITED COMMERCIAL,,,,111.7325,OTHER,76.13,99.47,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,744.38,OTHER,613.5,801.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,MONUMENT,COMMERCIAL,,,,654.4,,613.5,801.64,
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,UNITED HEALTH,UNITED COMMERCIAL,,,,613.5,,613.5,801.64,
BAG/MASK PROCEDURE,7210014,CDM,,,,INPATIENT,,,124.25,49.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,113.07,OTHER,93.19,121.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BAG/MASK PROCEDURE,7210014,CDM,,,,INPATIENT,,,124.25,49.7,MONUMENT,COMMERCIAL,,,,99.4,,93.19,121.77,
BAG/MASK PROCEDURE,7210014,CDM,,,,INPATIENT,,,124.25,49.7,UNITED HEALTH,UNITED COMMERCIAL,,,,93.19,,93.19,121.77,
OB C-SECTION,7210015,CDM,,,,INPATIENT,,,1540.75,616.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1402.08,OTHER,1155.56,1509.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB C-SECTION,7210015,CDM,,,,INPATIENT,,,1540.75,616.3,MONUMENT,COMMERCIAL,,,,1232.6,,1155.56,1509.94,
OB C-SECTION,7210015,CDM,,,,INPATIENT,,,1540.75,616.3,UNITED HEALTH,UNITED COMMERCIAL,,,,4800,PER CASE,1155.56,1509.94,
FOLEY CATHERTERIZATION PROC,7210018,CDM,,,,INPATIENT,,,135.75,54.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,123.53,OTHER,101.81,133.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
FOLEY CATHERTERIZATION PROC,7210018,CDM,,,,INPATIENT,,,135.75,54.3,MONUMENT,COMMERCIAL,,,,108.6,,101.81,133.04,
FOLEY CATHERTERIZATION PROC,7210018,CDM,,,,INPATIENT,,,135.75,54.3,UNITED HEALTH,UNITED COMMERCIAL,,,,101.81,,101.81,133.04,
OB CARE LEVEL 1,7210020,CDM,,,,INPATIENT,,,99,39.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,90.09,OTHER,74.25,97.02,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB CARE LEVEL 1,7210020,CDM,,,,INPATIENT,,,99,39.6,MONUMENT,COMMERCIAL,,,,79.2,,74.25,97.02,
OB CARE LEVEL 1,7210020,CDM,,,,INPATIENT,,,99,39.6,UNITED HEALTH,UNITED COMMERCIAL,,,,2600,PER CASE,74.25,97.02,
CARDIAC MONITOR,7210022,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CARDIAC MONITOR,7210022,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
CARDIAC MONITOR,7210022,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
OB CARE LEVEL 2,7210030,CDM,,,,INPATIENT,,,155.75,62.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,141.73,OTHER,116.81,152.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB CARE LEVEL 2,7210030,CDM,,,,INPATIENT,,,155.75,62.3,MONUMENT,COMMERCIAL,,,,124.6,,116.81,152.64,
OB CARE LEVEL 2,7210030,CDM,,,,INPATIENT,,,155.75,62.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3400,PER CASE,116.81,152.64,
OB CARE LEVEL 3,7210040,CDM,,,,INPATIENT,,,285.75,114.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,260.03,OTHER,214.31,280.04,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB CARE LEVEL 3,7210040,CDM,,,,INPATIENT,,,285.75,114.3,MONUMENT,COMMERCIAL,,,,228.6,,214.31,280.04,
OB CARE LEVEL 3,7210040,CDM,,,,INPATIENT,,,285.75,114.3,UNITED HEALTH,UNITED COMMERCIAL,,,,3400,PER CASE,214.31,280.04,
OB CARE LEVEL 4,7210050,CDM,,,,INPATIENT,,,660.5,264.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,601.06,OTHER,495.38,647.29,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OB CARE LEVEL 4,7210050,CDM,,,,INPATIENT,,,660.5,264.2,MONUMENT,COMMERCIAL,,,,528.4,,495.38,647.29,
OB CARE LEVEL 4,7210050,CDM,,,,INPATIENT,,,660.5,264.2,UNITED HEALTH,UNITED COMMERCIAL,,,,3400,PER CASE,495.38,647.29,
INTERNAL FM,7210060,CDM,,,,INPATIENT,,,394.75,157.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,359.22,OTHER,296.06,386.86,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INTERNAL FM,7210060,CDM,,,,INPATIENT,,,394.75,157.9,MONUMENT,COMMERCIAL,,,,315.8,,296.06,386.86,
INTERNAL FM,7210060,CDM,,,,INPATIENT,,,394.75,157.9,UNITED HEALTH,UNITED COMMERCIAL,,,,296.06,,296.06,386.86,
LOCAL/PUDENDAL PROCEDURE,7210062,CDM,,,,INPATIENT,,,117.5,47,BLUE CROSS ANTHEM,COMMERCIAL,,,,106.93,OTHER,88.13,115.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LOCAL/PUDENDAL PROCEDURE,7210062,CDM,,,,INPATIENT,,,117.5,47,MONUMENT,COMMERCIAL,,,,94,,88.13,115.15,
LOCAL/PUDENDAL PROCEDURE,7210062,CDM,,,,INPATIENT,,,117.5,47,UNITED HEALTH,UNITED COMMERCIAL,,,,88.13,,88.13,115.15,
NRS ATTENDED TRANSPORT,7210068,CDM,,,,INPATIENT,,,633.25,253.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,576.26,OTHER,474.94,620.59,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NRS ATTENDED TRANSPORT,7210068,CDM,,,,INPATIENT,,,633.25,253.3,MONUMENT,COMMERCIAL,,,,506.6,,474.94,620.59,
NRS ATTENDED TRANSPORT,7210068,CDM,,,,INPATIENT,,,633.25,253.3,UNITED HEALTH,UNITED COMMERCIAL,,,,474.94,,474.94,620.59,
PELVIC EXAM PROCEDURE,7210070,CDM,,,,INPATIENT,,,256.5,102.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,233.42,OTHER,192.38,251.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PELVIC EXAM PROCEDURE,7210070,CDM,,,,INPATIENT,,,256.5,102.6,MONUMENT,COMMERCIAL,,,,205.2,,192.38,251.37,
PELVIC EXAM PROCEDURE,7210070,CDM,,,,INPATIENT,,,256.5,102.6,UNITED HEALTH,UNITED COMMERCIAL,,,,192.38,,192.38,251.37,
SITZ BATH,7210072,CDM,,,,INPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.13,OTHER,32.25,42.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SITZ BATH,7210072,CDM,,,,INPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
SITZ BATH,7210072,CDM,,,,INPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,,32.25,,32.25,42.14,
STAPLE/SUTURE REMOVAL,7210074,CDM,,,,INPATIENT,,,43,17.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,39.13,OTHER,32.25,42.14,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
STAPLE/SUTURE REMOVAL,7210074,CDM,,,,INPATIENT,,,43,17.2,MONUMENT,COMMERCIAL,,,,34.4,,32.25,42.14,
STAPLE/SUTURE REMOVAL,7210074,CDM,,,,INPATIENT,,,43,17.2,UNITED HEALTH,UNITED COMMERCIAL,,,,32.25,,32.25,42.14,
TEDS,7210076,CDM,,,,INPATIENT,,,56.5,22.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,51.42,OTHER,42.38,55.37,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
TEDS,7210076,CDM,,,,INPATIENT,,,56.5,22.6,MONUMENT,COMMERCIAL,,,,45.2,,42.38,55.37,
TEDS,7210076,CDM,,,,INPATIENT,,,56.5,22.6,UNITED HEALTH,UNITED COMMERCIAL,,,,42.38,,42.38,55.37,
URINE CATH/IN & OUT,7210078,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
URINE CATH/IN & OUT,7210078,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
URINE CATH/IN & OUT,7210078,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
VACUUM EXTRACTION,7210080,CDM,,,,INPATIENT,,,474.25,189.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,431.57,OTHER,355.69,464.77,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VACUUM EXTRACTION,7210080,CDM,,,,INPATIENT,,,474.25,189.7,MONUMENT,COMMERCIAL,,,,379.4,,355.69,464.77,
VACUUM EXTRACTION,7210080,CDM,,,,INPATIENT,,,474.25,189.7,UNITED HEALTH,UNITED COMMERCIAL,,,,355.69,,355.69,464.77,
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,497.2,OTHER,466.13,609.07,PERCENT OF CHARGES BASED ON HCPCS CODE
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,MONUMENT,COMMERCIAL,,,,497.2,,466.13,609.07,
MASSAGE THERAPY 15 MINS,97124GP,CPT,420,RC,GP,OUTPATIENT,,,120.75,48.3,UNITED HEALTH,UNITED COMMERCIAL,,,,102.6375,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
HEARING SCREEN,92586,CPT,470,RC,,OUTPATIENT,,,289.75,115.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,231.8,OTHER,217.31,283.96,PERCENT OF CHARGES BASED ON HCPCS CODE
HEARING SCREEN,92586,CPT,470,RC,,OUTPATIENT,,,289.75,115.9,MONUMENT,COMMERCIAL,,,,231.8,,217.31,283.96,
MANUAL THERAPY OT,97140GO,CPT,430,RC,GO,OUTPATIENT,,,102.75,41.1,UNITED HEALTH,UNITED COMMERCIAL,,,,87.3375,OTHER,77.06,100.7,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,744.38,OTHER,613.5,801.64,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,MONUMENT,COMMERCIAL,,,,654.4,,613.5,801.64,
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,UNITED HEALTH,UNITED COMMERCIAL,,,,613.5,,613.5,801.64,
PHOTOTHERAPY,7220012,CDM,,,,INPATIENT,,,514.25,205.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,467.97,OTHER,385.69,503.97,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PHOTOTHERAPY,7220012,CDM,,,,INPATIENT,,,514.25,205.7,MONUMENT,COMMERCIAL,,,,411.4,,385.69,503.97,
PHOTOTHERAPY,7220012,CDM,,,,INPATIENT,,,514.25,205.7,UNITED HEALTH,UNITED COMMERCIAL,,,,385.69,,385.69,503.97,
HABERMAN FEEDER/SOFT FEEDER,7220018,CDM,,,,INPATIENT,,,76.75,30.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,69.84,OTHER,57.56,75.22,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
HABERMAN FEEDER/SOFT FEEDER,7220018,CDM,,,,INPATIENT,,,76.75,30.7,MONUMENT,COMMERCIAL,,,,61.4,,57.56,75.22,
HABERMAN FEEDER/SOFT FEEDER,7220018,CDM,,,,INPATIENT,,,76.75,30.7,UNITED HEALTH,UNITED COMMERCIAL,,,,57.56,,57.56,75.22,
LUMBAR PUNCTURE,7220020,CDM,,,,INPATIENT,,,290.75,116.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,264.58,OTHER,218.06,284.94,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
LUMBAR PUNCTURE,7220020,CDM,,,,INPATIENT,,,290.75,116.3,MONUMENT,COMMERCIAL,,,,232.6,,218.06,284.94,
LUMBAR PUNCTURE,7220020,CDM,,,,INPATIENT,,,290.75,116.3,UNITED HEALTH,UNITED COMMERCIAL,,,,218.06,,218.06,284.94,
SUCTION PROCEDURE,7220022,CDM,,,,INPATIENT,,,92.75,37.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,84.4,OTHER,69.56,90.9,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
SUCTION PROCEDURE,7220022,CDM,,,,INPATIENT,,,92.75,37.1,MONUMENT,COMMERCIAL,,,,74.2,,69.56,90.9,
SUCTION PROCEDURE,7220022,CDM,,,,INPATIENT,,,92.75,37.1,UNITED HEALTH,UNITED COMMERCIAL,,,,69.56,,69.56,90.9,
UMBILICAL CATH PROCEDURE,36510,CPT,360,RC,,OUTPATIENT,,,548.25,219.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,438.6,OTHER,411.19,537.29,PERCENT OF CHARGES BASED ON HCPCS CODE
UMBILICAL CATH PROCEDURE,36510,CPT,360,RC,,OUTPATIENT,,,548.25,219.3,MONUMENT,COMMERCIAL,,,,438.6,,411.19,537.29,
MANUAL THERAPY,97140GP,CPT,420,RC,GP,OUTPATIENT,,,144.38,57.752,UNITED HEALTH,UNITED COMMERCIAL,,,,122.723,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
WARMER ISOLETTE,7220026,CDM,,,,INPATIENT,,,161.25,64.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,146.74,OTHER,120.94,158.03,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
WARMER ISOLETTE,7220026,CDM,,,,INPATIENT,,,161.25,64.5,MONUMENT,COMMERCIAL,,,,129,,120.94,158.03,
WARMER ISOLETTE,7220026,CDM,,,,INPATIENT,,,161.25,64.5,UNITED HEALTH,UNITED COMMERCIAL,,,,120.94,,120.94,158.03,
IV ACCESS/VOLUTROL/BURETTE,7220028,CDM,,,,INPATIENT,,,159.5,63.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,145.15,OTHER,119.63,156.31,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
IV ACCESS/VOLUTROL/BURETTE,7220028,CDM,,,,INPATIENT,,,159.5,63.8,MONUMENT,COMMERCIAL,,,,127.6,,119.63,156.31,
IV ACCESS/VOLUTROL/BURETTE,7220028,CDM,,,,INPATIENT,,,159.5,63.8,UNITED HEALTH,UNITED COMMERCIAL,,,,119.63,,119.63,156.31,
MATERNAL SUCTION SETUP,7220030,CDM,,,,INPATIENT,,,97,38.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.27,OTHER,72.75,95.06,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MATERNAL SUCTION SETUP,7220030,CDM,,,,INPATIENT,,,97,38.8,MONUMENT,COMMERCIAL,,,,77.6,,72.75,95.06,
MATERNAL SUCTION SETUP,7220030,CDM,,,,INPATIENT,,,97,38.8,UNITED HEALTH,UNITED COMMERCIAL,,,,72.75,,72.75,95.06,
INFANT INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,631.8,OTHER,592.31,773.96,PERCENT OF CHARGES BASED ON HCPCS CODE
INFANT INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,MONUMENT,COMMERCIAL,,,,631.8,,592.31,773.96,
THERAPEUTIC PROC GROUP (VISIT),97150GO,CPT,433,RC,GO,OUTPATIENT,,,86.5,34.6,UNITED HEALTH,UNITED COMMERCIAL,,,,73.525,OTHER,64.88,84.77,PERCENT OF TOTAL BILLED CHARGES
TRANSCUTANEOUS BILIRUBIN,88720,CPT,300,RC,,OUTPATIENT,,,28.75,11.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,23,OTHER,21.56,28.18,PERCENT OF CHARGES BASED ON HCPCS CODE
TRANSCUTANEOUS BILIRUBIN,88720,CPT,300,RC,,OUTPATIENT,,,28.75,11.5,MONUMENT,COMMERCIAL,,,,23,,21.56,28.18,
AQUATIC THERAPY - GROUP,97150GP,CPT,423,RC,GP,OUTPATIENT,,,91.25,36.5,UNITED HEALTH,UNITED COMMERCIAL,,,,77.5625,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
BANKED BREASTMILK PER OUNCE,7220036,CDM,,,,INPATIENT,,,6.25,2.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,5.69,OTHER,4.69,6.13,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BANKED BREASTMILK PER OUNCE,7220036,CDM,,,,INPATIENT,,,6.25,2.5,MONUMENT,COMMERCIAL,,,,5,,4.69,6.13,
BANKED BREASTMILK PER OUNCE,7220036,CDM,,,,INPATIENT,,,6.25,2.5,UNITED HEALTH,UNITED COMMERCIAL,,,,4.69,,4.69,6.13,
CIRCUMCISION,54150,CPT,360,RC,,OUTPATIENT,,,1304.5,521.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1043.6,OTHER,978.38,1278.41,PERCENT OF CHARGES BASED ON HCPCS CODE
CIRCUMCISION,54150,CPT,360,RC,,OUTPATIENT,,,1304.5,521.8,MONUMENT,COMMERCIAL,,,,1043.6,,978.38,1278.41,
PT THERAPY EVAL LOW COMPLEXITY,97161GP,CPT,424,RC,GP,OUTPATIENT,,,303,121.2,UNITED HEALTH,UNITED COMMERCIAL,,,,257.55,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY EVALUATION REPEAT(NSY,94760,CPT,460,RC,,OUTPATIENT,,,96.75,38.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,77.4,OTHER,72.56,94.82,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY EVALUATION REPEAT(NSY,94760,CPT,460,RC,,OUTPATIENT,,,96.75,38.7,MONUMENT,COMMERCIAL,,,,77.4,,72.56,94.82,
PT THERAPY EVAL MODERATE COMP,97162GP,CPT,424,RC,GP,OUTPATIENT,,,349,139.6,UNITED HEALTH,UNITED COMMERCIAL,,,,296.65,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY/PER DAY,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,BLUE CROSS ANTHEM,COMMERCIAL,,,,154,OTHER,144.38,188.65,PERCENT OF CHARGES BASED ON HCPCS CODE
OXIMETRY/PER DAY,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,MONUMENT,COMMERCIAL,,,,154,,144.38,188.65,
PT THERAPY EVALHIGH COMPLEXITY,97163GP,CPT,424,RC,GP,OUTPATIENT,,,394,157.6,UNITED HEALTH,UNITED COMMERCIAL,,,,334.9,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
DELIVER PLACENTA,59414,CPT,722,RC,,OUTPATIENT,,,5228.48,2091.392,BLUE CROSS ANTHEM,COMMERCIAL,,,,4182.784,OTHER,3921.4,5123.9,PERCENT OF CHARGES BASED ON HCPCS CODE
DELIVER PLACENTA,59414,CPT,722,RC,,OUTPATIENT,,,5228.48,2091.392,MONUMENT,COMMERCIAL,,,,4182.8,,3921.4,5123.9,
PT REASSESSMENT,97164GP,CPT,424,RC,GP,OUTPATIENT,,,142.26,56.904,UNITED HEALTH,UNITED COMMERCIAL,,,,120.921,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,BLUE CROSS ANTHEM,COMMERCIAL,,,,1011.872,OTHER,948.6,1239.5,PERCENT OF CHARGES BASED ON HCPCS CODE
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,MONUMENT,COMMERCIAL,,,,1011.9,,948.6,1239.5,
OT EVAL - LOW COMPLEXITY,97165GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UNITED HEALTH,UNITED COMMERCIAL,,,,170.731,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OB US LIMITED FETUS(S) BEDSIDE,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,BLUE CROSS ANTHEM,COMMERCIAL,,,,173.76,OTHER,162.9,212.9,PERCENT OF CHARGES BASED ON HCPCS CODE
OB US LIMITED FETUS(S) BEDSIDE,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,MONUMENT,COMMERCIAL,,,,173.8,,162.9,212.9,
OT EVAL - MODERATE COMPLEXITY,97166GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UNITED HEALTH,UNITED COMMERCIAL,,,,170.731,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 1, EST",G0463,HCPCS,510,RC,,INPATIENT,,,51,20.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,46.41,OTHER,38.3,50,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OP VISIT LEVEL 1, EST",G0463,HCPCS,510,RC,,INPATIENT,,,51,20.4,MONUMENT,COMMERCIAL,,,,40.8,,38.3,50,
"OP VISIT LEVEL 1, EST",G0463,HCPCS,510,RC,,INPATIENT,,,51,20.4,UNITED HEALTH,UNITED COMMERCIAL,,,,38.3,,38.3,50,
"OP VISIT LEVEL 2, EST",G0463,HCPCS,510,RC,,INPATIENT,,,112,44.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,101.92,OTHER,84,109.8,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OP VISIT LEVEL 2, EST",G0463,HCPCS,510,RC,,INPATIENT,,,112,44.8,MONUMENT,COMMERCIAL,,,,89.6,,84,109.8,
"OP VISIT LEVEL 2, EST",G0463,HCPCS,510,RC,,INPATIENT,,,112,44.8,UNITED HEALTH,UNITED COMMERCIAL,,,,84,,84,109.8,
"OP VISIT LEVEL 3, EST",G0463,HCPCS,510,RC,,INPATIENT,,,185,74,BLUE CROSS ANTHEM,COMMERCIAL,,,,168.35,OTHER,138.8,181.3,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OP VISIT LEVEL 3, EST",G0463,HCPCS,510,RC,,INPATIENT,,,185,74,MONUMENT,COMMERCIAL,,,,148,,138.8,181.3,
"OP VISIT LEVEL 3, EST",G0463,HCPCS,510,RC,,INPATIENT,,,185,74,UNITED HEALTH,UNITED COMMERCIAL,,,,138.8,,138.8,181.3,
"OP VISIT LEVEL 4, EST",G0463,HCPCS,510,RC,,INPATIENT,,,274,109.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,249.34,OTHER,205.5,268.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OP VISIT LEVEL 4, EST",G0463,HCPCS,510,RC,,INPATIENT,,,274,109.6,MONUMENT,COMMERCIAL,,,,219.2,,205.5,268.5,
"OP VISIT LEVEL 4, EST",G0463,HCPCS,510,RC,,INPATIENT,,,274,109.6,UNITED HEALTH,UNITED COMMERCIAL,,,,205.5,,205.5,268.5,
"OP VISIT LEVEL 5, EST",G0463,HCPCS,510,RC,,INPATIENT,,,371,148.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,337.61,OTHER,278.3,363.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OP VISIT LEVEL 5, EST",G0463,HCPCS,510,RC,,INPATIENT,,,371,148.4,MONUMENT,COMMERCIAL,,,,296.8,,278.3,363.6,
"OP VISIT LEVEL 5, EST",G0463,HCPCS,510,RC,,INPATIENT,,,371,148.4,UNITED HEALTH,UNITED COMMERCIAL,,,,278.3,,278.3,363.6,
EKG,93005,CPT,730,RC,,OUTPATIENT,,,362.25,144.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,289.8,OTHER,271.69,355.01,PERCENT OF CHARGES BASED ON HCPCS CODE
EKG,93005,CPT,730,RC,,OUTPATIENT,,,362.25,144.9,MONUMENT,COMMERCIAL,,,,289.8,,271.69,355.01,
OT EVAL - HIGH COMPLEXITY,97167GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UNITED HEALTH,UNITED COMMERCIAL,,,,170.731,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,76.5,99.96,PERCENT OF CHARGES BASED ON HCPCS CODE
RHYTHM STRIP,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,UNITED HEALTH,UNITED COMMERCIAL,,,,97.75,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP TRACING ONLY,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.752,OTHER,76.5,99.96,PERCENT OF CHARGES BASED ON HCPCS CODE
RHYTHM STRIP TRACING ONLY,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,MONUMENT,COMMERCIAL,,,,81.6,,76.5,99.96,
OT RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,UNITED HEALTH,UNITED COMMERCIAL,,,,97.75,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
HOLTER MONITOR RECORDING/SETUP,93225,CPT,731,RC,,OUTPATIENT,,,327.75,131.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,262.2,OTHER,245.81,321.2,PERCENT OF CHARGES BASED ON HCPCS CODE
HOLTER MONITOR RECORDING/SETUP,93225,CPT,731,RC,,OUTPATIENT,,,327.75,131.1,MONUMENT,COMMERCIAL,,,,262.2,,245.81,321.2,
THERAPEUTIC ACTIVITIES/15 MIN,97530GO,CPT,430,RC,GO,OUTPATIENT,,,108.25,43.3,UNITED HEALTH,UNITED COMMERCIAL,,,,92.0125,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSCOPY PROCEDURE,7310025,CDM,,,,INPATIENT,,,2996.25,1198.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,2726.59,OTHER,2247.19,2936.33,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
BRONCHOSCOPY PROCEDURE,7310025,CDM,,,,INPATIENT,,,2996.25,1198.5,MONUMENT,COMMERCIAL,,,,2397,,2247.19,2936.33,
BRONCHOSCOPY PROCEDURE,7310025,CDM,,,,INPATIENT,,,2996.25,1198.5,UNITED HEALTH,UNITED COMMERCIAL,,,,2247.19,,2247.19,2936.33,
CATHETERIZE FRO URINE SPEC,P9612,HCPCS,300,RC,,INPATIENT,,,152.5,61,BLUE CROSS ANTHEM,COMMERCIAL,,,,138.78,OTHER,114.4,149.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
CATHETERIZE FRO URINE SPEC,P9612,HCPCS,300,RC,,INPATIENT,,,152.5,61,MONUMENT,COMMERCIAL,,,,122,,114.4,149.5,
CATHETERIZE FRO URINE SPEC,P9612,HCPCS,300,RC,,INPATIENT,,,152.5,61,UNITED HEALTH,UNITED COMMERCIAL,,,,114.4,,114.4,149.5,
OBSERVATION OB,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.21,OTHER,58.69,76.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBSERVATION OB,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,MONUMENT,COMMERCIAL,,,,62.6,,58.69,76.69,
OBSERVATION OB,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,UNITED HEALTH,UNITED COMMERCIAL,,,,58.69,,58.69,76.69,
OBSERVATION ROOM,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,71.21,OTHER,58.69,76.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBSERVATION ROOM,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,MONUMENT,COMMERCIAL,,,,62.6,,58.69,76.69,
OBSERVATION ROOM,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,UNITED HEALTH,UNITED COMMERCIAL,,,,58.69,,58.69,76.69,
THERAPEUTIC/DIAG INJ LEVEL I,96372,CPT,260,RC,,OUTPATIENT,,,272.5,109,BLUE CROSS ANTHEM,COMMERCIAL,,,,218,OTHER,204.38,267.05,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC/DIAG INJ LEVEL I,96372,CPT,260,RC,,OUTPATIENT,,,272.5,109,MONUMENT,COMMERCIAL,,,,218,,204.38,267.05,
THERAPEUTIC ACT,97530GP,CPT,420,RC,GP,OUTPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,122.4,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC/DIAG INJ LEVEL II,96372,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,129.8,OTHER,121.69,159.01,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC/DIAG INJ LEVEL II,96372,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,MONUMENT,COMMERCIAL,,,,129.8,,121.69,159.01,
THERAPEUTIC ACTIVITIES,97530GP,CPT,420,RC,GP,OUTPATIENT,,,113.75,45.5,UNITED HEALTH,UNITED COMMERCIAL,,,,96.6875,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
IM VACCINATION <18 YRS OLD,90460,CPT,761,RC,,OUTPATIENT,,,137,54.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,109.6,OTHER,102.75,134.26,PERCENT OF CHARGES BASED ON HCPCS CODE
IM VACCINATION <18 YRS OLD,90460,CPT,761,RC,,OUTPATIENT,,,137,54.8,MONUMENT,COMMERCIAL,,,,109.6,,102.75,134.26,
SELF CARE MANAGEMENT/15 MIN,97535GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,UNITED HEALTH,UNITED COMMERCIAL,,,,64.175,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
COLL OF BLOOD BY VENI PUNCTUR,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,20.8,OTHER,19.5,25.48,PERCENT OF CHARGES BASED ON HCPCS CODE
COLL OF BLOOD BY VENI PUNCTUR,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,MONUMENT,COMMERCIAL,,,,20.8,,19.5,25.48,
SELF CARE MANAGEMENT/15 MIN,97535GP,CPT,420,RC,GP,OUTPATIENT,,,139,55.6,UNITED HEALTH,UNITED COMMERCIAL,,,,118.15,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE FLUSH/DRAW,90784,CPT,361,RC,,OUTPATIENT,,,110.25,44.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,88.2,OTHER,82.69,108.05,PERCENT OF CHARGES BASED ON HCPCS CODE
CENTRAL LINE FLUSH/DRAW,90784,CPT,361,RC,,OUTPATIENT,,,110.25,44.1,MONUMENT,COMMERCIAL,,,,88.2,,82.69,108.05,
COMMUNITY-WORK REINT TRN/15 MN,97537GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,UNITED HEALTH,UNITED COMMERCIAL,,,,64.175,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,INPATIENT,,,534.5,213.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,486.4,OTHER,400.88,523.81,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,INPATIENT,,,534.5,213.8,MONUMENT,COMMERCIAL,,,,427.6,,400.88,523.81,
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,INPATIENT,,,534.5,213.8,UNITED HEALTH,UNITED COMMERCIAL,,,,400.88,,400.88,523.81,
IV INFUS THERAPY INIT LVL I,96365,CPT,260,RC,,OUTPATIENT,,,618.25,247.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,494.6,OTHER,463.69,605.89,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS THERAPY INIT LVL I,96365,CPT,260,RC,,OUTPATIENT,,,618.25,247.3,MONUMENT,COMMERCIAL,,,,494.6,,463.69,605.89,
WHEELCHAIR MANAGEMENT / 15 MIN,97542GO,CPT,430,RC,GO,OUTPATIENT,,,119,47.6,UNITED HEALTH,UNITED COMMERCIAL,,,,101.15,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
IV INFUS THERAPY INIT LVL II,96365,CPT,260,RC,,OUTPATIENT,,,550.25,220.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,440.2,OTHER,412.69,539.25,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUS THERAPY INIT LVL II,96365,CPT,260,RC,,OUTPATIENT,,,550.25,220.1,MONUMENT,COMMERCIAL,,,,440.2,,412.69,539.25,
WHEELCHAIR MANAGEMENT / 15 MIN,97542GP,CPT,420,RC,GP,OUTPATIENT,,,125,50,UNITED HEALTH,UNITED COMMERCIAL,,,,106.25,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION THERAPY ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,78.6,OTHER,73.69,96.29,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFUSION THERAPY ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,MONUMENT,COMMERCIAL,,,,78.6,,73.69,96.29,
ACTIVE WOUND CARE <20CM,97597GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
IV INFU THERAPY INIT LVL III,96365,CPT,260,RC,,OUTPATIENT,,,562.75,225.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,450.2,OTHER,422.06,551.5,PERCENT OF CHARGES BASED ON HCPCS CODE
IV INFU THERAPY INIT LVL III,96365,CPT,260,RC,,OUTPATIENT,,,562.75,225.1,MONUMENT,COMMERCIAL,,,,450.2,,422.06,551.5,
ACTIVE WOUND CARE >20CM,97598GP,CPT,420,RC,GP,OUTPATIENT,,,155.75,62.3,UNITED HEALTH,UNITED COMMERCIAL,,,,132.3875,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
INITIATION OF INFUSION PUMP,96416,CPT,335,RC,,OUTPATIENT,,,830.75,332.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,664.6,OTHER,623.06,814.14,PERCENT OF CHARGES BASED ON HCPCS CODE
INITIATION OF INFUSION PUMP,96416,CPT,335,RC,,OUTPATIENT,,,830.75,332.3,MONUMENT,COMMERCIAL,,,,664.6,,623.06,814.14,
WOUND CARE NON SELECTIVE,97602GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,UNITED HEALTH,UNITED COMMERCIAL,,,,304.1895,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
OSTOMY CARE VISIT,G0463,HCPCS,510,RC,,INPATIENT,,,104,41.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,94.64,OTHER,78,101.92,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OSTOMY CARE VISIT,G0463,HCPCS,510,RC,,INPATIENT,,,104,41.6,MONUMENT,COMMERCIAL,,,,83.2,,78,101.92,
OSTOMY CARE VISIT,G0463,HCPCS,510,RC,,INPATIENT,,,104,41.6,UNITED HEALTH,UNITED COMMERCIAL,,,,78,,78,101.92,
ABSCESS DRAIN NECK/CHEST,21501,CPT,761,RC,,OUTPATIENT,,,3972.25,1588.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,3177.8,OTHER,2979.19,3892.81,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSCESS DRAIN NECK/CHEST,21501,CPT,761,RC,,OUTPATIENT,,,3972.25,1588.9,MONUMENT,COMMERCIAL,,,,3177.8,,2979.19,3892.81,
PHYSICAL PERFORM-CAP TEST/15MN,97750GO,CPT,430,RC,GO,OUTPATIENT,,,140.75,56.3,UNITED HEALTH,UNITED COMMERCIAL,,,,119.6375,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EA ADD'L IVP,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC EA ADD'L IVP,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
PHYSICAL PERFORMANCE TEST 15 M,97750GP,CPT,420,RC,GP,OUTPATIENT,,,148,59.2,UNITED HEALTH,UNITED COMMERCIAL,,,,125.8,OTHER,111,145.04,PERCENT OF TOTAL BILLED CHARGES
OBS IM/SQ VACCINE,90471,CPT,761,RC,,INPATIENT,,,144,57.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,131.04,OTHER,108,141.12,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS IM/SQ VACCINE,90471,CPT,761,RC,,INPATIENT,,,144,57.6,MONUMENT,COMMERCIAL,,,,115.2,,108,141.12,
OBS IM/SQ VACCINE,90471,CPT,761,RC,,INPATIENT,,,144,57.6,UNITED HEALTH,UNITED COMMERCIAL,,,,108,,108,141.12,
OBS STRAIGHT BLADDER CATHETER,51701,CPT,450,RC,,INPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,203.05,OTHER,108.75,142.1,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS STRAIGHT BLADDER CATHETER,51701,CPT,450,RC,,INPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,116,,108.75,142.1,
OBS STRAIGHT BLADDER CATHETER,51701,CPT,450,RC,,INPATIENT,,,223.13,89.252,UNITED HEALTH,UNITED COMMERCIAL,,,,108.75,,108.75,142.1,
"OBS FOLEY CATHETER, SIMPLE",51702,CPT,320,RC,,INPATIENT,,,343.75,137.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,312.81,OTHER,257.81,336.88,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OBS FOLEY CATHETER, SIMPLE",51702,CPT,320,RC,,INPATIENT,,,343.75,137.5,MONUMENT,COMMERCIAL,,,,275,,257.81,336.88,
"OBS FOLEY CATHETER, SIMPLE",51702,CPT,320,RC,,INPATIENT,,,343.75,137.5,UNITED HEALTH,UNITED COMMERCIAL,,,,257.81,,257.81,336.88,
"OBS FOLEY CATHETER, COMPLEX",51703,CPT,320,RC,,INPATIENT,,,450.5,180.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,409.96,OTHER,337.88,441.49,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OBS FOLEY CATHETER, COMPLEX",51703,CPT,320,RC,,INPATIENT,,,450.5,180.2,MONUMENT,COMMERCIAL,,,,360.4,,337.88,441.49,
"OBS FOLEY CATHETER, COMPLEX",51703,CPT,320,RC,,INPATIENT,,,450.5,180.2,UNITED HEALTH,UNITED COMMERCIAL,,,,337.88,,337.88,441.49,
"OBS CONCURRENT MEDICATED, INF",96368,CPT,450,RC,,INPATIENT,,,132.25,52.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,120.35,OTHER,99.19,129.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
"OBS CONCURRENT MEDICATED, INF",96368,CPT,450,RC,,INPATIENT,,,132.25,52.9,MONUMENT,COMMERCIAL,,,,105.8,,99.19,129.61,
"OBS CONCURRENT MEDICATED, INF",96368,CPT,450,RC,,INPATIENT,,,132.25,52.9,UNITED HEALTH,UNITED COMMERCIAL,,,,99.19,,99.19,129.61,
OBS BLADDER IRRIGATION,51700,CPT,450,RC,,INPATIENT,,,621.5,248.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,565.57,OTHER,466.13,609.07,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS BLADDER IRRIGATION,51700,CPT,450,RC,,INPATIENT,,,621.5,248.6,MONUMENT,COMMERCIAL,,,,497.2,,466.13,609.07,
OBS BLADDER IRRIGATION,51700,CPT,450,RC,,INPATIENT,,,621.5,248.6,UNITED HEALTH,UNITED COMMERCIAL,,,,466.13,,466.13,609.07,
OBS CHEST TUBE INSERT,32551,CPT,450,RC,,INPATIENT,,,1144.5,457.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,1041.5,OTHER,858.38,1121.61,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
OBS CHEST TUBE INSERT,32551,CPT,450,RC,,INPATIENT,,,1144.5,457.8,MONUMENT,COMMERCIAL,,,,915.6,,858.38,1121.61,
OBS CHEST TUBE INSERT,32551,CPT,450,RC,,INPATIENT,,,1144.5,457.8,UNITED HEALTH,UNITED COMMERCIAL,,,,858.38,,858.38,1121.61,
NG-OG TUBE,43753,CPT,450,RC,,INPATIENT,,,527.09,210.836,BLUE CROSS ANTHEM,COMMERCIAL,,,,479.65,OTHER,203.44,265.83,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
NG-OG TUBE,43753,CPT,450,RC,,INPATIENT,,,527.09,210.836,MONUMENT,COMMERCIAL,,,,217,,203.44,265.83,
NG-OG TUBE,43753,CPT,450,RC,,INPATIENT,,,527.09,210.836,UNITED HEALTH,UNITED COMMERCIAL,,,,203.44,,203.44,265.83,
BIOPSY DEEP TISSUE OF BACK CT,21925,CPT,361,RC,,OUTPATIENT,,,2552.25,1020.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,2041.8,OTHER,1914.19,2501.21,PERCENT OF CHARGES BASED ON HCPCS CODE
BIOPSY DEEP TISSUE OF BACK CT,21925,CPT,361,RC,,OUTPATIENT,,,2552.25,1020.9,MONUMENT,COMMERCIAL,,,,2041.8,,1914.19,2501.21,
ORTHOTICS FIT-TRAINING/15 MIN,97760GO,CPT,430,RC,GO,OUTPATIENT,,,275,110,UNITED HEALTH,UNITED COMMERCIAL,,,,233.75,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
BIOPSY OF LIVER  NEEDLE,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,1221.4,OTHER,1145.06,1496.22,PERCENT OF CHARGES BASED ON HCPCS CODE
BIOPSY OF LIVER  NEEDLE,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,MONUMENT,COMMERCIAL,,,,1221.4,,1145.06,1496.22,
ORTHOTICS FITTING 15 MINS,97760GP,CPT,420,RC,GP,OUTPATIENT,,,117.75,47.1,UNITED HEALTH,UNITED COMMERCIAL,,,,100.0875,OTHER,88.31,115.4,PERCENT OF TOTAL BILLED CHARGES
NEEDLE BIOPSY ABDOMINAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,1210.4,OTHER,1134.75,1482.74,PERCENT OF CHARGES BASED ON HCPCS CODE
NEEDLE BIOPSY ABDOMINAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,MONUMENT,COMMERCIAL,,,,1210.4,,1134.75,1482.74,
PROSTHETIC TRAINING / 15 MIN,97761GO,CPT,430,RC,GO,OUTPATIENT,,,87.14,34.856,UNITED HEALTH,UNITED COMMERCIAL,,,,74.069,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION INITIAL RAD,99152,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
MODERATE SEDATION INITIAL RAD,99152,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
ORHOTIC/PROSTHETIC CHECK/15 MN,97763GO,CPT,430,RC,GO,OUTPATIENT,,,250.54,100.216,UNITED HEALTH,UNITED COMMERCIAL,,,,212.959,OTHER,40.31,52.68,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAINAGE,49419,CPT,320,RC,,OUTPATIENT,,,3599.5,1439.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,2879.6,OTHER,2699.63,3527.51,PERCENT OF CHARGES BASED ON HCPCS CODE
ABSCESS DRAINAGE,49419,CPT,320,RC,,OUTPATIENT,,,3599.5,1439.8,MONUMENT,COMMERCIAL,,,,2879.6,,2699.63,3527.51,
C/O FOR ORTHOTIC/PROSTH USE,97763GP,CPT,420,RC,GP,OUTPATIENT,,,123.75,49.5,UNITED HEALTH,UNITED COMMERCIAL,,,,105.1875,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION (RAD),99153,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,175,OTHER,164.06,214.38,PERCENT OF CHARGES BASED ON HCPCS CODE
MODERATE SEDATION (RAD),99153,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,MONUMENT,COMMERCIAL,,,,175,,164.06,214.38,
PENG BENZATHINE/PROCAINE INJ,J0558,HCPCS,516,RC,,OUTPATIENT,,,15,6,UNITED HEALTH,UNITED COMMERCIAL,,,,12.75,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM RADIOLOGY,7614946,CDM,,,,INPATIENT,,,638.5,255.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,581.04,OTHER,478.88,625.73,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM RADIOLOGY,7614946,CDM,,,,INPATIENT,,,638.5,255.4,MONUMENT,COMMERCIAL,,,,510.8,,478.88,625.73,
RECOVERY ROOM RADIOLOGY,7614946,CDM,,,,INPATIENT,,,638.5,255.4,UNITED HEALTH,UNITED COMMERCIAL,,,,478.88,,478.88,625.73,
RECOVERY ROOM RADIOLOGY ADD'L,7614948,CDM,710,RC,,INPATIENT,,,128.25,51.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,116.71,OTHER,96.19,125.69,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
RECOVERY ROOM RADIOLOGY ADD'L,7614948,CDM,710,RC,,INPATIENT,,,128.25,51.3,MONUMENT,COMMERCIAL,,,,102.6,,96.19,125.69,
RECOVERY ROOM RADIOLOGY ADD'L,7614948,CDM,710,RC,,INPATIENT,,,128.25,51.3,UNITED HEALTH,UNITED COMMERCIAL,,,,96.19,,96.19,125.69,
NEBULIZER TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,BLUE CROSS ANTHEM,COMMERCIAL,,,,299.576,OTHER,98.81,129.12,PERCENT OF CHARGES BASED ON HCPCS CODE
NEBULIZER TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,MONUMENT,COMMERCIAL,,,,105.4,,98.81,129.12,
PENICILLIN G BENZATHINE INJ,J0561,HCPCS,516,RC,,OUTPATIENT,,,20,8,UNITED HEALTH,UNITED COMMERCIAL,,,,17,OTHER,15,19.6,PERCENT OF TOTAL BILLED CHARGES
BLOOD DRAW OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,223.14,89.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.512,OTHER,167.4,218.7,PERCENT OF CHARGES BASED ON HCPCS CODE
BLOOD DRAW OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,223.14,89.256,MONUMENT,COMMERCIAL,,,,178.5,,167.4,218.7,
DIPHENHYDRAMINE HCL INJECTIO,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1.7,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,223.14,89.256,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.512,OTHER,167.4,218.7,PERCENT OF CHARGES BASED ON HCPCS CODE
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,223.14,89.256,MONUMENT,COMMERCIAL,,,,178.5,,167.4,218.7,
ROCEPHIN INJ,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1.7,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,BLUE CROSS ANTHEM,COMMERCIAL,,,,424.368,OTHER,397.8,519.9,PERCENT OF CHARGES BASED ON HCPCS CODE
CHANGE OF BLADDER TUBE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,MONUMENT,COMMERCIAL,,,,424.4,,397.8,519.9,
DEXAMETHASONE SODIUM PHOS,J1100,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE COMPLEX,51710,CPT,320,RC,,OUTPATIENT,,,572.8,229.12,BLUE CROSS ANTHEM,COMMERCIAL,,,,458.24,OTHER,429.6,561.3,PERCENT OF CHARGES BASED ON HCPCS CODE
CHANGE OF BLADDER TUBE COMPLEX,51710,CPT,320,RC,,OUTPATIENT,,,572.8,229.12,MONUMENT,COMMERCIAL,,,,458.2,,429.6,561.3,
KETOROLAC TROMETHAMINE INJ,J1885,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UNITED HEALTH,UNITED COMMERCIAL,,,,1.7,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
US LIMITED NONVAS EXTR BILAT,7688250,CPT,450,RC,50,OUTPATIENT,,,554.5,221.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,443.6,OTHER,415.88,543.41,PERCENT OF CHARGES BASED ON HCPCS CODE
US LIMITED NONVAS EXTR BILAT,7688250,CPT,450,RC,50,OUTPATIENT,,,554.5,221.8,MONUMENT,COMMERCIAL,,,,443.6,,415.88,543.41,
ONDANSETRON HCL INJECTION,J2405,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
MDCR SCREENING EKG,G0404,HCPCS,770,RC,,INPATIENT,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,,,,68.25,OTHER,56.25,73.5,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MDCR SCREENING EKG,G0404,HCPCS,770,RC,,INPATIENT,,,75,30,MONUMENT,COMMERCIAL,,,,60,,56.25,73.5,
MDCR SCREENING EKG,G0404,HCPCS,770,RC,,INPATIENT,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,,,,56.25,,56.25,73.5,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF PNEUMOCOCCOL VACCINE,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF PNEUMOCOCCOL VACCINE,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF PNEUMOCOCCOL VACCINE,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF HEPATITIS B VACC,G0010,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF HEPATITIS B VACC,G0010,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF HEPATITIS B VACC,G0010,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF PNEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF PNEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF PNEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
ADMIN OF PHEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,BLUE CROSS ANTHEM,COMMERCIAL,,,,52.55,OTHER,43.31,56.6,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
ADMIN OF PHEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,MONUMENT,COMMERCIAL,,,,46.2,,43.31,56.6,
ADMIN OF PHEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UNITED HEALTH,UNITED COMMERCIAL,,,,43.31,,43.31,56.6,
LIVING WITH PAIN (GROUP CLASS),9150000,CDM,,,,OUTPATIENT,,,120,48,BLUE CROSS ANTHEM,COMMERCIAL,,,,96,OTHER,90,117.6,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVING WITH PAIN (GROUP CLASS),9150000,CDM,,,,OUTPATIENT,,,120,48,MONUMENT,COMMERCIAL,,,,96,,90,117.6,
PROMETHAZINE HCL INJECTION,J2550,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3.4,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
US CAROTID DUPLEX,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1079.8,OTHER,1012.31,1322.76,PERCENT OF CHARGES BASED ON HCPCS CODE
US CAROTID DUPLEX,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,MONUMENT,COMMERCIAL,,,,1079.8,,1012.31,1322.76,
METHYLPREDNISOLONE INJECTION,J2920,HCPCS,516,RC,,OUTPATIENT,,,6,2.4,UNITED HEALTH,UNITED COMMERCIAL,,,,5.1,OTHER,4.5,5.88,PERCENT OF TOTAL BILLED CHARGES
VESSEL MAPPING HEMO ACCESS,G0365,HCPCS,402,RC,,INPATIENT,,,717.5,287,BLUE CROSS ANTHEM,COMMERCIAL,,,,652.93,OTHER,538.13,703.15,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
VESSEL MAPPING HEMO ACCESS,G0365,HCPCS,402,RC,,INPATIENT,,,717.5,287,MONUMENT,COMMERCIAL,,,,574,,538.13,703.15,
VESSEL MAPPING HEMO ACCESS,G0365,HCPCS,402,RC,,INPATIENT,,,717.5,287,UNITED HEALTH,UNITED COMMERCIAL,,,,538.13,,538.13,703.15,
US DUPLEX V/A FLOW BIL,93925,CPT,402,RC,,OUTPATIENT,,,959.25,383.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,767.4,OTHER,719.44,940.07,PERCENT OF CHARGES BASED ON HCPCS CODE
US DUPLEX V/A FLOW BIL,93925,CPT,402,RC,,OUTPATIENT,,,959.25,383.7,MONUMENT,COMMERCIAL,,,,767.4,,719.44,940.07,
METHYLPREDNISOLONE INJECTION,J2930,HCPCS,516,RC,,OUTPATIENT,,,9,3.6,UNITED HEALTH,UNITED COMMERCIAL,,,,7.65,OTHER,6.75,8.82,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER BILATERAL,93970,CPT,921,RC,,OUTPATIENT,,,1293.25,517.3,BLUE CROSS ANTHEM,COMMERCIAL,,,,1034.6,OTHER,969.94,1267.39,PERCENT OF CHARGES BASED ON HCPCS CODE
US VEN DOPPLER BILATERAL,93970,CPT,921,RC,,OUTPATIENT,,,1293.25,517.3,MONUMENT,COMMERCIAL,,,,1034.6,,969.94,1267.39,
TRIAMCINOLONE ACETONIDE INJ,J3301,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,UNITED HEALTH,UNITED COMMERCIAL,,,,3.4,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER UNILATERAL,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,742.8,OTHER,696.38,909.93,PERCENT OF CHARGES BASED ON HCPCS CODE
US VEN DOPPLER UNILATERAL,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,MONUMENT,COMMERCIAL,,,,742.8,,696.38,909.93,
NORMAL SALINE 1000CC BAG,J7030,HCPCS,516,RC,,OUTPATIENT,,,5,2,UNITED HEALTH,UNITED COMMERCIAL,,,,4.25,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
DUPLEX V/A FLOW UNILATERAL,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,429.2,OTHER,402.38,525.77,PERCENT OF CHARGES BASED ON HCPCS CODE
DUPLEX V/A FLOW UNILATERAL,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,MONUMENT,COMMERCIAL,,,,429.2,,402.38,525.77,
NORMAL SALINE 250CC BAG,J7050,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER LIMITED,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,BLUE CROSS ANTHEM,COMMERCIAL,,,,467.2,OTHER,438,572.32,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER DOPPLER LIMITED,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,MONUMENT,COMMERCIAL,,,,467.2,,438,572.32,
PREDNISONE ORAL,J7506,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER ONLY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,BLUE CROSS ANTHEM,COMMERCIAL,,,,366.944,OTHER,344,449.5,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER DOPPLER ONLY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,MONUMENT,COMMERCIAL,,,,366.9,,344,449.5,
PR PREDNISONE IMMEDIATE RELEAS,J7512,HCPCS,516,RC,,OUTPATIENT,,,0.05,0.02,UNITED HEALTH,UNITED COMMERCIAL,,,,0.0425,OTHER,0.04,0.05,PERCENT OF TOTAL BILLED CHARGES
US HEAD DUP EXTRACRANIAL ARTER,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,BLUE CROSS ANTHEM,COMMERCIAL,,,,1079.8,OTHER,1012.31,1322.76,PERCENT OF CHARGES BASED ON HCPCS CODE
US HEAD DUP EXTRACRANIAL ARTER,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,MONUMENT,COMMERCIAL,,,,1079.8,,1012.31,1322.76,
"ALBUTEROL, INHALATION SOLUTION",J7613,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
LIVER ONLY,76705,CPT,402,RC,,OUTPATIENT,,,620.9,248.36,BLUE CROSS ANTHEM,COMMERCIAL,,,,496.72,OTHER,465.7,608.5,PERCENT OF CHARGES BASED ON HCPCS CODE
LIVER ONLY,76705,CPT,402,RC,,OUTPATIENT,,,620.9,248.36,MONUMENT,COMMERCIAL,,,,496.7,,465.7,608.5,
ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
AMB BP MONITOR RECORDING,93786,CPT,920,RC,,OUTPATIENT,,,224.25,89.7,BLUE CROSS ANTHEM,COMMERCIAL,,,,179.4,OTHER,168.19,219.77,PERCENT OF CHARGES BASED ON HCPCS CODE
AMB BP MONITOR RECORDING,93786,CPT,920,RC,,OUTPATIENT,,,224.25,89.7,MONUMENT,COMMERCIAL,,,,179.4,,168.19,219.77,
SCHOOL/CAMP PHY LEVEL 1,P99901,HCPCS,516,RC,,OUTPATIENT,,,35,14,UNITED HEALTH,UNITED COMMERCIAL,,,,29.75,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
AMB BP 24 HRS SCAN ANALYSIS,93788,CPT,480,RC,,OUTPATIENT,,,475.5,190.2,BLUE CROSS ANTHEM,COMMERCIAL,,,,380.4,OTHER,356.63,465.99,PERCENT OF CHARGES BASED ON HCPCS CODE
AMB BP 24 HRS SCAN ANALYSIS,93788,CPT,480,RC,,OUTPATIENT,,,475.5,190.2,MONUMENT,COMMERCIAL,,,,380.4,,356.63,465.99,
DOT PHYSICAL,P99904,HCPCS,516,RC,,OUTPATIENT,,,170,68,UNITED HEALTH,UNITED COMMERCIAL,,,,144.5,OTHER,127.5,166.6,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PHLEBOTOMY,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,BLUE CROSS ANTHEM,COMMERCIAL,,,,212.8,OTHER,199.5,260.68,PERCENT OF CHARGES BASED ON HCPCS CODE
THERAPEUTIC PHLEBOTOMY,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,MONUMENT,COMMERCIAL,,,,212.8,,199.5,260.68,
ONDANSETRON 1 MG,Q0162,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UNITED HEALTH,UNITED COMMERCIAL,,,,0.85,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
PICC LINE PLACEMENT,36569,CPT,361,RC,,INPATIENT,,,1516.25,606.5,BLUE CROSS ANTHEM,COMMERCIAL,,,,1379.79,OTHER,1137.19,1485.93,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PICC LINE PLACEMENT,36569,CPT,361,RC,,INPATIENT,,,1516.25,606.5,MONUMENT,COMMERCIAL,,,,1213,,1137.19,1485.93,
PICC LINE PLACEMENT,36569,CPT,361,RC,,INPATIENT,,,1516.25,606.5,UNITED HEALTH,UNITED COMMERCIAL,,,,1137.19,,1137.19,1485.93,
MEDTRONIC MINIMED INSULIN PUMP,9420009,CDM,,,,INPATIENT,,,300,120,BLUE CROSS ANTHEM,COMMERCIAL,,,,273,OTHER,225,294,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
MEDTRONIC MINIMED INSULIN PUMP,9420009,CDM,,,,INPATIENT,,,300,120,MONUMENT,COMMERCIAL,,,,240,,225,294,
MEDTRONIC MINIMED INSULIN PUMP,9420009,CDM,,,,INPATIENT,,,300,120,UNITED HEALTH,UNITED COMMERCIAL,,,,225,,225,294,
CARDIAC REHAB W/MONITOR,93798,CPT,948,RC,,OUTPATIENT,,,231.33,92.532,BLUE CROSS ANTHEM,COMMERCIAL,,,,185.064,OTHER,131.63,171.99,PERCENT OF CHARGES BASED ON HCPCS CODE
CARDIAC REHAB W/MONITOR,93798,CPT,948,RC,,OUTPATIENT,,,231.33,92.532,MONUMENT,COMMERCIAL,,,,140.4,,131.63,171.99,
"CLINDAMYCIN PHOSP, 300MG INJ",S0077,HCPCS,,,,OUTPATIENT,,,22,8.8,UNITED HEALTH,UNITED COMMERCIAL,,,,18.7,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB WITH EXERCISE,G0424,HCPCS,948,RC,,INPATIENT,,,192,76.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,174.72,OTHER,144,188.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PULMONARY REHAB WITH EXERCISE,G0424,HCPCS,948,RC,,INPATIENT,,,192,76.8,MONUMENT,COMMERCIAL,,,,153.6,,144,188.16,
PULMONARY REHAB WITH EXERCISE,G0424,HCPCS,948,RC,,INPATIENT,,,192,76.8,UNITED HEALTH,UNITED COMMERCIAL,,,,144,,144,188.16,
SUPERVISED EXERCISE THERAPY,93668,CPT,943,RC,,OUTPATIENT,,,192,76.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,153.6,OTHER,144,188.16,PERCENT OF CHARGES BASED ON HCPCS CODE
SUPERVISED EXERCISE THERAPY,93668,CPT,943,RC,,OUTPATIENT,,,192,76.8,MONUMENT,COMMERCIAL,,,,153.6,,144,188.16,
ONDANSETRON 4MG,S0119,HCPCS,,,,OUTPATIENT,,,39,15.6,UNITED HEALTH,UNITED COMMERCIAL,,,,33.15,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
WALK TEST W/O2 SATS 6 MINS,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,BLUE CROSS ANTHEM,COMMERCIAL,,,,178.504,OTHER,84.56,110.5,PERCENT OF CHARGES BASED ON HCPCS CODE
WALK TEST W/O2 SATS 6 MINS,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,MONUMENT,COMMERCIAL,,,,90.2,,84.56,110.5,
SPLINT DIGIT,S8450,HCPCS,516,RC,,OUTPATIENT,,,5,2,UNITED HEALTH,UNITED COMMERCIAL,,,,4.25,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB MGMT CLASS (1),G0239,HCPCS,410,RC,,INPATIENT,,,192,76.8,BLUE CROSS ANTHEM,COMMERCIAL,,,,174.72,OTHER,144,188.16,"PERCENT OF BILLED CHARGES WITH DRG LIMIT, FLOOR AMOUNT, CEILING AMOUNT"
PULMONARY REHAB MGMT CLASS (1),G0239,HCPCS,410,RC,,INPATIENT,,,192,76.8,MONUMENT,COMMERCIAL,,,,153.6,,144,188.16,
PULMONARY REHAB MGMT CLASS (1),G0239,HCPCS,410,RC,,INPATIENT,,,192,76.8,UNITED HEALTH,UNITED COMMERCIAL,144,,,,OTHER,144,188.16,"PER VISIT OUTPATIENT CAN TRIGGER A FLAT RATE PER REVENUE CODE, A PERCENTAGE OF ITEM CHARGES, OR A PERCENTAGE OF TOTAL CHARGES"
MED/SURG LEVEL I,1100001,CDM,,,,INPATIENT,,,1891.5,756.6,AETNA,AETNA COMMERCIAL,1853.67,98,,,OTHER,1418.63,1853.67,PERCENT OF TOTAL BILLED CHARGES
MED/SURG LEVEL II,1100002,CDM,,,,INPATIENT,,,2626.5,1050.6,AETNA,AETNA COMMERCIAL,2573.97,98,,,OTHER,1969.88,2573.97,PERCENT OF TOTAL BILLED CHARGES
MED/SURG LEVEL III,1100003,CDM,,,,INPATIENT,,,3571.5,1428.6,AETNA,AETNA COMMERCIAL,3500.07,98,,,OTHER,2678.63,3500.07,PERCENT OF TOTAL BILLED CHARGES
MED/SURG W/TELEMETRY,1100005,CDM,,,,INPATIENT,,,4096.5,1638.6,AETNA,AETNA COMMERCIAL,4014.57,98,,,OTHER,3072.38,4014.57,PERCENT OF TOTAL BILLED CHARGES
ICU LEVEL I,1100010,CDM,,,,INPATIENT,,,4306.5,1722.6,AETNA,AETNA COMMERCIAL,4220.37,98,,,OTHER,3229.88,4220.37,PERCENT OF TOTAL BILLED CHARGES
ICU LEVEL II,1100011,CDM,,,,INPATIENT,,,4831.5,1932.6,AETNA,AETNA COMMERCIAL,4734.87,98,,,OTHER,3623.63,4734.87,PERCENT OF TOTAL BILLED CHARGES
ICU TRANSITIONAL,1100015,CDM,,,,INPATIENT,,,4096.5,1638.6,AETNA,AETNA COMMERCIAL,4014.57,98,,,OTHER,3072.38,4014.57,PERCENT OF TOTAL BILLED CHARGES
ICU MED SURG,1100020,CDM,,,,INPATIENT,,,946.25,378.5,AETNA,AETNA COMMERCIAL,927.325,98,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
TPAC ROOM RATE,1100030,CDM,,,,INPATIENT,,,400,160,AETNA,AETNA COMMERCIAL,392,98,,,OTHER,300,392,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION ELECTIVE (ICU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,AETNA,AETNA COMMERCIAL,1451.87,98,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
SEMI-PRIVATE ROOM & BOARD,1200001,CDM,,,,INPATIENT,,,946.25,378.5,AETNA,AETNA COMMERCIAL,927.325,98,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
NEWBORN CARE,1200002,CDM,,,,INPATIENT,,,729.5,291.8,AETNA,AETNA COMMERCIAL,714.91,98,,,OTHER,547.13,714.91,PERCENT OF TOTAL BILLED CHARGES
SEMI-PRIVATE ROOM OB,1200004,CDM,,,,INPATIENT,,,946.25,378.5,AETNA,AETNA COMMERCIAL,927.325,98,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
TRAY CEN VENOUS CATH 5.0 FR,1600000,CDM,,,,INPATIENT,,,500.5,200.2,AETNA,AETNA COMMERCIAL,490.49,98,,,OTHER,375.38,490.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
PRESSURE TRANSDUCER,1600162,CDM,,,,INPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
PORT ACCESS TRAY,1600166,CDM,,,,INPATIENT,,,38,15.2,AETNA,AETNA COMMERCIAL,37.24,98,,,OTHER,28.5,37.24,PERCENT OF TOTAL BILLED CHARGES
PUMP VSCD ANTIEMBIOLIC,1610200,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
KUGEL HERNIA PATCH,1610201,CDM,,,,INPATIENT,,,724.5,289.8,AETNA,AETNA COMMERCIAL,710.01,98,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
SPINAL LUMBAR PUNCTURE,1610210,CDM,,,,INPATIENT,,,249.25,99.7,AETNA,AETNA COMMERCIAL,244.265,98,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
PUMP IV,1610212,CDM,,,,INPATIENT,,,291.75,116.7,AETNA,AETNA COMMERCIAL,285.915,98,,,OTHER,218.81,285.92,PERCENT OF TOTAL BILLED CHARGES
PUMP KENDALL,1610218,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
PUMP FEEDING,1610220,CDM,,,,INPATIENT,,,144.25,57.7,AETNA,AETNA COMMERCIAL,141.365,98,,,OTHER,108.19,141.37,PERCENT OF TOTAL BILLED CHARGES
IV PUMP PER DAY,1610222,CDM,,,,INPATIENT,,,291.75,116.7,AETNA,AETNA COMMERCIAL,285.915,98,,,OTHER,218.81,285.92,PERCENT OF TOTAL BILLED CHARGES
TRACTION BUCKS BOOT,1610242,CDM,,,,INPATIENT,,,175,70,AETNA,AETNA COMMERCIAL,171.5,98,,,OTHER,131.25,171.5,PERCENT OF TOTAL BILLED CHARGES
PROBE COVER KIT,1610244,CDM,,,,INPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 15MM,1611000,CDM,,,,INPATIENT,,,922.5,369,AETNA,AETNA COMMERCIAL,904.05,98,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 20MM,1611020,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 25MM,1611040,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 30MM,1611060,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 35MM,1611080,CDM,,,,INPATIENT,,,739.5,295.8,AETNA,AETNA COMMERCIAL,724.71,98,,,OTHER,554.63,724.71,PERCENT OF TOTAL BILLED CHARGES
INSUFFLATOR  HEATED,1611900,CDM,,,,INPATIENT,,,199.5,79.8,AETNA,AETNA COMMERCIAL,195.51,98,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 40MM,1612000,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 45MM,1612020,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 50MM,1612040,CDM,,,,INPATIENT,,,929,371.6,AETNA,AETNA COMMERCIAL,910.42,98,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 55MM,1612060,CDM,,,,INPATIENT,,,922.5,369,AETNA,AETNA COMMERCIAL,904.05,98,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 60MM,1612080,CDM,,,,INPATIENT,,,922.5,369,AETNA,AETNA COMMERCIAL,904.05,98,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON DRILL PIN 4.5MM,1613000,CDM,,,,INPATIENT,,,382,152.8,AETNA,AETNA COMMERCIAL,374.36,98,,,OTHER,286.5,374.36,PERCENT OF TOTAL BILLED CHARGES
BAG BLOOD TRANSFER,1613030,CDM,,,,INPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
BLANKET FULL BODY ADULT,1613050,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
BLANKET UPPER BODY,1613070,CDM,,,,INPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH EXCELL 5MM BLADELESS,1613100,CDM,,,,INPATIENT,,,261.5,104.6,AETNA,AETNA COMMERCIAL,256.27,98,,,OTHER,196.13,256.27,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH EXCEL 5MM SLEEVE,1613105,CDM,,,,INPATIENT,,,153.25,61.3,AETNA,AETNA COMMERCIAL,150.185,98,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH 150MM PNEUMONEEDLE,1613110,CDM,,,,INPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ENDOSTITCH,1613115,CDM,,,,INPATIENT,,,328.25,131.3,AETNA,AETNA COMMERCIAL,321.685,98,,,OTHER,246.19,321.69,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPIC SPOT MARKER,1613117,CDM,,,,INPATIENT,,,102.25,40.9,AETNA,AETNA COMMERCIAL,100.205,98,,,OTHER,76.69,100.21,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 8MM,1613140,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 10MM,1613142,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 12MM,1613144,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV 9 INCH,1613154,CDM,,,,INPATIENT,,,168,67.2,AETNA,AETNA COMMERCIAL,164.64,98,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV X-LARGE,1613155,CDM,,,,INPATIENT,,,200.25,80.1,AETNA,AETNA COMMERCIAL,196.245,98,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV 12 INCH,1613156,CDM,,,,INPATIENT,,,139.25,55.7,AETNA,AETNA COMMERCIAL,136.465,98,,,OTHER,104.44,136.47,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV XX-LARGE,1613157,CDM,,,,INPATIENT,,,200.25,80.1,AETNA,AETNA COMMERCIAL,196.245,98,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
CANNULA SURETAC 7MM,1613202,CDM,,,,INPATIENT,,,125.75,50.3,AETNA,AETNA COMMERCIAL,123.235,98,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
CATH FEMALE KIT,1613227,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
TRAY CATH 14FR,1613228,CDM,,,,INPATIENT,,,29.75,11.9,AETNA,AETNA COMMERCIAL,29.155,98,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
CATH THERMO (SWANZ),1613229,CDM,,,,INPATIENT,,,631.75,252.7,AETNA,AETNA COMMERCIAL,619.115,98,,,OTHER,473.81,619.12,PERCENT OF TOTAL BILLED CHARGES
CATH TRIPLE LUMEN,1613232,CDM,,,,INPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 08FR 3CC PED,1613240,CDM,,,,INPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 10FR 5CC PED,1613241,CDM,,,,INPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 12FR 5CC,1613242,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 14FR 5CC,1613243,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 5CC,1613244,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 18FR 5CC,1613245,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 5CC,1613246,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 22FR 5CC,1613247,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 5CC,1613248,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR W/UR,1613249,CDM,,,,INPATIENT,,,125.75,50.3,AETNA,AETNA COMMERCIAL,123.235,98,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 30CC,1613250,CDM,,,,INPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 30CC,1613255,CDM,,,,INPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 18FR 30CC,1613256,CDM,,,,INPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 30CC 3-WAY,1613257,CDM,,,,INPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 22FR 30CC,1613258,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 30CC,1613259,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 30CC 3-WAY,1613260,CDM,,,,INPATIENT,,,87.75,35.1,AETNA,AETNA COMMERCIAL,85.995,98,,,OTHER,65.81,86,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 5CC COUNCIL,1613265,CDM,,,,INPATIENT,,,182.75,73.1,AETNA,AETNA COMMERCIAL,179.095,98,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
POLYPECTOMY SNARE,1613295,CDM,,,,INPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
V-CATH INSERTION,1613315,CDM,,,,INPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
V-CATH MIDLINE 3FR,1613316,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
V-CATH MIDLINE 4FR,1613317,CDM,,,,INPATIENT,,,339.25,135.7,AETNA,AETNA COMMERCIAL,332.465,98,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
V-CATH KIT 2FR,1613318,CDM,,,,INPATIENT,,,384.5,153.8,AETNA,AETNA COMMERCIAL,376.81,98,,,OTHER,288.38,376.81,PERCENT OF TOTAL BILLED CHARGES
V-CATH PICC 3FR,1613319,CDM,,,,INPATIENT,,,439,175.6,AETNA,AETNA COMMERCIAL,430.22,98,,,OTHER,329.25,430.22,PERCENT OF TOTAL BILLED CHARGES
V-CATH PICC 4FR,1613320,CDM,,,,INPATIENT,,,350,140,AETNA,AETNA COMMERCIAL,343,98,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
V-CATH INTRODUCER 3.0FR,1613321,CDM,,,,INPATIENT,,,105.5,42.2,AETNA,AETNA COMMERCIAL,103.39,98,,,OTHER,79.13,103.39,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER 22 X 25MM,1613322,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER HUBER  22 X 3/4,1613324,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NEEDLE HUBER WINGED EXT.,1613327,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER 20G X 25MM,1613328,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
OXISENSOR MAX-P,1613330,CDM,,,,INPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
CEMENT SIMPLEX,1613350,CDM,,,,INPATIENT,,,516.5,206.6,AETNA,AETNA COMMERCIAL,506.17,98,,,OTHER,387.38,506.17,PERCENT OF TOTAL BILLED CHARGES
CEMENT BONE PALACOS,1613352,CDM,,,,INPATIENT,,,433.5,173.4,AETNA,AETNA COMMERCIAL,424.83,98,,,OTHER,325.13,424.83,PERCENT OF TOTAL BILLED CHARGES
CHEMO - TAXAL SET TUBING,1613355,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
DERMABOND SKIN ADHESIVE,1613358,CDM,,,,INPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
CIRCUITS VENT W/TRAPS,1613370,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
CIRCUIT VENTILATOR HEATED WR,1613371,CDM,,,,INPATIENT,,,120,48,AETNA,AETNA COMMERCIAL,117.6,98,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
CIRCUIT BILEVEL HEATED WIRE,1613372,CDM,,,,INPATIENT,,,230.5,92.2,AETNA,AETNA COMMERCIAL,225.89,98,,,OTHER,172.88,225.89,PERCENT OF TOTAL BILLED CHARGES
EASY CAP II CO2 DETECTOR,1613374,CDM,,,,INPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
FOG REDUCTION DEVICE,1613376,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
COLLECTION SET  DISP TUBING,1613385,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
DRAIN LARGE WOUND 5/8X15,1613450,CDM,,,,INPATIENT,,,184.75,73.9,AETNA,AETNA COMMERCIAL,181.055,98,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
DRAIN PVC 1/4 CONSTAVAC,1613451,CDM,,,,INPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
DRAIN PVC 1/8 SNYDER,1613452,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
DRAIN BLAKE FLUTED 19FR,1613459,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN BLAKE FLUTED 15FR,1613460,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAPE SURG IOBAN 6650,1613480,CDM,,,,INPATIENT,,,525.75,210.3,AETNA,AETNA COMMERCIAL,515.235,98,,,OTHER,394.31,515.24,PERCENT OF TOTAL BILLED CHARGES
DRAPE CASSETTE,1613490,CDM,,,,INPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
GERIGLOVE,1613692,CDM,,,,INPATIENT,,,152.25,60.9,AETNA,AETNA COMMERCIAL,149.205,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
ENDO CLIP 10MM M/L ER320,1613700,CDM,,,,INPATIENT,,,558,223.2,AETNA,AETNA COMMERCIAL,546.84,98,,,OTHER,418.5,546.84,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE FILTERS,1613710,CDM,,,,INPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE DEPLETION FILTER,1613712,CDM,,,,INPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
ENDOPOUCH RETRIEVER,1613720,CDM,,,,INPATIENT,,,516.25,206.5,AETNA,AETNA COMMERCIAL,505.925,98,,,OTHER,387.19,505.93,PERCENT OF TOTAL BILLED CHARGES
ENDO DISSECTOR 5MM,1613730,CDM,,,,INPATIENT,,,545.75,218.3,AETNA,AETNA COMMERCIAL,534.835,98,,,OTHER,409.31,534.84,PERCENT OF TOTAL BILLED CHARGES
ENDO RETRACTOR,1613740,CDM,,,,INPATIENT,,,635.75,254.3,AETNA,AETNA COMMERCIAL,623.035,98,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
END CUTTER 4.2,1613750,CDM,,,,INPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH MULTISEAL CAPS,1613760,CDM,,,,INPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
IV BLOOD SET Y-TYPE,1613805,CDM,,,,INPATIENT,,,28.5,11.4,AETNA,AETNA COMMERCIAL,27.93,98,,,OTHER,21.38,27.93,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 19 GA,1613820,CDM,,,,INPATIENT,,,13.5,5.4,AETNA,AETNA COMMERCIAL,13.23,98,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 21 GA,1613821,CDM,,,,INPATIENT,,,63.75,25.5,AETNA,AETNA COMMERCIAL,62.475,98,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 23 GA,1613822,CDM,,,,INPATIENT,,,63.75,25.5,AETNA,AETNA COMMERCIAL,62.475,98,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 25 GA,1613823,CDM,,,,INPATIENT,,,13.5,5.4,AETNA,AETNA COMMERCIAL,13.23,98,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
IV CONT EVACUATED 500 ML,1613840,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
IV CONT EVACUATED 1000 ML,1613841,CDM,,,,INPATIENT,,,32.25,12.9,AETNA,AETNA COMMERCIAL,31.605,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
AGGRESS MENISCUS 4.0MM,1613875,CDM,,,,INPATIENT,,,524.5,209.8,AETNA,AETNA COMMERCIAL,514.01,98,,,OTHER,393.38,514.01,PERCENT OF TOTAL BILLED CHARGES
AGGRESS MENISCUS 5.0,1613880,CDM,,,,INPATIENT,,,573.25,229.3,AETNA,AETNA COMMERCIAL,561.785,98,,,OTHER,429.94,561.79,PERCENT OF TOTAL BILLED CHARGES
IV PRIMARY VEN/NONVEN SET,1613905,CDM,,,,INPATIENT,,,22,8.8,AETNA,AETNA COMMERCIAL,21.56,98,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
INTERLINK T-CON EXT,1613906,CDM,,,,INPATIENT,,,12,4.8,AETNA,AETNA COMMERCIAL,11.76,98,,,OTHER,9,11.76,PERCENT OF TOTAL BILLED CHARGES
INTERLINK SYSTEM,1613907,CDM,,,,INPATIENT,,,22,8.8,AETNA,AETNA COMMERCIAL,21.56,98,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
IV SECONDARY SET,1613915,CDM,,,,INPATIENT,,,13.5,5.4,AETNA,AETNA COMMERCIAL,13.23,98,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE KNEE (PEDS) IMMOBILIZ,1614100,CDM,,,,INPATIENT,,,117.25,46.9,AETNA,AETNA COMMERCIAL,114.905,98,,,OTHER,87.94,114.91,PERCENT OF TOTAL BILLED CHARGES
KIT FETAL PRESSURE,1614232,CDM,,,,INPATIENT,,,256.5,102.6,AETNA,AETNA COMMERCIAL,251.37,98,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
KIT GASTRIC LAVAGE,1614234,CDM,,,,INPATIENT,,,144.25,57.7,AETNA,AETNA COMMERCIAL,141.365,98,,,OTHER,108.19,141.37,PERCENT OF TOTAL BILLED CHARGES
TRAY INTUBATION,1614238,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
LINEAR STAPLER 55MM STAND GIA,1614270,CDM,,,,INPATIENT,,,572.25,228.9,AETNA,AETNA COMMERCIAL,560.805,98,,,OTHER,429.19,560.81,PERCENT OF TOTAL BILLED CHARGES
LINEAR STAPLER 60MM BLUE,1614280,CDM,,,,INPATIENT,,,532.5,213,AETNA,AETNA COMMERCIAL,521.85,98,,,OTHER,399.38,521.85,PERCENT OF TOTAL BILLED CHARGES
RELOAD 60MM STANDARD 3.5MM BLU,1614282,CDM,,,,INPATIENT,,,346,138.4,AETNA,AETNA COMMERCIAL,339.08,98,,,OTHER,259.5,339.08,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER 35MM VASCULAR,1614285,CDM,,,,INPATIENT,,,1089.75,435.9,AETNA,AETNA COMMERCIAL,1067.955,98,,,OTHER,817.31,1067.96,PERCENT OF TOTAL BILLED CHARGES
35MM STANDARD/VAS. RELOADS,1614290,CDM,,,,INPATIENT,,,501.75,200.7,AETNA,AETNA COMMERCIAL,491.715,98,,,OTHER,376.31,491.72,PERCENT OF TOTAL BILLED CHARGES
35MM VASCULAR RELOADS,1614295,CDM,,,,INPATIENT,,,501.75,200.7,AETNA,AETNA COMMERCIAL,491.715,98,,,OTHER,376.31,491.72,PERCENT OF TOTAL BILLED CHARGES
LINENS DRAPE HIP W/C-ARM,1614300,CDM,,,,INPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 3,1614584,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 4,1614586,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 5,1614588,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
NEEDLE WHITACRE 22GX3 1/2,1614609,CDM,,,,INPATIENT,,,59.5,23.8,AETNA,AETNA COMMERCIAL,58.31,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST SMALL,1614706,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST MEDIUM,1614707,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST LARGE,1614708,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST XLG,1614709,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV SMALL,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV MEDIUM,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV LARGE,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE MED,1614736,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE LARGE,1614737,CDM,,,,INPATIENT,,,86,34.4,AETNA,AETNA COMMERCIAL,84.28,98,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE X-LGE,1614738,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO SPLINT CLAVICAL MEDIUM,1614833,CDM,,,,INPATIENT,,,142.75,57.1,AETNA,AETNA COMMERCIAL,139.895,98,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
ORTHO SPLINT CLAVICAL LARGE,1614834,CDM,,,,INPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
ORTHO SUPPORT KNEE MEDIUM,L1830,HCPCS,274,RC,,INPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PAD HELL & ELBOW PROTECTOR,1614948,CDM,,,,INPATIENT,,,15,6,AETNA,AETNA COMMERCIAL,14.7,98,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
INFUSION SET INTERTIP,1614952,CDM,,,,INPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
INFUSION SET POWER LOC SAFETY,1614954,CDM,,,,INPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
PAD GROUNDING,1614965,CDM,,,,INPATIENT,,,57,22.8,AETNA,AETNA COMMERCIAL,55.86,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
DUO THEM PAD HYPO 24X60,1614972,CDM,,,,INPATIENT,,,155.75,62.3,AETNA,AETNA COMMERCIAL,152.635,98,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
DUO THERM PAD 18X24,1614976,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
PAIN BUSTER,1614980,CDM,,,,INPATIENT,,,724.5,289.8,AETNA,AETNA COMMERCIAL,710.01,98,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
STAPLE SKIN EXTRACTOR,1615135,CDM,,,,INPATIENT,,,4,1.6,AETNA,AETNA COMMERCIAL,3.92,98,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
TENDON SPACER SZ 4,1615141,CDM,,,,INPATIENT,,,1360.25,544.1,AETNA,AETNA COMMERCIAL,1333.045,98,,,OTHER,1020.19,1333.05,PERCENT OF TOTAL BILLED CHARGES
TENDON SPACER SZ 5,1615142,CDM,,,,INPATIENT,,,1360.25,544.1,AETNA,AETNA COMMERCIAL,1333.045,98,,,OTHER,1020.19,1333.05,PERCENT OF TOTAL BILLED CHARGES
STRYKERFLOW PUMP & HAND,1615308,CDM,,,,INPATIENT,,,292,116.8,AETNA,AETNA COMMERCIAL,286.16,98,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
STERI CUFF 18 INCH,1615324,CDM,,,,INPATIENT,,,186.5,74.6,AETNA,AETNA COMMERCIAL,182.77,98,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
STERI CUFF 34 INCH,1615326,CDM,,,,INPATIENT,,,236,94.4,AETNA,AETNA COMMERCIAL,231.28,98,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
STOCKING EMB XLG,1615354,CDM,,,,INPATIENT,,,108.5,43.4,AETNA,AETNA COMMERCIAL,106.33,98,,,OTHER,81.38,106.33,PERCENT OF TOTAL BILLED CHARGES
SUCTION TIP KAMVAC MINI,1615421,CDM,,,,INPATIENT,,,150.75,60.3,AETNA,AETNA COMMERCIAL,147.735,98,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
SUCTION TIP POOLE,1615440,CDM,,,,INPATIENT,,,40.5,16.2,AETNA,AETNA COMMERCIAL,39.69,98,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
SUPPORTER MALE LARGE,1615467,CDM,,,,INPATIENT,,,101.25,40.5,AETNA,AETNA COMMERCIAL,99.225,98,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,234,93.6,AETNA,AETNA COMMERCIAL,229.32,98,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 5.5,1615510,CDM,,,,INPATIENT,,,265.5,106.2,AETNA,AETNA COMMERCIAL,260.19,98,,,OTHER,199.13,260.19,PERCENT OF TOTAL BILLED CHARGES
TUBE TRACHEOSTOMY #7,1615511,CDM,,,,INPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
TRAY EPIDURAL CONTINUOUS,1615520,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
TRAY LUMBAR PUNCTURE ADULT,1615525,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
TRAY LUMBAR PUNCTURE PEDS,1615526,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
TRAY LACERATION REPAIR,1615536,CDM,,,,INPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
TRAY SUBCLAVIAN #61248,1615539,CDM,,,,INPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
TRAY EYE,1615540,CDM,,,,INPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
TRAY BONE MARROW,1615542,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY CHEST TUBE,1615544,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY THORANCENTESIS,1615545,CDM,,,,INPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
TRAY I&D,1615546,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY SUTURING,1615548,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
CUSTOM RADIOLOGY TRAY,1615549,CDM,,,,INPATIENT,,,114,45.6,AETNA,AETNA COMMERCIAL,111.72,98,,,OTHER,85.5,111.72,PERCENT OF TOTAL BILLED CHARGES
TRAY TRACH,1615550,CDM,,,,INPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
SPARC SLING SYSTEM W/TENSION,1615852,CDM,,,,INPATIENT,,,2108.75,843.5,AETNA,AETNA COMMERCIAL,2066.575,98,,,OTHER,1581.56,2066.58,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SYSTEM,1620000,CDM,,,,INPATIENT,,,292,116.8,AETNA,AETNA COMMERCIAL,286.16,98,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
K-PAD PUMP PER DAY,1620100,CDM,,,,INPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
PACIFERS ORTHODONTIC,1621545,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
WIRE GUIDE J 125CM,1621980,CDM,,,,INPATIENT,,,125.75,50.3,AETNA,AETNA COMMERCIAL,123.235,98,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
PENEDRIL DRILL TIP,1622225,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
LACTATION CONSULT,1622230,CDM,722,RC,,INPATIENT,,,170.25,68.1,AETNA,AETNA COMMERCIAL,166.845,98,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
LACTATION CONSULT PAST 30 DAYS,99211,CPT,510,RC,,OUTPATIENT,,,170.25,68.1,AETNA,AETNA COMMERCIAL,166.845,98,,,OTHER,127.7,166.8,PERCENT OF TOTAL BILLED CHARGES
PUMP BREAST,1622240,CDM,,,,INPATIENT,,,129.75,51.9,AETNA,AETNA COMMERCIAL,127.155,98,,,OTHER,97.31,127.16,PERCENT OF TOTAL BILLED CHARGES
BREAST/NIPPLE SHIELD,1622242,CDM,,,,INPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
BREAST PUMP KIT,1622244,CDM,,,,INPATIENT,,,169.75,67.9,AETNA,AETNA COMMERCIAL,166.355,98,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
TRAY TRIPLE LUMEN CATH,1622590,CDM,,,,INPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
TRAY TUOHY NEEDLE CATH SET 18G,1622592,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
TUR Y-TYPE SET,1622594,CDM,,,,INPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
BAG URI-METER DRAIN,1622596,CDM,,,,INPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,87.75,35.1,AETNA,AETNA COMMERCIAL,85.995,98,,,OTHER,65.81,86,PERCENT OF TOTAL BILLED CHARGES
BI PAP DIAP CIRCUITS,1623350,CDM,,,,INPATIENT,,,103.25,41.3,AETNA,AETNA COMMERCIAL,101.185,98,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,199.5,79.8,AETNA,AETNA COMMERCIAL,195.51,98,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,148,59.2,AETNA,AETNA COMMERCIAL,145.04,98,,,OTHER,111,145.04,PERCENT OF TOTAL BILLED CHARGES
STERILMED FOOTPAD STD,1624238,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
STERILMED FOOT PAD LG,1624239,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC LENS MORGAN,V2797,HCPCS,270,RC,,BOTH,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
I/A PAK,1631600,CDM,,,,INPATIENT,,,715.25,286.1,AETNA,AETNA COMMERCIAL,700.945,98,,,OTHER,536.44,700.95,PERCENT OF TOTAL BILLED CHARGES
NASAL PACK RHINO POCKET MEDIUM,1631831,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
NASAL PACK RHIN0 POCKET LARGE,1631832,CDM,,,,INPATIENT,,,64,25.6,AETNA,AETNA COMMERCIAL,62.72,98,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
NEEDLE HYPO NERVE BLOCK,1631870,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
NERVE BLOCK SET CONTINUOUS,1631880,CDM,,,,INPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
INSULATED BLOCK SET,1631890,CDM,,,,INPATIENT,,,136.5,54.6,AETNA,AETNA COMMERCIAL,133.77,98,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
CUTTING LOOP 24FR,1639376,CDM,,,,INPATIENT,,,496.25,198.5,AETNA,AETNA COMMERCIAL,486.325,98,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER 75MM,1639377,CDM,,,,INPATIENT,,,995,398,AETNA,AETNA COMMERCIAL,975.1,98,,,OTHER,746.25,975.1,PERCENT OF TOTAL BILLED CHARGES
CUSHION RING - DONUT,1639378,CDM,,,,INPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
ACDA ANTICOAGULANT,1641000,CDM,,,,INPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 70 LT,1641025,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 55 RT,1641026,CDM,,,,INPATIENT,,,5414.5,2165.8,AETNA,AETNA COMMERCIAL,5306.21,98,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 55 LT,1641027,CDM,,,,INPATIENT,,,5414.5,2165.8,AETNA,AETNA COMMERCIAL,5306.21,98,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 60 RT,1641028,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 60 LT,C1776,HCPCS,278,RC,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 70 RT,C1776,HCPCS,278,RC,,INPATIENT,,,5825.75,2330.3,AETNA,AETNA COMMERCIAL,5709.235,98,,,OTHER,4369.31,5709.24,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 65 RT,1641031,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 65 LT,1641032,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 75 RT,1641033,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 75 LT,1641034,CDM,,,,INPATIENT,,,7982.75,3193.1,AETNA,AETNA COMMERCIAL,7823.095,98,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
GEL RATIO APPLICATION ASSEM,1641111,CDM,,,,INPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
GEL APPLICATOR TIP,1641112,CDM,,,,INPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
DRESSING HYDROCOLLOID REPLICAR,1641635,CDM,,,,INPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 10MM 155306",C1776,HCPCS,278,RC,,INPATIENT,,,6282.5,2513,AETNA,AETNA COMMERCIAL,6156.85,98,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 65,1641694,CDM,,,,INPATIENT,,,6282.5,2513,AETNA,AETNA COMMERCIAL,6156.85,98,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 65,1641695,CDM,,,,INPATIENT,,,6282.5,2513,AETNA,AETNA COMMERCIAL,6156.85,98,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 65,C1776,HCPCS,278,RC,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 65,1641697,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 70,1641698,CDM,,,,INPATIENT,,,4822.75,1929.1,AETNA,AETNA COMMERCIAL,4726.295,98,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 70,1641699,CDM,,,,INPATIENT,,,6282.5,2513,AETNA,AETNA COMMERCIAL,6156.85,98,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 70,1641700,CDM,,,,INPATIENT,,,4822.75,1929.1,AETNA,AETNA COMMERCIAL,4726.295,98,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 70,1641701,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 70,1641702,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 75,1641703,CDM,,,,INPATIENT,,,4587,1834.8,AETNA,AETNA COMMERCIAL,4495.26,98,,,OTHER,3440.25,4495.26,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 75,1641704,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 75,1641705,CDM,,,,INPATIENT,,,3980,1592,AETNA,AETNA COMMERCIAL,3900.4,98,,,OTHER,2985,3900.4,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 75,1641706,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 75,1641707,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 80,C1776,HCPCS,278,RC,,INPATIENT,,,4822.75,1929.1,AETNA,AETNA COMMERCIAL,4726.295,98,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 80,1641709,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 80,1641710,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 80,1641711,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 80,1641712,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 85,1641713,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 85,1641714,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 85,1641715,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 85,1641716,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 85,1641717,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON SMALL,C1776,HCPCS,278,RC,,INPATIENT,,,2730.75,1092.3,AETNA,AETNA COMMERCIAL,2676.135,98,,,OTHER,2048.06,2676.14,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON MEDIUM,1641900,CDM,,,,INPATIENT,,,2730.75,1092.3,AETNA,AETNA COMMERCIAL,2676.135,98,,,OTHER,2048.06,2676.14,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON LARGE,C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,AETNA,AETNA COMMERCIAL,1960.98,98,,,OTHER,1500.75,1960.98,PERCENT OF TOTAL BILLED CHARGES
BLADE GIGLI SAW,1642020,CDM,,,,INPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
BLADE BEAVER TYMPANOPLASTY,1642055,CDM,,,,INPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
BLADE CUDA 4.2  C9254,1642056,CDM,,,,INPATIENT,,,330,132,AETNA,AETNA COMMERCIAL,323.4,98,,,OTHER,247.5,323.4,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG WIDE MED,1642097,CDM,,,,INPATIENT,,,334.5,133.8,AETNA,AETNA COMMERCIAL,327.81,98,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
ANKLE TREATMENT KIT CUSTOM LG,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
ANKLE TREATMENT KIT CUSTOM SM,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
BRUSH INTRAMEDULLARY,1642150,CDM,,,,INPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
FEMORAL PRESSURIZER,1642218,CDM,,,,INPATIENT,,,158.25,63.3,AETNA,AETNA COMMERCIAL,155.085,98,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
DRAIN IRRIGATION,1642361,CDM,,,,INPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
SCANDIPHARM FLUTTER VALVE,1642600,CDM,,,,INPATIENT,,,279,111.6,AETNA,AETNA COMMERCIAL,273.42,98,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
SCISSORS 5MM CURVED W/CAUTERY,1642605,CDM,,,,INPATIENT,,,360.75,144.3,AETNA,AETNA COMMERCIAL,353.535,98,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 3 X 12,1642720,CDM,271,RC,,INPATIENT,,,29.75,11.9,AETNA,AETNA COMMERCIAL,29.155,98,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 4 X 30,1642723,CDM,271,RC,,INPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
SUTURE RETRIEVER HEWSON,1642750,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
WIRE GUIDE 60CM,1642900,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
WRIST JACK AGEE,1642950,CDM,,,,INPATIENT,,,5844.5,2337.8,AETNA,AETNA COMMERCIAL,5727.61,98,,,OTHER,4383.38,5727.61,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER RELOADS 75MM,1644010,CDM,,,,INPATIENT,,,665,266,AETNA,AETNA COMMERCIAL,651.7,98,,,OTHER,498.75,651.7,PERCENT OF TOTAL BILLED CHARGES
CIRCULAR STAPLER 29MM EEA,1644020,CDM,,,,INPATIENT,,,1741.25,696.5,AETNA,AETNA COMMERCIAL,1706.425,98,,,OTHER,1305.94,1706.43,PERCENT OF TOTAL BILLED CHARGES
STAPLER TA90 LONG,1644025,CDM,,,,INPATIENT,,,977.5,391,AETNA,AETNA COMMERCIAL,957.95,98,,,OTHER,733.13,957.95,PERCENT OF TOTAL BILLED CHARGES
ENDO LINEAR CUTTER 45MM 2.5 WH,1644030,CDM,,,,INPATIENT,,,1050.75,420.3,AETNA,AETNA COMMERCIAL,1029.735,98,,,OTHER,788.06,1029.74,PERCENT OF TOTAL BILLED CHARGES
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,589.25,235.7,AETNA,AETNA COMMERCIAL,577.465,98,,,OTHER,441.94,577.47,PERCENT OF TOTAL BILLED CHARGES
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,598.25,239.3,AETNA,AETNA COMMERCIAL,586.285,98,,,OTHER,448.69,586.29,PERCENT OF TOTAL BILLED CHARGES
LINEAR ENDO CUTTER 45MM 3.5MM,1644060,CDM,,,,INPATIENT,,,1462,584.8,AETNA,AETNA COMMERCIAL,1432.76,98,,,OTHER,1096.5,1432.76,PERCENT OF TOTAL BILLED CHARGES
GIA RELOAD 55MM STAND. BLUE,1644065,CDM,,,,INPATIENT,,,384.25,153.7,AETNA,AETNA COMMERCIAL,376.565,98,,,OTHER,288.19,376.57,PERCENT OF TOTAL BILLED CHARGES
MULTIFIRE GIA CART. 60-3.8,1644066,CDM,,,,INPATIENT,,,786.5,314.6,AETNA,AETNA COMMERCIAL,770.77,98,,,OTHER,589.88,770.77,PERCENT OF TOTAL BILLED CHARGES
GIA RELOAD 55MM STAND. WHITE,1644070,CDM,,,,INPATIENT,,,404.25,161.7,AETNA,AETNA COMMERCIAL,396.165,98,,,OTHER,303.19,396.17,PERCENT OF TOTAL BILLED CHARGES
SUTURE PASSER SWANSON,1644074,CDM,,,,INPATIENT,,,295.25,118.1,AETNA,AETNA COMMERCIAL,289.345,98,,,OTHER,221.44,289.35,PERCENT OF TOTAL BILLED CHARGES
SUTURE SKIN STAPLER,1644077,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STAPLES INT TA-55 3.5 BLUE,1644095,CDM,,,,INPATIENT,,,440,176,AETNA,AETNA COMMERCIAL,431.2,98,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
STAPLES INT TA-55 4.8 GREEN,1644096,CDM,,,,INPATIENT,,,269.85,107.94,AETNA,AETNA COMMERCIAL,264.453,98,,,OTHER,202.39,264.45,PERCENT OF TOTAL BILLED CHARGES
KIT DUAL LUMEN (REPAIR),1644222,CDM,,,,INPATIENT,,,649.25,259.7,AETNA,AETNA COMMERCIAL,636.265,98,,,OTHER,486.94,636.27,PERCENT OF TOTAL BILLED CHARGES
INSULSCAN WAND MOBILE INSTRUMT,1644822,CDM,,,,INPATIENT,,,130,52,AETNA,AETNA COMMERCIAL,127.4,98,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
BLADE SAGITAL K-123,1645025,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG K-124,1645026,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADE OSC,1645028,CDM,,,,INPATIENT,,,153.5,61.4,AETNA,AETNA COMMERCIAL,150.43,98,,,OTHER,115.13,150.43,PERCENT OF TOTAL BILLED CHARGES
TEAR RASP-LARGE,1645029,CDM,,,,INPATIENT,,,27.25,10.9,AETNA,AETNA COMMERCIAL,26.705,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG 3M  K 121,1645030,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADES 15 DEGREE EYES,1645032,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
IRR CANNULA 27 GA - EYES,1645034,CDM,,,,INPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
BURR ROUND 5.5MM,1645035,CDM,,,,INPATIENT,,,261.75,104.7,AETNA,AETNA COMMERCIAL,256.515,98,,,OTHER,196.31,256.52,PERCENT OF TOTAL BILLED CHARGES
CYSTITOME FORMED RC SHORT RAD,1645036,CDM,,,,INPATIENT,,,48.5,19.4,AETNA,AETNA COMMERCIAL,47.53,98,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
KNIFE CRESENT STRAIGHT,1645200,CDM,,,,INPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
KNIFE  OPHTHALMIC,1645230,CDM,,,,INPATIENT,,,269.75,107.9,AETNA,AETNA COMMERCIAL,264.355,98,,,OTHER,202.31,264.36,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON MTA,1645300,CDM,,,,INPATIENT,,,532.75,213.1,AETNA,AETNA COMMERCIAL,522.095,98,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
HEALON .85 ML,1645301,CDM,,,,INPATIENT,,,524.5,209.8,AETNA,AETNA COMMERCIAL,514.01,98,,,OTHER,393.38,514.01,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA 912,1645302,CDM,,,,INPATIENT,,,635.75,254.3,AETNA,AETNA COMMERCIAL,623.035,98,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA 920,1645303,CDM,,,,INPATIENT,,,635.75,254.3,AETNA,AETNA COMMERCIAL,623.035,98,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
LENS  MODEL 911A,1645307,CDM,,,,INPATIENT,,,820,328,AETNA,AETNA COMMERCIAL,803.6,98,,,OTHER,615,803.6,PERCENT OF TOTAL BILLED CHARGES
LENS  MODEL 913A,1645308,CDM,,,,INPATIENT,,,607.5,243,AETNA,AETNA COMMERCIAL,595.35,98,,,OTHER,455.63,595.35,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA Z9000,1645312,CDM,,,,INPATIENT,,,727.25,290.9,AETNA,AETNA COMMERCIAL,712.705,98,,,OTHER,545.44,712.71,PERCENT OF TOTAL BILLED CHARGES
LENS TECNIS Z9001,1645314,CDM,,,,INPATIENT,,,708,283.2,AETNA,AETNA COMMERCIAL,693.84,98,,,OTHER,531,693.84,PERCENT OF TOTAL BILLED CHARGES
LENS TECHNIS ZA9003,1645315,CDM,,,,INPATIENT,,,583.5,233.4,AETNA,AETNA COMMERCIAL,571.83,98,,,OTHER,437.63,571.83,PERCENT OF TOTAL BILLED CHARGES
LENS AMO ZCBOO,1645316,CDM,,,,INPATIENT,,,487.5,195,AETNA,AETNA COMMERCIAL,477.75,98,,,OTHER,365.63,477.75,PERCENT OF TOTAL BILLED CHARGES
LENS AR40,1645317,CDM,,,,INPATIENT,,,532.75,213.1,AETNA,AETNA COMMERCIAL,522.095,98,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
LENS AMO ZMBOO,1645318,CDM,,,,INPATIENT,,,1200,480,AETNA,AETNA COMMERCIAL,1176,98,,,OTHER,900,1176,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZLBOO,1645320,CDM,,,,INPATIENT,,,939.75,375.9,AETNA,AETNA COMMERCIAL,920.955,98,,,OTHER,704.81,920.96,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON SA60AT,1645454,CDM,,,,INPATIENT,,,835.5,334.2,AETNA,AETNA COMMERCIAL,818.79,98,,,OTHER,626.63,818.79,PERCENT OF TOTAL BILLED CHARGES
LENS  ALCON SN60WF,C1780,HCPCS,276,RC,,INPATIENT,,,338,135.2,AETNA,AETNA COMMERCIAL,331.24,98,,,OTHER,253.5,331.24,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL SN6,V2787,HCPCS,276,RC,,INPATIENT,,,495,198,AETNA,AETNA COMMERCIAL,485.1,98,,,OTHER,371.25,485.1,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON MA60AC,1645566,CDM,,,,INPATIENT,,,752.5,301,AETNA,AETNA COMMERCIAL,737.45,98,,,OTHER,564.38,737.45,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT400,1645568,CDM,,,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL AMO ZCT225,1645570,CDM,,,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT300,1645572,CDM,,,,INPATIENT,,,519.75,207.9,AETNA,AETNA COMMERCIAL,509.355,98,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT150,1645574,CDM,,,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL 450,1645576,CDM,,,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
PACK VITRECTOMY,1645689,CDM,,,,INPATIENT,,,1748.25,699.3,AETNA,AETNA COMMERCIAL,1713.285,98,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
PACK HOT REHEATER LG,1645700,CDM,,,,INPATIENT,,,170.25,68.1,AETNA,AETNA COMMERCIAL,166.845,98,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
POLAR PAD KNEE/SHOULDER,1645775,CDM,,,,INPATIENT,,,233.25,93.3,AETNA,AETNA COMMERCIAL,228.585,98,,,OTHER,174.94,228.59,PERCENT OF TOTAL BILLED CHARGES
CARPEL TUNNELL RELEASE KIT,1646100,CDM,,,,INPATIENT,,,646.25,258.5,AETNA,AETNA COMMERCIAL,633.325,98,,,OTHER,484.69,633.33,PERCENT OF TOTAL BILLED CHARGES
MAGNETIC PAD,1646350,CDM,,,,INPATIENT,,,111.25,44.5,AETNA,AETNA COMMERCIAL,109.025,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
TUBING INSUFLATION EC1101,1646650,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BAG ENDO 3X6,1647055,CDM,,,,INPATIENT,,,168,67.2,AETNA,AETNA COMMERCIAL,164.64,98,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
BANDAGE ESMARK 6 INCH,1647090,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CANISTER W/GEL,1647092,CDM,,,,INPATIENT,,,576.5,230.6,AETNA,AETNA COMMERCIAL,564.97,98,,,OTHER,432.38,564.97,PERCENT OF TOTAL BILLED CHARGES
CATH HICKMAN INTRO KIT 10FR,1647232,CDM,,,,INPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 16FR 5CC,1647240,CDM,,,,INPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 18FR 5CC,1647241,CDM,,,,INPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 20FR 5CC,1647242,CDM,,,,INPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CAUTERY COAGULATOR SUCTION,1647350,CDM,,,,INPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
DRAIN MALECTO 24FR,1647435,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
DRAPE C ARM,1647445,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
DRAIN HYER SCHULTE SUCT,1647450,CDM,,,,INPATIENT,,,59.5,23.8,AETNA,AETNA COMMERCIAL,58.31,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN 10FR J VAC,1647452,CDM,,,,INPATIENT,,,50.25,20.1,AETNA,AETNA COMMERCIAL,49.245,98,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
DRAPE ORTHO U,1647455,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
KALTOSTAT WOUND PACKING,1647487,CDM,,,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE SCALP FETAL,1647590,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE PACING,1647592,CDM,,,,INPATIENT,,,283.25,113.3,AETNA,AETNA COMMERCIAL,277.585,98,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
FLOWMETER  PEAK ADULT,1647594,CDM,,,,INPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FLOWMETER PEAK PED,1647596,CDM,,,,INPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FALOPE RING BAND APPL KIT,1647700,CDM,,,,INPATIENT,,,783.75,313.5,AETNA,AETNA COMMERCIAL,768.075,98,,,OTHER,587.81,768.08,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE .038,1647708,CDM,,,,INPATIENT,,,68.25,27.3,AETNA,AETNA COMMERCIAL,66.885,98,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE .035 STIFF TYPE,1647709,CDM,,,,INPATIENT,,,381.75,152.7,AETNA,AETNA COMMERCIAL,374.115,98,,,OTHER,286.31,374.12,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 20 FR,1647710,CDM,,,,INPATIENT,,,654.25,261.7,AETNA,AETNA COMMERCIAL,641.165,98,,,OTHER,490.69,641.17,PERCENT OF TOTAL BILLED CHARGES
GROSHONG 8FR SINGLE LUMEM,C1751,HCPCS,272,RC,,INPATIENT,,,1355.5,542.2,AETNA,AETNA COMMERCIAL,1328.39,98,,,OTHER,1016.63,1328.39,PERCENT OF TOTAL BILLED CHARGES
GELSYTE,1647718,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
DRESS OP-SITE 5-1/2 X 10,1647722,CDM,,,,INPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
LOOPS DISP RESECTING 24FR,1647820,CDM,,,,INPATIENT,,,564.75,225.9,AETNA,AETNA COMMERCIAL,553.455,98,,,OTHER,423.56,553.46,PERCENT OF TOTAL BILLED CHARGES
METZENBAUM DETACH-A TIP CRVD,1647830,CDM,,,,INPATIENT,,,245,98,AETNA,AETNA COMMERCIAL,240.1,98,,,OTHER,183.75,240.1,PERCENT OF TOTAL BILLED CHARGES
MESH MARLEX PRE-SHAPED W/CUT,1647850,CDM,278,RC,,INPATIENT,,,227.45,90.98,AETNA,AETNA COMMERCIAL,222.901,98,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
MESH MARLEX 10 X 14,1647855,CDM,278,RC,,INPATIENT,,,971.75,388.7,AETNA,AETNA COMMERCIAL,952.315,98,,,OTHER,728.81,952.32,PERCENT OF TOTAL BILLED CHARGES
OSTOMY LOOP SYS 2 3/4,1647880,CDM,,,,INPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
OSTOMY LOOP SYS 4,1647882,CDM,,,,INPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
IRRAGATOR VISIFLOW,1647910,CDM,,,,INPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
TROCAR 1 ENDOPATH TRISTER,1647968,CDM,,,,INPATIENT,,,432.5,173,AETNA,AETNA COMMERCIAL,423.85,98,,,OTHER,324.38,423.85,PERCENT OF TOTAL BILLED CHARGES
TROCAR 1 ENDOPATH BLADELESS,1647969,CDM,,,,INPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSAPORT PLUS 5MM,1647972,CDM,,,,INPATIENT,,,440,176,AETNA,AETNA COMMERCIAL,431.2,98,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
VOLDYNE BREATHING UNIT,1647998,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
PACING PATCH COMBO DEFIB,1648005,CDM,,,,INPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,AETNA,AETNA COMMERCIAL,3973.655,98,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
HANDSWITCH DISP SUCT COAG,1649020,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
FORCEP BIOPSY HOT/COLD,1649090,CDM,,,,INPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
DISPOSABLE FORCEPS,1649092,CDM,,,,INPATIENT,,,65.25,26.1,AETNA,AETNA COMMERCIAL,63.945,98,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 16GAX1-1/4,1649340,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CATH URETERAL WHISTLE TIP 5 FR,1649355,CDM,,,,INPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
CATH URETERAL WHISTLE TIP/AD 5,1649365,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
CONCHA THERM COLE IRR,1649375,CDM,,,,INPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
BIS MONITOR SENSORS,1649376,CDM,,,,INPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL OPEN PORT,1649377,CDM,,,,INPATIENT,,,73,29.2,AETNA,AETNA COMMERCIAL,71.54,98,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE FAST PATCH,1649381,CDM,,,,INPATIENT,,,150.75,60.3,AETNA,AETNA COMMERCIAL,147.735,98,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
BASKET DISP FOREIGN BODY,1649430,CDM,,,,INPATIENT,,,445.25,178.1,AETNA,AETNA COMMERCIAL,436.345,98,,,OTHER,333.94,436.35,PERCENT OF TOTAL BILLED CHARGES
STERI-CATH DL TRACH SIZE,1649555,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
SOFT URETRAL STENT 7FRX24,1649565,CDM,,,,INPATIENT,,,303.25,121.3,AETNA,AETNA COMMERCIAL,297.185,98,,,OTHER,227.44,297.19,PERCENT OF TOTAL BILLED CHARGES
BLADE SAW 2108-377,1649650,CDM,,,,INPATIENT,,,334.5,133.8,AETNA,AETNA COMMERCIAL,327.81,98,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
KNIFE  MYRINGOTOMY SICKLE,1649700,CDM,,,,INPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
ANCHOR OGDEN 7.4MM NON ST,1651000,CDM,,,,INPATIENT,,,721.25,288.5,AETNA,AETNA COMMERCIAL,706.825,98,,,OTHER,540.94,706.83,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS RC W ETHI,1652000,CDM,,,,INPATIENT,,,1408.75,563.5,AETNA,AETNA COMMERCIAL,1380.575,98,,,OTHER,1056.56,1380.58,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS W PANACRYL,1653000,CDM,,,,INPATIENT,,,1237.5,495,AETNA,AETNA COMMERCIAL,1212.75,98,,,OTHER,928.13,1212.75,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS 6.5X32MM",1670001,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BAG RESUSCITATION ADULT DISP,1671045,CDM,,,,INPATIENT,,,103.25,41.3,AETNA,AETNA COMMERCIAL,101.185,98,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
CATH CHOLANGIOGRAM TAUT,1671085,CDM,,,,INPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
CATH CHOLANGIOGRAPHY 19GA,1671090,CDM,,,,INPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA EXT SET 20,1671094,CDM,,,,INPATIENT,,,2.75,1.1,AETNA,AETNA COMMERCIAL,2.695,98,,,OTHER,2.06,2.7,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 18GA X 2,1671095,CDM,,,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 18GA X 1-1/4,1671096,CDM,,,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 22GA X 1,1671097,CDM,,,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 24GA X 3/4,1671098,CDM,,,,INPATIENT,,,20.5,8.2,AETNA,AETNA COMMERCIAL,20.09,98,,,OTHER,15.38,20.09,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 20GA X 1-1/4,1671099,CDM,,,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 16GA X 2,1671100,CDM,,,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH FOGARTY BILIARY 5FR,1671115,CDM,,,,INPATIENT,,,394.75,157.9,AETNA,AETNA COMMERCIAL,386.855,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
FEMORAL CANAL TIP W/SUCTION,1671375,CDM,,,,INPATIENT,,,119.75,47.9,AETNA,AETNA COMMERCIAL,117.355,98,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
NEEDLES  NON-CORING 22GX1,1671480,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLES WHITACRE 23GX3,1671481,CDM,,,,INPATIENT,,,59.5,23.8,AETNA,AETNA COMMERCIAL,58.31,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
"NEEDLES 20 X 1 GRIPPER""",1671482,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLE CATH INSYTE 24GU X 0.56,1671486,CDM,,,,INPATIENT,,,13,5.2,AETNA,AETNA COMMERCIAL,12.74,98,,,OTHER,9.75,12.74,PERCENT OF TOTAL BILLED CHARGES
PAPARELLA TYPE 1 VENT TUBE,1671580,CDM,,,,INPATIENT,,,130,52,AETNA,AETNA COMMERCIAL,127.4,98,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
PAPARELLA II EAR TUBE,1671582,CDM,,,,INPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PROBE ANTERIOR VITRECTOMY,1671635,CDM,,,,INPATIENT,,,820.75,328.3,AETNA,AETNA COMMERCIAL,804.335,98,,,OTHER,615.56,804.34,PERCENT OF TOTAL BILLED CHARGES
FINGER PROBE PEDIATRIC,1671637,CDM,,,,INPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
SEGURA BASKET 3FR,1671650,CDM,,,,INPATIENT,,,484,193.6,AETNA,AETNA COMMERCIAL,474.32,98,,,OTHER,363,474.32,PERCENT OF TOTAL BILLED CHARGES
TRAY SPINAL TAP,1671687,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
SURGICEL #1953,1671688,CDM,,,,INPATIENT,,,160.75,64.3,AETNA,AETNA COMMERCIAL,157.535,98,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
CANNULA KIT CONCEPT,1674025,CDM,,,,INPATIENT,,,66.25,26.5,AETNA,AETNA COMMERCIAL,64.925,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
OPTI-GUARD,1674440,CDM,,,,INPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
PILLOW ABDUCTION,1674500,CDM,,,,INPATIENT,,,221.25,88.5,AETNA,AETNA COMMERCIAL,216.825,98,,,OTHER,165.94,216.83,PERCENT OF TOTAL BILLED CHARGES
PIN GUIDE 3/32MM,1674562,CDM,,,,INPATIENT,,,151.5,60.6,AETNA,AETNA COMMERCIAL,148.47,98,,,OTHER,113.63,148.47,PERCENT OF TOTAL BILLED CHARGES
PILLOW  PRONE,1674600,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
M.R.I IMPLANTED PORT,1675077,CDM,,,,INPATIENT,,,1668.25,667.3,AETNA,AETNA COMMERCIAL,1634.885,98,,,OTHER,1251.19,1634.89,PERCENT OF TOTAL BILLED CHARGES
SCREW  CORTICAL 24MM DEPUY,1675502,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE MULCH 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,AETNA,AETNA COMMERCIAL,1922.025,98,,,OTHER,1470.94,1922.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 12MM 202.812",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,84.5,33.8,AETNA,AETNA COMMERCIAL,82.81,98,,,OTHER,63.38,82.81,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.834",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,AETNA,AETNA COMMERCIAL,63.3178,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.838",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,AETNA,AETNA COMMERCIAL,63.3178,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS/DCS 12.7MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,1021.25,408.5,AETNA,AETNA COMMERCIAL,1000.825,98,,,OTHER,765.94,1000.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, COMPRESS DHC/DCS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,159.75,63.9,AETNA,AETNA COMMERCIAL,156.555,98,,,OTHER,119.81,156.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,578.25,231.3,AETNA,AETNA COMMERCIAL,566.685,98,,,OTHER,433.69,566.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,AETNA,AETNA COMMERCIAL,558.6,98,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,AETNA,AETNA COMMERCIAL,558.6,98,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,AETNA,AETNA COMMERCIAL,558.6,98,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,AETNA,AETNA COMMERCIAL,62.965,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 62MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 74MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SYS 3.0MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,1270,508,AETNA,AETNA COMMERCIAL,1244.6,98,,,OTHER,952.5,1244.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 78MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,AETNA,AETNA COMMERCIAL,247.45,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,AETNA,AETNA COMMERCIAL,62.965,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,AETNA,AETNA COMMERCIAL,99.96,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 4.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,AETNA,AETNA COMMERCIAL,388.2172,98,,,OTHER,493.13,644.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,AETNA,AETNA COMMERCIAL,234.122,98,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,656,262.4,AETNA,AETNA COMMERCIAL,642.88,98,,,OTHER,492,642.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.0MM 54MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 7.3MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,832.55,333.02,AETNA,AETNA COMMERCIAL,815.899,98,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,AETNA,AETNA COMMERCIAL,63.5432,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.836",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,AETNA,AETNA COMMERCIAL,63.5432,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,AETNA,AETNA COMMERCIAL,63.5432,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,AETNA,AETNA COMMERCIAL,99.96,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,AETNA,AETNA COMMERCIAL,97.265,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,AETNA,AETNA COMMERCIAL,99.96,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,AETNA,AETNA COMMERCIAL,548.5648,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,AETNA,AETNA COMMERCIAL,548.5648,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 2.4MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 7.3MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,AETNA,AETNA COMMERCIAL,912.38,98,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, TAPERED 8-10MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,739.5,295.8,AETNA,AETNA COMMERCIAL,724.71,98,,,OTHER,554.63,724.71,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,375.5,150.2,AETNA,AETNA COMMERCIAL,367.99,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,212.75,85.1,AETNA,AETNA COMMERCIAL,208.495,98,,,OTHER,159.56,208.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,130.75,52.3,AETNA,AETNA COMMERCIAL,128.135,98,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,96.39,38.556,AETNA,AETNA COMMERCIAL,94.4622,98,,,OTHER,108.38,141.61,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,AETNA,AETNA COMMERCIAL,80.0954,98,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,153.75,61.5,AETNA,AETNA COMMERCIAL,150.675,98,,,OTHER,108.38,141.61,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE 6.5MM 30MM 103533",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM",1680071,CDM,,,,INPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,AETNA,AETNA COMMERCIAL,247.45,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 20MM 245844",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,AETNA,AETNA COMMERCIAL,786.94,98,,,OTHER,602.25,786.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 6.5MM 245-846",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,AETNA,AETNA COMMERCIAL,786.94,98,,,OTHER,602.25,786.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,AETNA,AETNA COMMERCIAL,80.0954,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,AETNA,AETNA COMMERCIAL,231.1526,98,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, SD SCHANZ 4.0MM 2.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,338.69,135.476,AETNA,AETNA COMMERCIAL,331.9162,98,,,OTHER,357.75,467.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 10MM",C1713,HCPCS,278,RC,,INPATIENT,,,388,155.2,AETNA,AETNA COMMERCIAL,380.24,98,,,OTHER,291,380.24,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,AETNA,AETNA COMMERCIAL,247.45,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,AETNA,AETNA COMMERCIAL,247.45,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI LONG TRD 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,AETNA,AETNA COMMERCIAL,388.2172,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI LT 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,AETNA,AETNA COMMERCIAL,388.2172,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, SCHANZ SD 4.0MM 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,378,151.2,AETNA,AETNA COMMERCIAL,370.44,98,,,OTHER,398.81,521.12,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,AETNA,AETNA COMMERCIAL,535.57,98,,,OTHER,409.88,535.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TAPS 3.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,370.25,148.1,AETNA,AETNA COMMERCIAL,362.845,98,,,OTHER,277.69,362.85,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 407.650",C1713,HCPCS,278,RC,,INPATIENT,,,682,272.8,AETNA,AETNA COMMERCIAL,668.36,98,,,OTHER,511.5,668.36,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 45MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,AETNA,AETNA COMMERCIAL,62.769,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS12.7MM 280.900",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,AETNA,AETNA COMMERCIAL,675.6806,98,,,OTHER,750.56,980.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,AETNA,AETNA COMMERCIAL,509.7274,98,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, 7.3MM 95MM TL 95MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,AETNA,AETNA COMMERCIAL,509.7274,98,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX SP 2.0MM 8MM",C1713,HCPCS,278,RC,,INPATIENT,,,125.5,50.2,AETNA,AETNA COMMERCIAL,122.99,98,,,OTHER,94.13,122.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TAPS 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,AETNA,AETNA COMMERCIAL,309.19,98,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,AETNA,AETNA COMMERCIAL,558.6,98,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,AETNA,AETNA COMMERCIAL,62.965,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,AETNA,AETNA COMMERCIAL,486.08,98,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,AETNA,AETNA COMMERCIAL,486.08,98,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,AETNA,AETNA COMMERCIAL,486.08,98,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,AETNA,AETNA COMMERCIAL,486.08,98,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI ST 4.0MM 48MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,AETNA,AETNA COMMERCIAL,641.655,98,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,AETNA,AETNA COMMERCIAL,247.45,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,AETNA,AETNA COMMERCIAL,547.82,98,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,AETNA,AETNA COMMERCIAL,535.57,98,,,OTHER,409.88,535.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST TI 2.7MM 10MM",1680148,CDM,,,,INPATIENT,,,373.25,149.3,AETNA,AETNA COMMERCIAL,365.785,98,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK STT8 2.7MM 202.214",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,AETNA,AETNA COMMERCIAL,234.122,98,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T8 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,AETNA,AETNA COMMERCIAL,234.122,98,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN BONE FT 4.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,AETNA,AETNA COMMERCIAL,97.265,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE MULCH 10.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,AETNA,AETNA COMMERCIAL,1922.025,98,,,OTHER,1470.94,1922.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN WASHERLOC 8MM 52MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,AETNA,AETNA COMMERCIAL,540.225,98,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,AETNA,AETNA COMMERCIAL,617.155,98,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,AETNA,AETNA COMMERCIAL,912.38,98,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,AETNA,AETNA COMMERCIAL,63.5432,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS 12.7MM 103535",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,AETNA,AETNA COMMERCIAL,675.6806,98,,,OTHER,765.94,1000.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,AETNA,AETNA COMMERCIAL,451.29,98,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,AETNA,AETNA COMMERCIAL,451.29,98,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,AETNA,AETNA COMMERCIAL,451.29,98,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, DHS/DCS LAG 12.7MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,AETNA,AETNA COMMERCIAL,675.6806,98,,,OTHER,794.44,1038.07,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE DRILL POINT,C1769,HCPCS,278,RC,,INPATIENT,,,523.75,209.5,AETNA,AETNA COMMERCIAL,513.275,98,,,OTHER,392.81,513.28,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 3.2MM 400MM,C1769,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,AETNA,AETNA COMMERCIAL,309.19,98,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 0.38MM 18MM,C1769,HCPCS,278,RC,,INPATIENT,,,432.75,173.1,AETNA,AETNA COMMERCIAL,424.095,98,,,OTHER,324.56,424.1,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRETHRD1.25MM 900.722,C1769,HCPCS,278,RC,,INPATIENT,,,74.46,29.784,AETNA,AETNA COMMERCIAL,72.9708,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 2.5MM 200MM,C1769,HCPCS,278,RC,,INPATIENT,,,263,105.2,AETNA,AETNA COMMERCIAL,257.74,98,,,OTHER,197.25,257.74,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 2.5MM 900.723",C1769,HCPCS,278,RC,,INPATIENT,,,121.91,48.764,AETNA,AETNA COMMERCIAL,119.4718,98,,,OTHER,141.19,184.49,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE,C1769,HCPCS,278,RC,,INPATIENT,,,50.35,20.14,AETNA,AETNA COMMERCIAL,49.343,98,,,OTHER,392.25,512.54,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 2.8MM 292.68",C1769,HCPCS,278,RC,,INPATIENT,,,115.29,46.116,AETNA,AETNA COMMERCIAL,112.9842,98,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 1.25MM 292.62",C1769,HCPCS,278,RC,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
GUIDE PIN 3/32MM 35-329640,C1776,HCPCS,278,RC,,INPATIENT,,,654.25,261.7,AETNA,AETNA COMMERCIAL,641.165,98,,,OTHER,490.69,641.17,PERCENT OF TOTAL BILLED CHARGES
"PIN, POSITION 4.5MM 298.3803S",C1776,HCPCS,278,RC,,INPATIENT,,,504.5,201.8,AETNA,AETNA COMMERCIAL,494.41,98,,,OTHER,378.38,494.41,PERCENT OF TOTAL BILLED CHARGES
"PIN, RESTORE BAYONET W/EYELET",C1776,HCPCS,278,RC,,INPATIENT,,,657.5,263,AETNA,AETNA COMMERCIAL,644.35,98,,,OTHER,493.13,644.35,PERCENT OF TOTAL BILLED CHARGES
"LOCKING, SCREW 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.25,223.7,AETNA,AETNA COMMERCIAL,548.065,98,,,OTHER,419.44,548.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DHS 4 HOLE 25MM 135DEG",C1713,HCPCS,278,RC,,INPATIENT,,,1661.5,664.6,AETNA,AETNA COMMERCIAL,1628.27,98,,,OTHER,1246.13,1628.27,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON 184764",C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,AETNA,AETNA COMMERCIAL,1960.98,98,,,OTHER,1500.75,1960.98,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON 37MM",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,AETNA,AETNA COMMERCIAL,755.6976,98,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR 34MM 11-150842",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,AETNA,AETNA COMMERCIAL,755.6976,98,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTN 11-150840",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,AETNA,AETNA COMMERCIAL,755.6976,98,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON ALL POLY",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,AETNA,AETNA COMMERCIAL,755.6976,98,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
IMPLANT SYSTEM SPEEDBRIDGE,C1776,HCPCS,278,RC,,INPATIENT,,,3323,1329.2,AETNA,AETNA COMMERCIAL,3256.54,98,,,OTHER,2492.25,3256.54,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC 103205",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,10397.25,4158.9,AETNA,AETNA COMMERCIAL,10189.305,98,,,OTHER,7797.94,10189.31,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC 103202",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,AETNA,AETNA COMMERCIAL,5663.7924,98,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1713,HCPCS,278,RC,,INPATIENT,,,8257.75,3303.1,AETNA,AETNA COMMERCIAL,8092.595,98,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589,1835.6,AETNA,AETNA COMMERCIAL,4497.22,98,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,AETNA,AETNA COMMERCIAL,3580.038,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOC 183028",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,AETNA,AETNA COMMERCIAL,3580.038,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK 183006",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,AETNA,AETNA COMMERCIAL,4498.2,98,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,AETNA,AETNA COMMERCIAL,3580.038,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK 183034",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,AETNA,AETNA COMMERCIAL,3580.038,98,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,AETNA,AETNA COMMERCIAL,4498.2,98,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING I-BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,AETNA,AETNA COMMERCIAL,7488.67,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,AETNA,AETNA COMMERCIAL,2040.5952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING ANT STAB",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL EARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,AETNA,AETNA COMMERCIAL,7488.67,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 183480",C1776,HCPCS,278,RC,,INPATIENT,,,2967.5,1187,AETNA,AETNA COMMERCIAL,2908.15,98,,,OTHER,2225.63,2908.15,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189064",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,AETNA,AETNA COMMERCIAL,2040.5952,98,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,4099.1,1639.64,AETNA,AETNA COMMERCIAL,4017.118,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,AETNA,AETNA COMMERCIAL,7488.67,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING DCM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,AETNA,AETNA COMMERCIAL,2040.5952,98,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,AETNA,AETNA COMMERCIAL,4161.9228,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,AETNA,AETNA COMMERCIAL,7488.67,98,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,AETNA,AETNA COMMERCIAL,4161.9228,98,,,OTHER,3185.15,4161.92,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189062",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 90MM 135'",1680231,CDM,,,,INPATIENT,,,1369,547.6,AETNA,AETNA COMMERCIAL,1341.62,98,,,OTHER,1026.75,1341.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 135'",1680232,CDM,,,,INPATIENT,,,1369,547.6,AETNA,AETNA COMMERCIAL,1341.62,98,,,OTHER,1026.75,1341.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 135'",1680234,CDM,,,,INPATIENT,,,1338.25,535.3,AETNA,AETNA COMMERCIAL,1311.485,98,,,OTHER,1003.69,1311.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 135'",1680235,CDM,,,,INPATIENT,,,1308,523.2,AETNA,AETNA COMMERCIAL,1281.84,98,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 140'",1680236,CDM,,,,INPATIENT,,,1247.25,498.9,AETNA,AETNA COMMERCIAL,1222.305,98,,,OTHER,935.44,1222.31,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 140'",1680237,CDM,,,,INPATIENT,,,1107.5,443,AETNA,AETNA COMMERCIAL,1085.35,98,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 140'",1680238,CDM,,,,INPATIENT,,,1308,523.2,AETNA,AETNA COMMERCIAL,1281.84,98,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 150'",1680239,CDM,,,,INPATIENT,,,1107.5,443,AETNA,AETNA COMMERCIAL,1085.35,98,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 150'",1680240,CDM,,,,INPATIENT,,,1107.5,443,AETNA,AETNA COMMERCIAL,1085.35,98,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 150'",1680242,CDM,,,,INPATIENT,,,1308,523.2,AETNA,AETNA COMMERCIAL,1281.84,98,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 145'",1680243,CDM,,,,INPATIENT,,,1107.5,443,AETNA,AETNA COMMERCIAL,1085.35,98,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 145'",1680244,CDM,,,,INPATIENT,,,1107.5,443,AETNA,AETNA COMMERCIAL,1085.35,98,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 145'",1680245,CDM,,,,INPATIENT,,,1308,523.2,AETNA,AETNA COMMERCIAL,1281.84,98,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 20MM",1680246,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 22MM",1680247,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 24MM",1680248,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 26MM",1680249,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 28MM",1680250,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 30MM",1680252,CDM,,,,INPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 32MM",1680253,CDM,,,,INPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 34MM",1680254,CDM,,,,INPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 36MM",1680255,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 38MM",1680256,CDM,,,,INPATIENT,,,78.5,31.4,AETNA,AETNA COMMERCIAL,76.93,98,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 40MM",1680257,CDM,,,,INPATIENT,,,78.5,31.4,AETNA,AETNA COMMERCIAL,76.93,98,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 42MM",1680258,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 44MM",1680259,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 46MM",1680260,CDM,,,,INPATIENT,,,82.75,33.1,AETNA,AETNA COMMERCIAL,81.095,98,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 48MM",1680262,CDM,,,,INPATIENT,,,82.75,33.1,AETNA,AETNA COMMERCIAL,81.095,98,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 50MM",1680263,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 52MM",1680264,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 56MM",1680265,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 70MM",1680268,CDM,,,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 75MM",1680269,CDM,,,,INPATIENT,,,114.75,45.9,AETNA,AETNA COMMERCIAL,112.455,98,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 80MM",1680270,CDM,,,,INPATIENT,,,114.75,45.9,AETNA,AETNA COMMERCIAL,112.455,98,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 85MM",1680272,CDM,,,,INPATIENT,,,114.75,45.9,AETNA,AETNA COMMERCIAL,112.455,98,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.14",1680273,CDM,,,,INPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.16",1680274,CDM,,,,INPATIENT,,,34,13.6,AETNA,AETNA COMMERCIAL,33.32,98,,,OTHER,25.5,33.32,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.18",1680275,CDM,,,,INPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.20",1680276,CDM,,,,INPATIENT,,,48.25,19.3,AETNA,AETNA COMMERCIAL,47.285,98,,,OTHER,36.19,47.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.22",1680277,CDM,,,,INPATIENT,,,23.25,9.3,AETNA,AETNA COMMERCIAL,22.785,98,,,OTHER,17.44,22.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.24",1680278,CDM,,,,INPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.26",1680279,CDM,,,,INPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.28",1680280,CDM,,,,INPATIENT,,,48.25,19.3,AETNA,AETNA COMMERCIAL,47.285,98,,,OTHER,36.19,47.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.30",1680282,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.32",1680283,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.34",1680284,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.36",1680285,CDM,,,,INPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.38",1680286,CDM,,,,INPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.40",1680287,CDM,,,,INPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.42",1680288,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.44",1680289,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.46",1680290,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.48",1680292,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.50",1680293,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.52",1680294,CDM,,,,INPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.54",1680295,CDM,,,,INPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.56",1680296,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.58",1680297,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.60",1680298,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.64",1680299,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.68",1680300,CDM,,,,INPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.70",1680302,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.72",1680303,CDM,,,,INPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.76",1680304,CDM,,,,INPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.80",1680305,CDM,,,,INPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.85",1680306,CDM,,,,INPATIENT,,,76.25,30.5,AETNA,AETNA COMMERCIAL,74.725,98,,,OTHER,57.19,74.73,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.90",1680307,CDM,,,,INPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.844",1680308,CDM,,,,INPATIENT,,,99.25,39.7,AETNA,AETNA COMMERCIAL,97.265,98,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.95",1680309,CDM,,,,INPATIENT,,,65.75,26.3,AETNA,AETNA COMMERCIAL,64.435,98,,,OTHER,49.31,64.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.05",1680310,CDM,,,,INPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.06",1680311,CDM,,,,INPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.025",1680312,CDM,,,,INPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.030",1680313,CDM,,,,INPATIENT,,,69.5,27.8,AETNA,AETNA COMMERCIAL,68.11,98,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.040",1680316,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.045",1680317,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.050",1680318,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.055",1680319,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.060",1680320,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.065",1680322,CDM,,,,INPATIENT,,,69.5,27.8,AETNA,AETNA COMMERCIAL,68.11,98,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.070",1680323,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,70.75,28.3,AETNA,AETNA COMMERCIAL,69.335,98,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,AETNA,AETNA COMMERCIAL,122.255,98,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,AETNA,AETNA COMMERCIAL,122.255,98,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,AETNA,AETNA COMMERCIAL,71.295,98,,,OTHER,54.56,71.3,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,AETNA,AETNA COMMERCIAL,71.295,98,,,OTHER,54.56,71.3,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,AETNA,AETNA COMMERCIAL,122.255,98,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,117.25,46.9,AETNA,AETNA COMMERCIAL,114.905,98,,,OTHER,87.94,114.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,AETNA,AETNA COMMERCIAL,122.255,98,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,88.75,35.5,AETNA,AETNA COMMERCIAL,86.975,98,,,OTHER,66.56,86.98,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM 70MM",1680350,CDM,,,,INPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,70.75,28.3,AETNA,AETNA COMMERCIAL,69.335,98,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,83.5,33.4,AETNA,AETNA COMMERCIAL,81.83,98,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,81.75,32.7,AETNA,AETNA COMMERCIAL,80.115,98,,,OTHER,61.31,80.12,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,AETNA,AETNA COMMERCIAL,73.01,98,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,49,19.6,AETNA,AETNA COMMERCIAL,48.02,98,,,OTHER,36.75,48.02,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 20MM 245848",C1713,HCPCS,278,RC,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,69.25,27.7,AETNA,AETNA COMMERCIAL,67.865,98,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.06",1680365,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.07",1680366,CDM,,,,INPATIENT,,,89.25,35.7,AETNA,AETNA COMMERCIAL,87.465,98,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.08",1680367,CDM,,,,INPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.09",1680368,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.10",1680369,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.11",1680370,CDM,,,,INPATIENT,,,123.5,49.4,AETNA,AETNA COMMERCIAL,121.03,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.12",1680372,CDM,,,,INPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.14",1680373,CDM,,,,INPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.16",1680374,CDM,,,,INPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.06",1680375,CDM,,,,INPATIENT,,,46.25,18.5,AETNA,AETNA COMMERCIAL,45.325,98,,,OTHER,34.69,45.33,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.008",1680376,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.010",1680377,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.012",1680378,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.014",1680379,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.16",1680380,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.18",1680382,CDM,,,,INPATIENT,,,59.75,23.9,AETNA,AETNA COMMERCIAL,58.555,98,,,OTHER,44.81,58.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.20",1680383,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.06",1680384,CDM,,,,INPATIENT,,,43.5,17.4,AETNA,AETNA COMMERCIAL,42.63,98,,,OTHER,32.63,42.63,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.08",1680385,CDM,,,,INPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.10",1680386,CDM,,,,INPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.12",1680387,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.14",1680388,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.16",1680389,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.18",1680390,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.20",1680392,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.22",1680393,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.24",1680394,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.10",1680395,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.12",1680396,CDM,,,,INPATIENT,,,53.5,21.4,AETNA,AETNA COMMERCIAL,52.43,98,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.14",1680397,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.16",1680398,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.18",1680400,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.20",1680402,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.22",1680403,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.24",1680404,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.28",1680406,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.32",1680407,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.36",1680408,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.40",1680409,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.45",1680410,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.50",1680412,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,81,32.4,AETNA,AETNA COMMERCIAL,79.38,98,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,26.75,10.7,AETNA,AETNA COMMERCIAL,26.215,98,,,OTHER,20.06,26.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,AETNA,AETNA COMMERCIAL,49.735,98,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,AETNA,AETNA COMMERCIAL,49.735,98,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,AETNA,AETNA COMMERCIAL,49.735,98,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,49,19.6,AETNA,AETNA COMMERCIAL,48.02,98,,,OTHER,36.75,48.02,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,59.75,23.9,AETNA,AETNA COMMERCIAL,58.555,98,,,OTHER,44.81,58.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,57.25,22.9,AETNA,AETNA COMMERCIAL,56.105,98,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,27,10.8,AETNA,AETNA COMMERCIAL,26.46,98,,,OTHER,20.25,26.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,AETNA,AETNA COMMERCIAL,49.49,98,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,AETNA,AETNA COMMERCIAL,49.49,98,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.5,19.4,AETNA,AETNA COMMERCIAL,47.53,98,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,28.25,11.3,AETNA,AETNA COMMERCIAL,27.685,98,,,OTHER,21.19,27.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,AETNA,AETNA COMMERCIAL,49.49,98,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,AETNA,AETNA COMMERCIAL,49.49,98,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.98,1680447,CDM,,,,INPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.95S,1680448,CDM,,,,INPATIENT,,,87.5,35,AETNA,AETNA COMMERCIAL,85.75,98,,,OTHER,65.63,85.75,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.99,1680449,CDM,,,,INPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
"NUTS,LAG BOLT 219.96",1680450,CDM,,,,INPATIENT,,,28.5,11.4,AETNA,AETNA COMMERCIAL,27.93,98,,,OTHER,21.38,27.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.32",1680451,CDM,,,,INPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.33",1680452,CDM,,,,INPATIENT,,,51,20.4,AETNA,AETNA COMMERCIAL,49.98,98,,,OTHER,38.25,49.98,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.34",1680453,CDM,,,,INPATIENT,,,103.5,41.4,AETNA,AETNA COMMERCIAL,101.43,98,,,OTHER,77.63,101.43,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.35",1680454,CDM,,,,INPATIENT,,,125.25,50.1,AETNA,AETNA COMMERCIAL,122.745,98,,,OTHER,93.94,122.75,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.36",1680455,CDM,,,,INPATIENT,,,244.25,97.7,AETNA,AETNA COMMERCIAL,239.365,98,,,OTHER,183.19,239.37,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.37",1680456,CDM,,,,INPATIENT,,,297.5,119,AETNA,AETNA COMMERCIAL,291.55,98,,,OTHER,223.13,291.55,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.38",1680457,CDM,,,,INPATIENT,,,269.5,107.8,AETNA,AETNA COMMERCIAL,264.11,98,,,OTHER,202.13,264.11,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.13",1680458,CDM,,,,INPATIENT,,,127,50.8,AETNA,AETNA COMMERCIAL,124.46,98,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.14",1680459,CDM,,,,INPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.15",1680460,CDM,,,,INPATIENT,,,145,58,AETNA,AETNA COMMERCIAL,142.1,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.16",1680461,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/4 TUBULAR 242.17",1680462,CDM,,,,INPATIENT,,,137.75,55.1,AETNA,AETNA COMMERCIAL,134.995,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/4 TUBULAR 242.18",1680463,CDM,,,,INPATIENT,,,145,58,AETNA,AETNA COMMERCIAL,142.1,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.02",1680464,CDM,,,,INPATIENT,,,56,22.4,AETNA,AETNA COMMERCIAL,54.88,98,,,OTHER,42,54.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.03",1680465,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.04",1680466,CDM,,,,INPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.05",1680467,CDM,,,,INPATIENT,,,69.5,27.8,AETNA,AETNA COMMERCIAL,68.11,98,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.06",1680468,CDM,,,,INPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.07",1680469,CDM,,,,INPATIENT,,,78.5,31.4,AETNA,AETNA COMMERCIAL,76.93,98,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.08",1680470,CDM,,,,INPATIENT,,,82.75,33.1,AETNA,AETNA COMMERCIAL,81.095,98,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.09",1680471,CDM,,,,INPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.10",1680472,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.11",1680473,CDM,,,,INPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.12",1680474,CDM,,,,INPATIENT,,,84.75,33.9,AETNA,AETNA COMMERCIAL,83.055,98,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,179.25,71.7,AETNA,AETNA COMMERCIAL,175.665,98,,,OTHER,134.44,175.67,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.04",1680476,CDM,,,,INPATIENT,,,183.5,73.4,AETNA,AETNA COMMERCIAL,179.83,98,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.05",1680477,CDM,,,,INPATIENT,,,225,90,AETNA,AETNA COMMERCIAL,220.5,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.06",1680478,CDM,,,,INPATIENT,,,251.75,100.7,AETNA,AETNA COMMERCIAL,246.715,98,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.07",1680479,CDM,,,,INPATIENT,,,251.75,100.7,AETNA,AETNA COMMERCIAL,246.715,98,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,153,61.2,AETNA,AETNA COMMERCIAL,149.94,98,,,OTHER,114.75,149.94,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.09",1680481,CDM,,,,INPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.10",1680482,CDM,,,,INPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.12",1680483,CDM,,,,INPATIENT,,,194.75,77.9,AETNA,AETNA COMMERCIAL,190.855,98,,,OTHER,146.06,190.86,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.02",1680484,CDM,,,,INPATIENT,,,92.25,36.9,AETNA,AETNA COMMERCIAL,90.405,98,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.03",1680485,CDM,,,,INPATIENT,,,96,38.4,AETNA,AETNA COMMERCIAL,94.08,98,,,OTHER,72,94.08,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.04",1680486,CDM,,,,INPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.05",1680487,CDM,,,,INPATIENT,,,247.75,99.1,AETNA,AETNA COMMERCIAL,242.795,98,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.06",1680488,CDM,,,,INPATIENT,,,263.5,105.4,AETNA,AETNA COMMERCIAL,258.23,98,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.07",1680489,CDM,,,,INPATIENT,,,274.5,109.8,AETNA,AETNA COMMERCIAL,269.01,98,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.08",1680490,CDM,,,,INPATIENT,,,276.75,110.7,AETNA,AETNA COMMERCIAL,271.215,98,,,OTHER,207.56,271.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.10",1680491,CDM,,,,INPATIENT,,,145,58,AETNA,AETNA COMMERCIAL,142.1,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.06",1680492,CDM,,,,INPATIENT,,,187,74.8,AETNA,AETNA COMMERCIAL,183.26,98,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.07",1680493,CDM,,,,INPATIENT,,,187,74.8,AETNA,AETNA COMMERCIAL,183.26,98,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.10",1680495,CDM,,,,INPATIENT,,,221.5,88.6,AETNA,AETNA COMMERCIAL,217.07,98,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.12",1680496,CDM,,,,INPATIENT,,,221.5,88.6,AETNA,AETNA COMMERCIAL,217.07,98,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.14",1680497,CDM,,,,INPATIENT,,,244.5,97.8,AETNA,AETNA COMMERCIAL,239.61,98,,,OTHER,183.38,239.61,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.16",1680498,CDM,,,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.18",1680499,CDM,,,,INPATIENT,,,396,158.4,AETNA,AETNA COMMERCIAL,388.08,98,,,OTHER,297,388.08,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T OBLIQUE ANG. 241.23",1680500,CDM,,,,INPATIENT,,,33.25,13.3,AETNA,AETNA COMMERCIAL,32.585,98,,,OTHER,24.94,32.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T OBLIQUE ANG. 241.25",1680501,CDM,,,,INPATIENT,,,323.75,129.5,AETNA,AETNA COMMERCIAL,317.275,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.13",1680502,CDM,,,,INPATIENT,,,187,74.8,AETNA,AETNA COMMERCIAL,183.26,98,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.14",1680503,CDM,,,,INPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.16",1680504,CDM,,,,INPATIENT,,,160.75,64.3,AETNA,AETNA COMMERCIAL,157.535,98,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.31(L)",1680505,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.33(L)",1680507,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.34",1680508,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.31(L)",1680509,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.32(R)",1680510,CDM,,,,INPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.33 (L)",1680511,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.34(R)",1680512,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.13",1680513,CDM,,,,INPATIENT,,,190.75,76.3,AETNA,AETNA COMMERCIAL,186.935,98,,,OTHER,143.06,186.94,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.14",1680514,CDM,,,,INPATIENT,,,366,146.4,AETNA,AETNA COMMERCIAL,358.68,98,,,OTHER,274.5,358.68,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.15",1680515,CDM,,,,INPATIENT,,,312.25,124.9,AETNA,AETNA COMMERCIAL,306.005,98,,,OTHER,234.19,306.01,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.16",1680516,CDM,,,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.18",1680517,CDM,,,,INPATIENT,,,554.25,221.7,AETNA,AETNA COMMERCIAL,543.165,98,,,OTHER,415.69,543.17,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,178.5,71.4,AETNA,AETNA COMMERCIAL,174.93,98,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.13",1680520,CDM,,,,INPATIENT,,,53.5,21.4,AETNA,AETNA COMMERCIAL,52.43,98,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.14",1680521,CDM,,,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.15",1680522,CDM,,,,INPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.16",1680523,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CLOVERLEAF 240.23",1680524,CDM,,,,INPATIENT,,,229,91.6,AETNA,AETNA COMMERCIAL,224.42,98,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CLOVERLEAF 240.24",1680525,CDM,,,,INPATIENT,,,247.75,99.1,AETNA,AETNA COMMERCIAL,242.795,98,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SPOON 240.05",1680526,CDM,,,,INPATIENT,,,233,93.2,AETNA,AETNA COMMERCIAL,228.34,98,,,OTHER,174.75,228.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SPOON 240.06",1680527,CDM,,,,INPATIENT,,,233,93.2,AETNA,AETNA COMMERCIAL,228.34,98,,,OTHER,174.75,228.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.34",1680528,CDM,,,,INPATIENT,,,308,123.2,AETNA,AETNA COMMERCIAL,301.84,98,,,OTHER,231,301.84,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.35",1680529,CDM,,,,INPATIENT,,,444.75,177.9,AETNA,AETNA COMMERCIAL,435.855,98,,,OTHER,333.56,435.86,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.36",1680530,CDM,,,,INPATIENT,,,343.25,137.3,AETNA,AETNA COMMERCIAL,336.385,98,,,OTHER,257.44,336.39,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L-BUTTRESS 240.44",1680531,CDM,,,,INPATIENT,,,323.75,129.5,AETNA,AETNA COMMERCIAL,317.275,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L-BUTTRESS 240.54",1680532,CDM,,,,INPATIENT,,,490.25,196.1,AETNA,AETNA COMMERCIAL,480.445,98,,,OTHER,367.69,480.45,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,593.75,237.5,AETNA,AETNA COMMERCIAL,581.875,98,,,OTHER,445.31,581.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,563.5,225.4,AETNA,AETNA COMMERCIAL,552.23,98,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,991.75,396.7,AETNA,AETNA COMMERCIAL,971.915,98,,,OTHER,743.81,971.92,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,AETNA,AETNA COMMERCIAL,1002.05,98,,,OTHER,766.88,1002.05,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,AETNA,AETNA COMMERCIAL,1002.05,98,,,OTHER,766.88,1002.05,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1055.75,422.3,AETNA,AETNA COMMERCIAL,1034.635,98,,,OTHER,791.81,1034.64,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,732.5,293,AETNA,AETNA COMMERCIAL,717.85,98,,,OTHER,549.38,717.85,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1085.75,434.3,AETNA,AETNA COMMERCIAL,1064.035,98,,,OTHER,814.31,1064.04,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 245.35",1680543,CDM,,,,INPATIENT,,,694,277.6,AETNA,AETNA COMMERCIAL,680.12,98,,,OTHER,520.5,680.12,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 245.32",1680544,CDM,,,,INPATIENT,,,539,215.6,AETNA,AETNA COMMERCIAL,528.22,98,,,OTHER,404.25,528.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 229.44",1680545,CDM,,,,INPATIENT,,,660.5,264.2,AETNA,AETNA COMMERCIAL,647.29,98,,,OTHER,495.38,647.29,PERCENT OF TOTAL BILLED CHARGES
"WIRE, CERCLAGE EYE 291.11",1680546,CDM,,,,INPATIENT,,,123.75,49.5,AETNA,AETNA COMMERCIAL,121.275,98,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
"WIRE, CERCLAGE COIL 291.05",1680547,CDM,,,,INPATIENT,,,104.75,41.9,AETNA,AETNA COMMERCIAL,102.655,98,,,OTHER,78.56,102.66,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,111.5,44.6,AETNA,AETNA COMMERCIAL,109.27,98,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,AETNA,AETNA COMMERCIAL,194.285,98,,,OTHER,148.69,194.29,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,AETNA,AETNA COMMERCIAL,194.285,98,,,OTHER,148.69,194.29,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,265.25,106.1,AETNA,AETNA COMMERCIAL,259.945,98,,,OTHER,198.94,259.95,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,AETNA,AETNA COMMERCIAL,157.535,98,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,AETNA,AETNA COMMERCIAL,157.535,98,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,AETNA,AETNA COMMERCIAL,157.535,98,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 2-HOLE,1680562,CDM,,,,INPATIENT,,,748.75,299.5,AETNA,AETNA COMMERCIAL,733.775,98,,,OTHER,561.56,733.78,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 4-HOLE,1680563,CDM,,,,INPATIENT,,,897.25,358.9,AETNA,AETNA COMMERCIAL,879.305,98,,,OTHER,672.94,879.31,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 6-HOLE,1680564,CDM,,,,INPATIENT,,,748.75,299.5,AETNA,AETNA COMMERCIAL,733.775,98,,,OTHER,561.56,733.78,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 8-HOLE,1680565,CDM,,,,INPATIENT,,,824.75,329.9,AETNA,AETNA COMMERCIAL,808.255,98,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,824.75,329.9,AETNA,AETNA COMMERCIAL,808.255,98,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,824.75,329.9,AETNA,AETNA COMMERCIAL,808.255,98,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,1049.5,419.8,AETNA,AETNA COMMERCIAL,1028.51,98,,,OTHER,787.13,1028.51,PERCENT OF TOTAL BILLED CHARGES
"PIN, CANNULATED GUIDE",1680569,CDM,,,,INPATIENT,,,320.25,128.1,AETNA,AETNA COMMERCIAL,313.845,98,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,1089.25,435.7,AETNA,AETNA COMMERCIAL,1067.465,98,,,OTHER,816.94,1067.47,PERCENT OF TOTAL BILLED CHARGES
MITEK MINI QUICKANCHOR,1680571,CDM,,,,INPATIENT,,,982.75,393.1,AETNA,AETNA COMMERCIAL,963.095,98,,,OTHER,737.06,963.1,PERCENT OF TOTAL BILLED CHARGES
MITEK GII QUICKANCHOR,1680572,CDM,,,,INPATIENT,,,1004.25,401.7,AETNA,AETNA COMMERCIAL,984.165,98,,,OTHER,753.19,984.17,PERCENT OF TOTAL BILLED CHARGES
MITEK SUPER QUICKANCHOR,1680573,CDM,,,,INPATIENT,,,1748.25,699.3,AETNA,AETNA COMMERCIAL,1713.285,98,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
CANCELLOUS BONE CHIPS 30CC,1680574,CDM,,,,INPATIENT,,,1323,529.2,AETNA,AETNA COMMERCIAL,1296.54,98,,,OTHER,992.25,1296.54,PERCENT OF TOTAL BILLED CHARGES
BIOMET ACL WASHER 14MM,1680575,CDM,,,,INPATIENT,,,402,160.8,AETNA,AETNA COMMERCIAL,393.96,98,,,OTHER,301.5,393.96,PERCENT OF TOTAL BILLED CHARGES
"WASHER, ACL 18MM",1680576,CDM,,,,INPATIENT,,,578.5,231.4,AETNA,AETNA COMMERCIAL,566.93,98,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 30MM",1680577,CDM,,,,INPATIENT,,,183.5,73.4,AETNA,AETNA COMMERCIAL,179.83,98,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 35MM",1680578,CDM,,,,INPATIENT,,,183.5,73.4,AETNA,AETNA COMMERCIAL,179.83,98,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 40MM",1680579,CDM,,,,INPATIENT,,,210,84,AETNA,AETNA COMMERCIAL,205.8,98,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 45MM",1680580,CDM,,,,INPATIENT,,,225,90,AETNA,AETNA COMMERCIAL,220.5,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 50MM",1680581,CDM,,,,INPATIENT,,,225,90,AETNA,AETNA COMMERCIAL,220.5,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 55MM",1680582,CDM,,,,INPATIENT,,,225,90,AETNA,AETNA COMMERCIAL,220.5,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 60MM",1680583,CDM,,,,INPATIENT,,,164.25,65.7,AETNA,AETNA COMMERCIAL,160.965,98,,,OTHER,123.19,160.97,PERCENT OF TOTAL BILLED CHARGES
CANN. INTERSCREW 7X25MM,1680584,CDM,,,,INPATIENT,,,339.25,135.7,AETNA,AETNA COMMERCIAL,332.465,98,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
CANN. INTERSCREW,1680585,CDM,,,,INPATIENT,,,339.25,135.7,AETNA,AETNA COMMERCIAL,332.465,98,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
"WASHER, SPIKED",1680586,CDM,,,,INPATIENT,,,87.5,35,AETNA,AETNA COMMERCIAL,85.75,98,,,OTHER,65.63,85.75,PERCENT OF TOTAL BILLED CHARGES
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,426.75,170.7,AETNA,AETNA COMMERCIAL,418.215,98,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS W/ETHIBOND,1680588,CDM,,,,INPATIENT,,,1000.75,400.3,AETNA,AETNA COMMERCIAL,980.735,98,,,OTHER,750.56,980.74,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 46MM",1680589,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 48MM",1680590,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 50MM",1680591,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 52MM",1680592,CDM,,,,INPATIENT,,,2742.5,1097,AETNA,AETNA COMMERCIAL,2687.65,98,,,OTHER,2056.88,2687.65,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 54MM",1680593,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 56MM",1680594,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 58MM",1680595,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 60MM",1680596,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 62MM",1680597,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 64MM",1680598,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 66MM",1680599,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 68MM",1680600,CDM,,,,INPATIENT,,,2660,1064,AETNA,AETNA COMMERCIAL,2606.8,98,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 42MM",1680601,CDM,,,,INPATIENT,,,2362.5,945,AETNA,AETNA COMMERCIAL,2315.25,98,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 45MM",1680602,CDM,,,,INPATIENT,,,2362.5,945,AETNA,AETNA COMMERCIAL,2315.25,98,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 48MM",1680603,CDM,,,,INPATIENT,,,2362.5,945,AETNA,AETNA COMMERCIAL,2315.25,98,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 51MM",1680604,CDM,,,,INPATIENT,,,2362.5,945,AETNA,AETNA COMMERCIAL,2315.25,98,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
HIP ACE LINER 42MM,1680606,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
HIP ACE LINER 43MM,1680607,CDM,,,,INPATIENT,,,1533,613.2,AETNA,AETNA COMMERCIAL,1502.34,98,,,OTHER,1149.75,1502.34,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 44MM",1680608,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 45MM",1680609,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 46MM",1680610,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 47MM",1680611,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 48MM",1680612,CDM,,,,INPATIENT,,,1487,594.8,AETNA,AETNA COMMERCIAL,1457.26,98,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 15MM 103530",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 20MM",1680614,CDM,,,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 25MM",1680615,CDM,,,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 30MM",1680616,CDM,,,,INPATIENT,,,263.5,105.4,AETNA,AETNA COMMERCIAL,258.23,98,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 35MM 103534",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 40MM 103535",1680618,CDM,,,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 45MM",1680619,CDM,,,,INPATIENT,,,263.5,105.4,AETNA,AETNA COMMERCIAL,258.23,98,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 50MM",1680620,CDM,,,,INPATIENT,,,274.5,109.8,AETNA,AETNA COMMERCIAL,269.01,98,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 60MM",1680621,CDM,,,,INPATIENT,,,263.5,105.4,AETNA,AETNA COMMERCIAL,258.23,98,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 70MM",1680622,CDM,,,,INPATIENT,,,263.5,105.4,AETNA,AETNA COMMERCIAL,258.23,98,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 20MM",1680623,CDM,,,,INPATIENT,,,229,91.6,AETNA,AETNA COMMERCIAL,224.42,98,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 30MM",1680624,CDM,,,,INPATIENT,,,240.25,96.1,AETNA,AETNA COMMERCIAL,235.445,98,,,OTHER,180.19,235.45,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 40MM",1680625,CDM,,,,INPATIENT,,,172,68.8,AETNA,AETNA COMMERCIAL,168.56,98,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5510,2204,AETNA,AETNA COMMERCIAL,5399.8,98,,,OTHER,4132.5,5399.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL COMP  12-162611",1680627,CDM,,,,INPATIENT,,,3248.25,1299.3,AETNA,AETNA COMMERCIAL,3183.285,98,,,OTHER,2436.19,3183.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL COMP 12-162613",1680628,CDM,,,,INPATIENT,,,4781,1912.4,AETNA,AETNA COMMERCIAL,4685.38,98,,,OTHER,3585.75,4685.38,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5379.5,2151.8,AETNA,AETNA COMMERCIAL,5271.91,98,,,OTHER,4034.63,5271.91,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,3248.25,1299.3,AETNA,AETNA COMMERCIAL,3183.285,98,,,OTHER,2436.19,3183.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,AETNA,AETNA COMMERCIAL,5590.9,98,,,OTHER,4278.75,5590.9,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,AETNA,AETNA COMMERCIAL,5590.9,98,,,OTHER,4278.75,5590.9,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,AETNA,AETNA COMMERCIAL,1177.47,98,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1803.25,721.3,AETNA,AETNA COMMERCIAL,1767.185,98,,,OTHER,1352.44,1767.19,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1134.5,453.8,AETNA,AETNA COMMERCIAL,1111.81,98,,,OTHER,850.88,1111.81,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1748.25,699.3,AETNA,AETNA COMMERCIAL,1713.285,98,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,AETNA,AETNA COMMERCIAL,1177.47,98,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1091.5,436.6,AETNA,AETNA COMMERCIAL,1069.67,98,,,OTHER,818.63,1069.67,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,AETNA,AETNA COMMERCIAL,1177.47,98,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,AETNA,AETNA COMMERCIAL,350.595,98,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,AETNA,AETNA COMMERCIAL,350.595,98,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,377,150.8,AETNA,AETNA COMMERCIAL,369.46,98,,,OTHER,282.75,369.46,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,AETNA,AETNA COMMERCIAL,350.595,98,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,AETNA,AETNA COMMERCIAL,350.595,98,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163005",1680646,CDM,,,,INPATIENT,,,247.75,99.1,AETNA,AETNA COMMERCIAL,242.795,98,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163010",1680647,CDM,,,,INPATIENT,,,289.75,115.9,AETNA,AETNA COMMERCIAL,283.955,98,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163015",1680648,CDM,,,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163020",1680649,CDM,,,,INPATIENT,,,301,120.4,AETNA,AETNA COMMERCIAL,294.98,98,,,OTHER,225.75,294.98,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163025",1680650,CDM,,,,INPATIENT,,,301,120.4,AETNA,AETNA COMMERCIAL,294.98,98,,,OTHER,225.75,294.98,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 16 X 65",1680654,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,AETNA,AETNA COMMERCIAL,2797.41,98,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,AETNA,AETNA COMMERCIAL,2797.41,98,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,AETNA,AETNA COMMERCIAL,2797.41,98,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 12 X 85",1680676,CDM,,,,INPATIENT,,,4474.5,1789.8,AETNA,AETNA COMMERCIAL,4385.01,98,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 14 X 85",1680677,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 16 X 85",1680678,CDM,,,,INPATIENT,,,4260.75,1704.3,AETNA,AETNA COMMERCIAL,4175.535,98,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 20 X 85",1680679,CDM,,,,INPATIENT,,,4261.25,1704.5,AETNA,AETNA COMMERCIAL,4176.025,98,,,OTHER,3195.94,4176.03,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM SPLINED 141614,1680681,CDM,,,,INPATIENT,,,5414.5,2165.8,AETNA,AETNA COMMERCIAL,5306.21,98,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
SCREW CORTEX 16MM 202.816,1680682,CDM,,,,INPATIENT,,,145.5,58.2,AETNA,AETNA COMMERCIAL,142.59,98,,,OTHER,109.13,142.59,PERCENT OF TOTAL BILLED CHARGES
TIBIAL TRAY OFFSET  141491,1680690,CDM,,,,INPATIENT,,,2402,960.8,AETNA,AETNA COMMERCIAL,2353.96,98,,,OTHER,1801.5,2353.96,PERCENT OF TOTAL BILLED CHARGES
LOCKING INSERT 141496,1680691,CDM,,,,INPATIENT,,,611.75,244.7,AETNA,AETNA COMMERCIAL,599.515,98,,,OTHER,458.81,599.52,PERCENT OF TOTAL BILLED CHARGES
TIBIAL TRAY BIOMET 141483,1680692,CDM,,,,INPATIENT,,,5988.75,2395.5,AETNA,AETNA COMMERCIAL,5868.975,98,,,OTHER,4491.56,5868.98,PERCENT OF TOTAL BILLED CHARGES
FEMORAL 65MM W/SCREW 183324,1680693,CDM,,,,INPATIENT,,,16906,6762.4,AETNA,AETNA COMMERCIAL,16567.88,98,,,OTHER,12679.5,16567.88,PERCENT OF TOTAL BILLED CHARGES
FEMORAL DISTAL AUGMENT 184184,1680694,CDM,,,,INPATIENT,,,2831.75,1132.7,AETNA,AETNA COMMERCIAL,2775.115,98,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORAL DISTAL AUGMENT 184204,1680695,CDM,,,,INPATIENT,,,2831.75,1132.7,AETNA,AETNA COMMERCIAL,2775.115,98,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORAL POSTERIOR AGMNT 184144,1680696,CDM,,,,INPATIENT,,,2831.75,1132.7,AETNA,AETNA COMMERCIAL,2775.115,98,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORALPOSTERIOR AGMNT 184164,1680697,CDM,,,,INPATIENT,,,2831.75,1132.7,AETNA,AETNA COMMERCIAL,2775.115,98,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
TISSUE FIXATION,C1776,HCPCS,278,RC,,INPATIENT,,,1675.5,670.2,AETNA,AETNA COMMERCIAL,1641.99,98,,,OTHER,1256.63,1641.99,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT CALIBRATED,1680703,CDM,,,,INPATIENT,,,346.25,138.5,AETNA,AETNA COMMERCIAL,339.325,98,,,OTHER,259.69,339.33,PERCENT OF TOTAL BILLED CHARGES
MAGNUM TAPER ADAPTER 6MM,C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,AETNA,AETNA COMMERCIAL,1272.775,98,,,OTHER,974.06,1272.78,PERCENT OF TOTAL BILLED CHARGES
MEDULLARY TUBE 2.5MM,C1776,HCPCS,278,RC,,INPATIENT,,,355,142,AETNA,AETNA COMMERCIAL,347.9,98,,,OTHER,266.25,347.9,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 3 FLUTED 4.2MM,1680709,CDM,,,,INPATIENT,,,590,236,AETNA,AETNA COMMERCIAL,578.2,98,,,OTHER,442.5,578.2,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 3 FLUTED 4.2MM 145MM,1680710,CDM,,,,INPATIENT,,,524,209.6,AETNA,AETNA COMMERCIAL,513.52,98,,,OTHER,393,513.52,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 3.2MM 400MM 357.399,1680712,CDM,,,,INPATIENT,,,372.5,149,AETNA,AETNA COMMERCIAL,365.05,98,,,OTHER,279.38,365.05,PERCENT OF TOTAL BILLED CHARGES
MINI ARC PRECISE,C1776,HCPCS,278,RC,,INPATIENT,,,3661.25,1464.5,AETNA,AETNA COMMERCIAL,3588.025,98,,,OTHER,2745.94,3588.03,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 3.5MM 110MM,1680717,CDM,,,,INPATIENT,,,297.75,119.1,AETNA,AETNA COMMERCIAL,291.795,98,,,OTHER,223.31,291.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TIBIAL FIXED 141233",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,AETNA,AETNA COMMERCIAL,1816.2144,98,,,OTHER,3203.25,4185.58,PERCENT OF TOTAL BILLED CHARGES
TIBIAL PLATE 75MM 141234,C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,AETNA,AETNA COMMERCIAL,1816.2144,98,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.5MM 310.25,1680730,CDM,,,,INPATIENT,,,280,112,AETNA,AETNA COMMERCIAL,274.4,98,,,OTHER,210,274.4,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 2.8MM 165MM,1680731,CDM,,,,INPATIENT,,,346.25,138.5,AETNA,AETNA COMMERCIAL,339.325,98,,,OTHER,259.69,339.33,PERCENT OF TOTAL BILLED CHARGES
WASHER 7.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,98.5,39.4,AETNA,AETNA COMMERCIAL,96.53,98,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.7MM 310.67,1680733,CDM,,,,INPATIENT,,,1380.5,552.2,AETNA,AETNA COMMERCIAL,1352.89,98,,,OTHER,1035.38,1352.89,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.0MM 140MM,1680735,CDM,,,,INPATIENT,,,490.5,196.2,AETNA,AETNA COMMERCIAL,480.69,98,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
CABLE 1.7X 750MM,C1776,HCPCS,278,RC,,INPATIENT,,,988.85,395.54,AETNA,AETNA COMMERCIAL,969.073,98,,,OTHER,1110.75,1451.38,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING MONO LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,6776,2710.4,AETNA,AETNA COMMERCIAL,6640.48,98,,,OTHER,5082,6640.48,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL, PLATE 87MM 141237",C1776,HCPCS,278,RC,,INPATIENT,,,4271,1708.4,AETNA,AETNA COMMERCIAL,4185.58,98,,,OTHER,3203.25,4185.58,PERCENT OF TOTAL BILLED CHARGES
HEAD ENDO II 46MM 12-139016,C1776,HCPCS,278,RC,,INPATIENT,,,970.25,388.1,AETNA,AETNA COMMERCIAL,950.845,98,,,OTHER,727.69,950.85,PERCENT OF TOTAL BILLED CHARGES
"TAPER ADAPTER, ENDO II 64MM",C1776,HCPCS,278,RC,,INPATIENT,,,324,129.6,AETNA,AETNA COMMERCIAL,317.52,98,,,OTHER,246.75,322.42,PERCENT OF TOTAL BILLED CHARGES
"SUTURE, ENDOBUTTON ULTRA",1680756,CDM,,,,INPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL,INTRAFIX SHEATH",C1776,HCPCS,278,RC,,INPATIENT,,,767.5,307,AETNA,AETNA COMMERCIAL,752.15,98,,,OTHER,575.63,752.15,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR",C1713,HCPCS,278,RC,,INPATIENT,,,288.25,115.3,AETNA,AETNA COMMERCIAL,282.485,98,,,OTHER,216.19,282.49,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 1.5MM,1680760,CDM,,,,INPATIENT,,,275.25,110.1,AETNA,AETNA COMMERCIAL,269.745,98,,,OTHER,206.44,269.75,PERCENT OF TOTAL BILLED CHARGES
"PLATE, ONE-THIRD TUBULAR",C1776,HCPCS,278,RC,,INPATIENT,,,365.9,146.36,AETNA,AETNA COMMERCIAL,358.582,98,,,OTHER,456,595.84,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 2.7MM,1680771,CDM,,,,INPATIENT,,,364.75,145.9,AETNA,AETNA COMMERCIAL,357.455,98,,,OTHER,273.56,357.46,PERCENT OF TOTAL BILLED CHARGES
PLATE 7-HOLE LCP,C1776,HCPCS,278,RC,,INPATIENT,,,347.76,139.104,AETNA,AETNA COMMERCIAL,340.8048,98,,,OTHER,433.69,566.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, INSTRUMENTS FOR 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,110,44,AETNA,AETNA COMMERCIAL,107.8,98,,,OTHER,82.5,107.8,PERCENT OF TOTAL BILLED CHARGES
"STARDRIVE, TI END CAP T40 0MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,AETNA,AETNA COMMERCIAL,621.81,98,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
"STARDRIVE, TI END CAP T40 15MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,AETNA,AETNA COMMERCIAL,621.81,98,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL CR MONO-LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,AETNA,AETNA COMMERCIAL,4161.9228,98,,,OTHER,4839.94,6324.19,PERCENT OF TOTAL BILLED CHARGES
"TAPER ADAPTER, MAGNUM",C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,AETNA,AETNA COMMERCIAL,1272.775,98,,,OTHER,974.06,1272.78,PERCENT OF TOTAL BILLED CHARGES
FEMORAL INTER LOCK 65MM 183008,C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 42MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,AETNA,AETNA COMMERCIAL,657.0508,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD COMPONENT,C1776,HCPCS,278,RC,,INPATIENT,,,1074.25,429.7,AETNA,AETNA COMMERCIAL,1052.765,98,,,OTHER,805.69,1052.77,PERCENT OF TOTAL BILLED CHARGES
"LINER, E1 RINGLOC EP-108222",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,AETNA,AETNA COMMERCIAL,4561.9,98,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
CLAMP FIXATION MATERIAL 4.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1691.93,676.772,AETNA,AETNA COMMERCIAL,1658.0914,98,,,OTHER,1961.63,2563.19,PERCENT OF TOTAL BILLED CHARGES
"ROD, CARBON FIBER 8.0 - 200MM",C1776,HCPCS,278,RC,,INPATIENT,,,331.28,132.512,AETNA,AETNA COMMERCIAL,324.6544,98,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
FIXATION NAIL 340MM (RT),C1776,HCPCS,278,RC,,INPATIENT,,,4446.75,1778.7,AETNA,AETNA COMMERCIAL,4357.815,98,,,OTHER,3335.06,4357.82,PERCENT OF TOTAL BILLED CHARGES
REAMING ROD W/BAL,C1776,HCPCS,278,RC,,INPATIENT,,,348.5,139.4,AETNA,AETNA COMMERCIAL,341.53,98,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
BLADES 11.0MM TITANIUM,C1776,HCPCS,278,RC,,INPATIENT,,,1758.5,703.4,AETNA,AETNA COMMERCIAL,1723.33,98,,,OTHER,1318.88,1723.33,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TUBULAR W/COLLAR 10 HL",C1713,HCPCS,278,RC,,INPATIENT,,,184.28,73.712,AETNA,AETNA COMMERCIAL,180.5944,98,,,OTHER,211.5,276.36,PERCENT OF TOTAL BILLED CHARGES
ENDO 11 HEAD 49MM,C1776,HCPCS,278,RC,,INPATIENT,,,1243.75,497.5,AETNA,AETNA COMMERCIAL,1218.875,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
MAGNUM HEAD 44MM,C1776,HCPCS,278,RC,,INPATIENT,,,3879.75,1551.9,AETNA,AETNA COMMERCIAL,3802.155,98,,,OTHER,2909.81,3802.16,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 43MM,1680802,CDM,,,,INPATIENT,,,1243.75,497.5,AETNA,AETNA COMMERCIAL,1218.875,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 26MM",1680805,CDM,,,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 34MM",1680806,CDM,,,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 38MM",1680807,CDM,,,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 40MM",1680808,CDM,,,,INPATIENT,,,411.25,164.5,AETNA,AETNA COMMERCIAL,403.025,98,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"PLATE,LCP CLAVICLE 02.112.080",1680810,CDM,,,,INPATIENT,,,1382.5,553,AETNA,AETNA COMMERCIAL,1354.85,98,,,OTHER,1036.88,1354.85,PERCENT OF TOTAL BILLED CHARGES
"PLATES, CONDYLAR 8-HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3842.5,1537,AETNA,AETNA COMMERCIAL,3765.65,98,,,OTHER,2881.88,3765.65,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 44MM,1680893,CDM,,,,INPATIENT,,,880,352,AETNA,AETNA COMMERCIAL,862.4,98,,,OTHER,660,862.4,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL ANT STAB BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
STEINMANN PIN,C1776,HCPCS,278,RC,,INPATIENT,,,208.5,83.4,AETNA,AETNA COMMERCIAL,204.33,98,,,OTHER,156.38,204.33,PERCENT OF TOTAL BILLED CHARGES
COPELAND HA RSRF HD 11-114644,C1776,HCPCS,278,RC,,INPATIENT,,,8996.5,3598.6,AETNA,AETNA COMMERCIAL,8816.57,98,,,OTHER,6747.38,8816.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX SP 12MM 202.872",1680898,CDM,,,,INPATIENT,,,145.5,58.2,AETNA,AETNA COMMERCIAL,142.59,98,,,OTHER,109.13,142.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, D 2.4MM 242.467 (L)",1680899,CDM,,,,INPATIENT,,,2494.25,997.7,AETNA,AETNA COMMERCIAL,2444.365,98,,,OTHER,1870.69,2444.37,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.4MM 310.530,1680900,CDM,,,,INPATIENT,,,495.5,198.2,AETNA,AETNA COMMERCIAL,485.59,98,,,OTHER,371.63,485.59,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 50MM 12-139024,1680903,CDM,,,,INPATIENT,,,1243.75,497.5,AETNA,AETNA COMMERCIAL,1218.875,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
CUP ACETABULAR 52MM PT-104052,1680904,CDM,,,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"PORT, INDWELLING",C1788,HCPCS,278,RC,,INPATIENT,,,433,173.2,AETNA,AETNA COMMERCIAL,424.34,98,,,OTHER,324.75,424.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DISTAL RADIUS 2.4MM 7HL",C1776,HCPCS,278,RC,,INPATIENT,,,2494.25,997.7,AETNA,AETNA COMMERCIAL,2444.365,98,,,OTHER,1870.69,2444.37,PERCENT OF TOTAL BILLED CHARGES
"WIRE, KIRSCHNER W/TROCAR POINT",C1776,HCPCS,278,RC,,INPATIENT,,,223.02,89.208,AETNA,AETNA COMMERCIAL,218.5596,98,,,OTHER,42,54.88,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.0MM 100MM,1681000,CDM,,,,INPATIENT,,,315.5,126.2,AETNA,AETNA COMMERCIAL,309.19,98,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 1.8MM W/DEPT MARK,1681001,CDM,,,,INPATIENT,,,490.5,196.2,AETNA,AETNA COMMERCIAL,480.69,98,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189080",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
ENDO II TAPER/ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,328.5,131.4,AETNA,AETNA COMMERCIAL,321.93,98,,,OTHER,246.38,321.93,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 48MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,AETNA,AETNA COMMERCIAL,657.0508,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, HUMERUS 3.5MM 3 HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3627.25,1450.9,AETNA,AETNA COMMERCIAL,3554.705,98,,,OTHER,2720.44,3554.71,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DISTAL RADIUS 2.4MM 3HL",C1713,HCPCS,278,RC,,INPATIENT,,,1652.62,661.048,AETNA,AETNA COMMERCIAL,1619.5676,98,,,OTHER,1808.25,2362.78,PERCENT OF TOTAL BILLED CHARGES
SHOULDER SYSTEM STD ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,429.84,171.936,AETNA,AETNA COMMERCIAL,421.2432,98,,,OTHER,427.13,558.11,PERCENT OF TOTAL BILLED CHARGES
TIBIAL PLATE 63MM,C1776,HCPCS,278,RC,,INPATIENT,,,1788.8,715.52,AETNA,AETNA COMMERCIAL,1753.024,98,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARNG 10 X 63MM",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,AETNA,AETNA COMMERCIAL,1511.3952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL PLATE 79MM 141235",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,AETNA,AETNA COMMERCIAL,1816.2144,98,,,OTHER,1779.77,2325.56,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 10MMX79MM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,AETNA,AETNA COMMERCIAL,2040.5952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TUBULAR 1/3 W/COLLAR",C1713,HCPCS,278,RC,,INPATIENT,,,172.94,69.176,AETNA,AETNA COMMERCIAL,169.4812,98,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
"LINER, SIZE 23 EP-108223",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,AETNA,AETNA COMMERCIAL,4561.9,98,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 36MM 11-363660,C1776,HCPCS,278,RC,,INPATIENT,,,820.8,328.32,AETNA,AETNA COMMERCIAL,804.384,98,,,OTHER,767.24,1002.52,PERCENT OF TOTAL BILLED CHARGES
"LINER, RINGLOC 40MM EP-108424",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,AETNA,AETNA COMMERCIAL,4561.9,98,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
MAGNUM MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,1964.48,785.792,AETNA,AETNA COMMERCIAL,1925.1904,98,,,OTHER,1473.36,1925.19,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DHS-DCP HOLES 4",C1713,HCPCS,278,RC,,INPATIENT,,,1079.57,431.828,AETNA,AETNA COMMERCIAL,1057.9786,98,,,OTHER,1176.19,1536.89,PERCENT OF TOTAL BILLED CHARGES
MESH LF LG 10.8CM X 16.0CM,1681031,CDM,278,RC,,INPATIENT,,,536,214.4,AETNA,AETNA COMMERCIAL,525.28,98,,,OTHER,402,525.28,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN WASHERLOC 50MM",C1776,HCPCS,278,RC,,INPATIENT,,,612.5,245,AETNA,AETNA COMMERCIAL,600.25,98,,,OTHER,459.38,600.25,PERCENT OF TOTAL BILLED CHARGES
"MESH, DIMENSIONAL KNITTED 6X4",1681037,CDM,278,RC,,INPATIENT,,,400.75,160.3,AETNA,AETNA COMMERCIAL,392.735,98,,,OTHER,300.56,392.74,PERCENT OF TOTAL BILLED CHARGES
FEMORAL MEDIUM 154601,C1776,HCPCS,278,RC,,INPATIENT,,,8880.25,3552.1,AETNA,AETNA COMMERCIAL,8702.645,98,,,OTHER,6660.19,8702.65,PERCENT OF TOTAL BILLED CHARGES
BEARING MED LF 4MM 159548,C1776,HCPCS,278,RC,,INPATIENT,,,1988.93,795.572,AETNA,AETNA COMMERCIAL,1949.1514,98,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 47MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,AETNA,AETNA COMMERCIAL,657.0508,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 12MMX63MM",C1776,HCPCS,278,RC,,INPATIENT,,,2610.5,1044.2,AETNA,AETNA COMMERCIAL,2558.29,98,,,OTHER,1957.88,2558.29,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL,FIXED CRUCIATE PLATE EA",C1776,HCPCS,278,RC,,INPATIENT,,,2373.62,949.448,AETNA,AETNA COMMERCIAL,2326.1476,98,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
VENTRALEX PATCH CIRCLE 4.3,1681147,CDM,,,,INPATIENT,,,1198.5,479.4,AETNA,AETNA COMMERCIAL,1174.53,98,,,OTHER,898.88,1174.53,PERCENT OF TOTAL BILLED CHARGES
END CAP TI W/T40 5MM STARDRIVE,C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,AETNA,AETNA COMMERCIAL,621.81,98,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
PLATE FIBULA DSTL 2.7MM 3.5MM,C1713,HCPCS,278,RC,,INPATIENT,,,1271.59,508.636,AETNA,AETNA COMMERCIAL,1246.1582,98,,,OTHER,1560.19,2038.65,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD COMP 32MM 163667,C1776,HCPCS,278,RC,,INPATIENT,,,1836.75,734.7,AETNA,AETNA COMMERCIAL,1800.015,98,,,OTHER,1377.56,1800.02,PERCENT OF TOTAL BILLED CHARGES
CABLE W/CRIMP 1.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1481,592.4,AETNA,AETNA COMMERCIAL,1451.38,98,,,OTHER,1110.75,1451.38,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 3.2MM 310.31,1681161,CDM,,,,INPATIENT,,,279.25,111.7,AETNA,AETNA COMMERCIAL,273.665,98,,,OTHER,209.44,273.67,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 4.5MM,1681164,CDM,,,,INPATIENT,,,279.25,111.7,AETNA,AETNA COMMERCIAL,273.665,98,,,OTHER,209.44,273.67,PERCENT OF TOTAL BILLED CHARGES
MOUULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,3534.25,1413.7,AETNA,AETNA COMMERCIAL,3463.565,98,,,OTHER,2650.69,3463.57,PERCENT OF TOTAL BILLED CHARGES
"LINER, E1 RINGLOC ACETABULAR",C1776,HCPCS,278,RC,,INPATIENT,,,2995.75,1198.3,AETNA,AETNA COMMERCIAL,2935.835,98,,,OTHER,2246.81,2935.84,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,2274.5,909.8,AETNA,AETNA COMMERCIAL,2229.01,98,,,OTHER,1705.88,2229.01,PERCENT OF TOTAL BILLED CHARGES
COPELAND HA RSRF HD 11-114643,C1776,HCPCS,278,RC,,INPATIENT,,,10278.75,4111.5,AETNA,AETNA COMMERCIAL,10073.175,98,,,OTHER,7709.06,10073.18,PERCENT OF TOTAL BILLED CHARGES
CURVED BROAD LCP 4.5MM PL,C1776,HCPCS,278,RC,,INPATIENT,,,2623,1049.2,AETNA,AETNA COMMERCIAL,2570.54,98,,,OTHER,1967.25,2570.54,PERCENT OF TOTAL BILLED CHARGES
ALLODERM 6X16,1681180,CDM,,,,INPATIENT,,,8932.5,3573,AETNA,AETNA COMMERCIAL,8753.85,98,,,OTHER,6699.38,8753.85,PERCENT OF TOTAL BILLED CHARGES
SUTURE ANCHOR 5.5MM 904922P,C1713,HCPCS,278,RC,,INPATIENT,,,912.75,365.1,AETNA,AETNA COMMERCIAL,894.495,98,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
BLADE HYPER,C1776,HCPCS,278,RC,,INPATIENT,,,423.5,169.4,AETNA,AETNA COMMERCIAL,415.03,98,,,OTHER,317.63,415.03,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEAR 10MM 189720",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,AETNA,AETNA COMMERCIAL,4161.9228,98,,,OTHER,3185.15,4161.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, PEEK TENODESIS 6.25X15",C1713,HCPCS,278,RC,,INPATIENT,,,867.25,346.9,AETNA,AETNA COMMERCIAL,849.905,98,,,OTHER,650.44,849.91,PERCENT OF TOTAL BILLED CHARGES
LIMITED REGENEREX RINGLOC 58MM,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT RINGLOC 3.2MM,1681192,CDM,,,,INPATIENT,,,220.32,88.128,AETNA,AETNA COMMERCIAL,215.9136,98,,,OTHER,165.24,215.91,PERCENT OF TOTAL BILLED CHARGES
APICAL PLUG,C1776,HCPCS,278,RC,,INPATIENT,,,575.5,230.2,AETNA,AETNA COMMERCIAL,563.99,98,,,OTHER,431.63,563.99,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 56MM PT-104056,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
PEEK ANCHOR 4.5MM 904840P,1681195,CDM,,,,INPATIENT,,,912.75,365.1,AETNA,AETNA COMMERCIAL,894.495,98,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
"CUP, RINGLOC 50MM PT-116050",C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,AETNA,AETNA COMMERCIAL,352.8,98,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"PACK, OXFORD KNEE RESECTION",1681201,CDM,,,,INPATIENT,,,1909.75,763.9,AETNA,AETNA COMMERCIAL,1871.555,98,,,OTHER,1432.31,1871.56,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL BLADE,1681202,CDM,,,,INPATIENT,,,274.5,109.8,AETNA,AETNA COMMERCIAL,269.01,98,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
DRILL CANN 2.0MM 310.221,1681207,CDM,,,,INPATIENT,,,1272.5,509,AETNA,AETNA COMMERCIAL,1247.05,98,,,OTHER,954.38,1247.05,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.874",1681208,CDM,,,,INPATIENT,,,153.75,61.5,AETNA,AETNA COMMERCIAL,150.675,98,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 02.112.139(L)",1681209,CDM,,,,INPATIENT,,,2052.5,821,AETNA,AETNA COMMERCIAL,2011.45,98,,,OTHER,1539.38,2011.45,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 204.850",1681210,CDM,,,,INPATIENT,,,83.25,33.3,AETNA,AETNA COMMERCIAL,81.585,98,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
SAFETY KNIFE BC378235,1681211,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 407.646",1681212,CDM,,,,INPATIENT,,,613,245.2,AETNA,AETNA COMMERCIAL,600.74,98,,,OTHER,459.75,600.74,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD   12-139014,1681213,CDM,,,,INPATIENT,,,1243.75,497.5,AETNA,AETNA COMMERCIAL,1218.875,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 10X71 103535,1681214,CDM,,,,INPATIENT,,,5525,2210,AETNA,AETNA COMMERCIAL,5414.5,98,,,OTHER,4143.75,5414.5,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM BIOMET 141616,1681215,CDM,,,,INPATIENT,,,3551.5,1420.6,AETNA,AETNA COMMERCIAL,3480.47,98,,,OTHER,2663.63,3480.47,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL 72.5MM 183013",1681216,CDM,278,RC,,INPATIENT,,,3653.1,1461.24,AETNA,AETNA COMMERCIAL,3580.038,98,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"PLATE,DHS 38MM 4HOLE 281.040",1681217,CDM,,,,INPATIENT,,,1661.5,664.6,AETNA,AETNA COMMERCIAL,1628.27,98,,,OTHER,1246.13,1628.27,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 25MM PT-104060,1681218,CDM,,,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"LINER, RINGLOC 44MM EP-108625",1681219,CDM,,,,INPATIENT,,,7179.75,2871.9,AETNA,AETNA COMMERCIAL,7036.155,98,,,OTHER,5384.81,7036.16,PERCENT OF TOTAL BILLED CHARGES
FEMORAL TAPERLOC 18.5 103216,1681220,CDM,,,,INPATIENT,,,8781.5,3512.6,AETNA,AETNA COMMERCIAL,8605.87,98,,,OTHER,6586.13,8605.87,PERCENT OF TOTAL BILLED CHARGES
FEMORAL TAPERLOC 20.0 103210,1681221,CDM,,,,INPATIENT,,,6016.25,2406.5,AETNA,AETNA COMMERCIAL,5895.925,98,,,OTHER,4512.19,5895.93,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM OXFORD 154721,1681222,CDM,,,,INPATIENT,,,5998.75,2399.5,AETNA,AETNA COMMERCIAL,5878.775,98,,,OTHER,4499.06,5878.78,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM OXFORD 159577,1681223,CDM,,,,INPATIENT,,,2804.5,1121.8,AETNA,AETNA COMMERCIAL,2748.41,98,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
BLADES TIT HELICAL 456.301,1681224,CDM,,,,INPATIENT,,,1973,789.2,AETNA,AETNA COMMERCIAL,1933.54,98,,,OTHER,1479.75,1933.54,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD  12-139014,1681225,CDM,,,,INPATIENT,,,1243.75,497.5,AETNA,AETNA COMMERCIAL,1218.875,98,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
TIBAL TRAY BIOMET OFFSET,1681226,CDM,,,,INPATIENT,,,611.75,244.7,AETNA,AETNA COMMERCIAL,599.515,98,,,OTHER,458.81,599.52,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM TRAY PAR 154723,1681227,CDM,,,,INPATIENT,,,5998.75,2399.5,AETNA,AETNA COMMERCIAL,5878.775,98,,,OTHER,4499.06,5878.78,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL PEGGED 161469,1681228,CDM,,,,INPATIENT,,,5194.89,2077.956,AETNA,AETNA COMMERCIAL,5090.9922,98,,,OTHER,3896.17,5090.99,PERCENT OF TOTAL BILLED CHARGES
KNEE MENISCAL BEARING 159578,1681230,CDM,,,,INPATIENT,,,2804.5,1121.8,AETNA,AETNA COMMERCIAL,2748.41,98,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
SHOULDER CUFF,1681232,CDM,,,,INPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,INPATIENT,,,2315.72,926.288,AETNA,AETNA COMMERCIAL,2269.4056,98,,,OTHER,1736.8,2269.4,PERCENT OF TOTAL BILLED CHARGES
MESH (IMPLANTABLE),C1781,HCPCS,278,RC,,INPATIENT,,,2738.44,1095.376,AETNA,AETNA COMMERCIAL,2683.6712,98,,,OTHER,2053.8,2683.7,PERCENT OF TOTAL BILLED CHARGES
"LEAD, NEUROSTIMULATOR",C1778,HCPCS,278,RC,,INPATIENT,,,9708.61,3883.444,AETNA,AETNA COMMERCIAL,9514.4378,98,,,OTHER,7281.5,9514.4,PERCENT OF TOTAL BILLED CHARGES
TISSUE LOCALIZATION EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,545.42,218.168,AETNA,AETNA COMMERCIAL,534.5116,98,,,OTHER,409.1,534.5,PERCENT OF TOTAL BILLED CHARGES
"STENT, NON-COR, TEM W/O DEL",C2617,HCPCS,278,RC,,INPATIENT,,,941.08,376.432,AETNA,AETNA COMMERCIAL,922.2584,98,,,OTHER,705.8,922.3,PERCENT OF TOTAL BILLED CHARGES
GENERATOR NEURO RECHG BAT SY,C1820,HCPCS,278,RC,,INPATIENT,,,42327.52,16931.008,AETNA,AETNA COMMERCIAL,41480.9696,98,,,OTHER,31745.6,41481,PERCENT OF TOTAL BILLED CHARGES
"PATIENT PROGR, NEUROSTIM",C1787,HCPCS,278,RC,,INPATIENT,,,4370.67,1748.268,AETNA,AETNA COMMERCIAL,4283.2566,98,,,OTHER,3278,4283.3,PERCENT OF TOTAL BILLED CHARGES
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,AETNA,AETNA COMMERCIAL,3973.655,98,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
APOGEE SYSTEM W/INTEXEN LP,1684010,CDM,,,,INPATIENT,,,6369.75,2547.9,AETNA,AETNA COMMERCIAL,6242.355,98,,,OTHER,4777.31,6242.36,PERCENT OF TOTAL BILLED CHARGES
MONARC + SUBFASCIAL HAMMOCK,1684020,CDM,,,,INPATIENT,,,4054.75,1621.9,AETNA,AETNA COMMERCIAL,3973.655,98,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
PERIGEE SYSTEM W/INTEXEN LP,1684030,CDM,,,,INPATIENT,,,7041.75,2816.7,AETNA,AETNA COMMERCIAL,6900.915,98,,,OTHER,5281.31,6900.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, TITANIUM CANN 48MM",1684037,CDM,,,,INPATIENT,,,613,245.2,AETNA,AETNA COMMERCIAL,600.74,98,,,OTHER,459.75,600.74,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 52MM PT-116052,1684038,CDM,,,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
ENDO TAPER/ADAPTER 139247,1684043,CDM,,,,INPATIENT,,,329,131.6,AETNA,AETNA COMMERCIAL,322.42,98,,,OTHER,246.75,322.42,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 20MM 245842",1684044,CDM,,,,INPATIENT,,,846.25,338.5,AETNA,AETNA COMMERCIAL,829.325,98,,,OTHER,634.69,829.33,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 16MM 3213-065-0805",1684045,CDM,,,,INPATIENT,,,912.75,365.1,AETNA,AETNA COMMERCIAL,894.495,98,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
THREAD TIP GUIDE 3.2MM,1684046,CDM,,,,INPATIENT,,,82.75,33.1,AETNA,AETNA COMMERCIAL,81.095,98,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
FEMORAL VANGUARD CR 183033,1684047,CDM,,,,INPATIENT,,,4589.01,1835.604,AETNA,AETNA COMMERCIAL,4497.2298,98,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 12X79 183462,1684048,CDM,,,,INPATIENT,,,2967.5,1187,AETNA,AETNA COMMERCIAL,2908.15,98,,,OTHER,2225.63,2908.15,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 54MM PT-104054,1684049,CDM,,,,INPATIENT,,,5939,2375.6,AETNA,AETNA COMMERCIAL,5820.22,98,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 36MM 11-363661,1684050,CDM,,,,INPATIENT,,,3134.75,1253.9,AETNA,AETNA COMMERCIAL,3072.055,98,,,OTHER,2351.06,3072.06,PERCENT OF TOTAL BILLED CHARGES
VANGRD RT INTRLCK 60MM 183004,1684051,CDM,,,,INPATIENT,,,4589,1835.6,AETNA,AETNA COMMERCIAL,4497.22,98,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 12X67 189042,1684052,CDM,,,,INPATIENT,,,2082.24,832.896,AETNA,AETNA COMMERCIAL,2040.5952,98,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
POWER PORT TITANIUM SM,C1788,HCPCS,278,RC,,INPATIENT,,,561.6,224.64,AETNA,AETNA COMMERCIAL,550.368,98,,,OTHER,982.69,1284.05,PERCENT OF TOTAL BILLED CHARGES
POWER PORT MRI DEVICE 8FR,C1788,HCPCS,278,RC,,INPATIENT,,,540,216,AETNA,AETNA COMMERCIAL,529.2,98,,,OTHER,982.69,1284.05,PERCENT OF TOTAL BILLED CHARGES
GUIDE WIRE,C1769,HCPCS,278,RC,,INPATIENT,,,307.87,123.148,AETNA,AETNA COMMERCIAL,301.7126,98,,,OTHER,230.9,301.7,PERCENT OF TOTAL BILLED CHARGES
WASHER 6.5 /CANCELLOUS SCREW,1690001,CDM,,,,INPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
NURSERY SPECIAL CARE,1790010,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 4-8 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,AETNA,AETNA COMMERCIAL,1420.755,98,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 2-4 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,AETNA,AETNA COMMERCIAL,1224.755,98,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA ADD'L SEQ THERA DGN,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV CONCURRENTLY INFUSED,96368,CPT,450,RC,,OUTPATIENT,,,216,86.4,AETNA,AETNA COMMERCIAL,211.68,98,,,OTHER,162,211.68,PERCENT OF TOTAL BILLED CHARGES
IV INFUSED SEQ EA ADD'L,96367,CPT,450,RC,,OUTPATIENT,,,156,62.4,AETNA,AETNA COMMERCIAL,152.88,98,,,OTHER,117,152.88,PERCENT OF TOTAL BILLED CHARGES
CHEMO INJ SQ IM NONHORMONAL,96401,CPT,331,RC,,OUTPATIENT,,,271,108.4,AETNA,AETNA COMMERCIAL,265.58,98,,,OTHER,203.25,265.58,PERCENT OF TOTAL BILLED CHARGES
CHEMO INJ SQ IM HORMONAL AGENT,96402,CPT,331,RC,,OUTPATIENT,,,272,108.8,AETNA,AETNA COMMERCIAL,266.56,98,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
APPLICATION ON BODY INJECTOR,96377,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,AETNA,AETNA COMMERCIAL,159.005,98,,,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL I,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,270.94,354.03,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL II,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,219.94,287.39,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL III,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
OBS IV INFUS > 16 MINS INITIAL,96365,CPT,260,RC,,INPATIENT,,,475.75,190.3,AETNA,AETNA COMMERCIAL,466.235,98,,,OTHER,356.81,466.24,PERCENT OF TOTAL BILLED CHARGES
OBS IV INFUS EA ADD'L HR,96366,CPT,450,RC,,INPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH (FIRST MED),96374,CPT,450,RC,,INPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH NEW MED ADDON,96375,CPT,450,RC,,INPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH SAME MED ADDON,96376,CPT,260,RC,,INPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IM/SQ INJ,96372,CPT,260,RC,,INPATIENT,,,190.5,76.2,AETNA,AETNA COMMERCIAL,186.69,98,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
OBS IV HYDRATION (INITIAL),96360,CPT,450,RC,,INPATIENT,,,448,179.2,AETNA,AETNA COMMERCIAL,439.04,98,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
OBS SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,INPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
OBS IV HYDRATION ADD'L HR,96361,CPT,450,RC,,INPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
BAMLANIVIMAB,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,AETNA,AETNA COMMERCIAL,321.1558,98,,,OTHER,245.8,321.2,PERCENT OF TOTAL BILLED CHARGES
BAMLANIVIMAB MS,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,AETNA,AETNA COMMERCIAL,321.1558,98,,,OTHER,245.8,321.2,PERCENT OF TOTAL BILLED CHARGES
REGENERON,M0243,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,AETNA,AETNA COMMERCIAL,457.7972,98,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
REGENERON MS,M0243,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,AETNA,AETNA COMMERCIAL,457.5718,98,,,OTHER,350.2,457.6,PERCENT OF TOTAL BILLED CHARGES
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,AETNA,AETNA COMMERCIAL,457.7972,98,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
BAMLAN AND ETESEV INFUSION MS,M0245,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,AETNA,AETNA COMMERCIAL,457.5718,98,,,OTHER,350.2,457.6,PERCENT OF TOTAL BILLED CHARGES
SOTROVIMAB INFUSION,M0247,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,AETNA,AETNA COMMERCIAL,457.7972,98,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
SOTROVIMAB INFUSION MS,M0247,HCPCS,771,RC,,INPATIENT,,,897.92,359.168,AETNA,AETNA COMMERCIAL,879.9616,98,,,OTHER,673.4,880,PERCENT OF TOTAL BILLED CHARGES
"TIXAGEV AND CILGAV, INJ",M0220,HCPCS,771,RC,,INPATIENT,,,156.17,62.468,AETNA,AETNA COMMERCIAL,153.0466,98,,,OTHER,117.1,153,PERCENT OF TOTAL BILLED CHARGES
BEBTELOVIMAB INJECTION,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,AETNA,AETNA COMMERCIAL,356.4162,98,,,OTHER,272.8,356.4,PERCENT OF TOTAL BILLED CHARGES
BEBTELOVIMAB INJECTION MS,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,AETNA,AETNA COMMERCIAL,356.4162,98,,,OTHER,272.8,356.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNIZATION ADMIN,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
IMMUNIZATION ADMIN EACH ADD,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,AETNA,AETNA COMMERCIAL,89.915,98,,,OTHER,68.8,89.9,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 1-2 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,AETNA,AETNA COMMERCIAL,1126.755,98,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
CONCURRENT ADMIN OF CHEMO,96549,CPT,261,RC,,OUTPATIENT,,,301.75,120.7,AETNA,AETNA COMMERCIAL,295.715,98,,,OTHER,226.31,295.72,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 0-1 HOUR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,AETNA,AETNA COMMERCIAL,1028.755,98,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
TRAY DRESSING,2700010,CDM,,,,INPATIENT,,,30.25,12.1,AETNA,AETNA COMMERCIAL,29.645,98,,,OTHER,22.69,29.65,PERCENT OF TOTAL BILLED CHARGES
SAFE EXAM,2700012,CDM,,,,INPATIENT,,,389,155.6,AETNA,AETNA COMMERCIAL,381.22,98,,,OTHER,291.75,381.22,PERCENT OF TOTAL BILLED CHARGES
EVIDENCE COLLECTION,2700014,CDM,,,,INPATIENT,,,389,155.6,AETNA,AETNA COMMERCIAL,381.22,98,,,OTHER,291.75,381.22,PERCENT OF TOTAL BILLED CHARGES
ADAPTER REMOTE RES SPIKE,2700020,CDM,,,,INPATIENT,,,155.75,62.3,AETNA,AETNA COMMERCIAL,152.635,98,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
AERO CHAMBER,2700030,CDM,,,,INPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
BAG BILE REG,2700040,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
CROSSFLOW OUTFLOW TUBING,2700060,CDM,,,,INPATIENT,,,147.75,59.1,AETNA,AETNA COMMERCIAL,144.795,98,,,OTHER,110.81,144.8,PERCENT OF TOTAL BILLED CHARGES
ARM SLING LG,2700070,CDM,,,,INPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
ARM SLING MD,2700080,CDM,,,,INPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
ARM SLING SM,2700090,CDM,,,,INPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
LOWER BODY WARMER BLANKET,2700092,CDM,,,,INPATIENT,,,27.25,10.9,AETNA,AETNA COMMERCIAL,26.705,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
ATHLETIC SUPPORTER MD,2700100,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ATHLETIC SUPPORTER SM,2700110,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM CHILD W/PAD,2700120,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
BAG RESUS W/MASK ADULT,2700130,CDM,,,,INPATIENT,,,103.25,41.3,AETNA,AETNA COMMERCIAL,101.185,98,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
BAG RESUS W/MASK CHILD,2700140,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
BANDAGE ESMARK W/O LINER,2700170,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
BITE PROOF BITE BLOCK,2700180,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
BITE BLOCK DISPOSIBLE,2700200,CDM,,,,INPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
FLUTTER VALVE (BLUE),2700211,CDM,,,,INPATIENT,,,135.5,54.2,AETNA,AETNA COMMERCIAL,132.79,98,,,OTHER,101.63,132.79,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST XLG OPEN,2700240,CDM,,,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
CUFF CRYO KNEE MED W/COOLER,2700242,CDM,,,,INPATIENT,,,170.75,68.3,AETNA,AETNA COMMERCIAL,167.335,98,,,OTHER,128.06,167.34,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS ANES TRAY,2700270,CDM,,,,INPATIENT,,,267.75,107.1,AETNA,AETNA COMMERCIAL,262.395,98,,,OTHER,200.81,262.4,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 5CM,2700300,CDM,,,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 7CM,2700301,CDM,,,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 9CM,2700302,CDM,,,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 15CM,2700303,CDM,,,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 5CM,2700304,CDM,,,,INPATIENT,,,118.75,47.5,AETNA,AETNA COMMERCIAL,116.375,98,,,OTHER,89.06,116.38,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOR 20G 7.5CM,2700305,CDM,,,,INPATIENT,,,126.75,50.7,AETNA,AETNA COMMERCIAL,124.215,98,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 10CM,2700306,CDM,,,,INPATIENT,,,126.75,50.7,AETNA,AETNA COMMERCIAL,124.215,98,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 12.5CM,2700307,CDM,,,,INPATIENT,,,118.75,47.5,AETNA,AETNA COMMERCIAL,116.375,98,,,OTHER,89.06,116.38,PERCENT OF TOTAL BILLED CHARGES
GALACTOGRAPHY INFUSION UNIT,2700308,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
GALACTOGRAPHY KIT DGK002X,2700309,CDM,,,,INPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
YUEH CENTESIS NEEDLE 9646,2700310,CDM,,,,INPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
TRAY CENTRAL VEIN CATH,2700500,CDM,,,,INPATIENT,,,132,52.8,AETNA,AETNA COMMERCIAL,129.36,98,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
TRAY CENTRAL LINE,2700501,CDM,,,,INPATIENT,,,300,120,AETNA,AETNA COMMERCIAL,294,98,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
BAG CLOSED URINARY DRAIN,2700630,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CONSTAVAC PVC BLOOD KIT,2700720,CDM,,,,INPATIENT,,,851.25,340.5,AETNA,AETNA COMMERCIAL,834.225,98,,,OTHER,638.44,834.23,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC,2701000,CDM,,,,INPATIENT,,,899.5,359.8,AETNA,AETNA COMMERCIAL,881.51,98,,,OTHER,674.63,881.51,PERCENT OF TOTAL BILLED CHARGES
BLADDER FOLEY TRAY 18FR,2701210,CDM,,,,INPATIENT,,,111.25,44.5,AETNA,AETNA COMMERCIAL,109.025,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
BLADDER FOLEY TRAY 16FR,2701230,CDM,,,,INPATIENT,,,111.25,44.5,AETNA,AETNA COMMERCIAL,109.025,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA MEDIUM,2701310,CDM,,,,INPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA LG,2701320,CDM,,,,INPATIENT,,,142.75,57.1,AETNA,AETNA COMMERCIAL,139.895,98,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA XLG,2701330,CDM,,,,INPATIENT,,,142.75,57.1,AETNA,AETNA COMMERCIAL,139.895,98,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
HUMID VENT PED.,2701340,CDM,,,,INPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
PREFIL HUMIDIFER 650ML,2701360,CDM,,,,INPATIENT,,,27.25,10.9,AETNA,AETNA COMMERCIAL,26.705,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER MD,2701370,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER SM,2701380,CDM,,,,INPATIENT,,,38.5,15.4,AETNA,AETNA COMMERCIAL,37.73,98,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER XLG,2701390,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
IMMOB  SHOULDER LG,2701400,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
IMMOB  SHOULDER XXLG,2701410,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
BARRIER CREAM,2701420,CDM,,,,INPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
PERCUTAN INTROD KIT,2701430,CDM,,,,INPATIENT,,,314.75,125.9,AETNA,AETNA COMMERCIAL,308.455,98,,,OTHER,236.06,308.46,PERCENT OF TOTAL BILLED CHARGES
IV CATH EXT. SET,2701460,CDM,,,,INPATIENT,,,22.75,9.1,AETNA,AETNA COMMERCIAL,22.295,98,,,OTHER,17.06,22.3,PERCENT OF TOTAL BILLED CHARGES
IV WARMING SET HOTLINE,2701470,CDM,,,,INPATIENT,,,93.75,37.5,AETNA,AETNA COMMERCIAL,91.875,98,,,OTHER,70.31,91.88,PERCENT OF TOTAL BILLED CHARGES
POUCH CADD PUMP DISP,2701500,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 20 SMALL""",2701540,CDM,,,,INPATIENT,,,168,67.2,AETNA,AETNA COMMERCIAL,164.64,98,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 22 MEDIUM""",2701550,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 18 X-SMALL""",2701560,CDM,,,,INPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 24 LARGE""",L1830,HCPCS,274,RC,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE, BRACE HINGED LONG",2701572,CDM,,,,INPATIENT,,,308.75,123.5,AETNA,AETNA COMMERCIAL,302.575,98,,,OTHER,231.56,302.58,PERCENT OF TOTAL BILLED CHARGES
"KNEE, BRACE HINGED SHORT",L1833,HCPCS,274,RC,,INPATIENT,,,299.75,119.9,AETNA,AETNA COMMERCIAL,293.755,98,,,OTHER,224.81,293.76,PERCENT OF TOTAL BILLED CHARGES
WRIST HOLDER,2701590,CDM,,,,INPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
RESERVOIR SUCTION 100CC,2701610,CDM,,,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
SAL. SUMP ANTI-REFLUX ADDPT,2701620,CDM,,,,INPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
MASK SEAL EASY,2701630,CDM,,,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PRESS. MONIT. KIT W/TRAN,2701640,CDM,,,,INPATIENT,,,130.5,52.2,AETNA,AETNA COMMERCIAL,127.89,98,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
OPTIVAC KIT DOUBLE MIX SYSTEM,2701650,CDM,,,,INPATIENT,,,189,75.6,AETNA,AETNA COMMERCIAL,185.22,98,,,OTHER,141.75,185.22,PERCENT OF TOTAL BILLED CHARGES
MIX EVAC II,2701660,CDM,,,,INPATIENT,,,398.25,159.3,AETNA,AETNA COMMERCIAL,390.285,98,,,OTHER,298.69,390.29,PERCENT OF TOTAL BILLED CHARGES
KIT MULTIMED BDL LUMEN 7FR,2701670,CDM,,,,INPATIENT,,,264.75,105.9,AETNA,AETNA COMMERCIAL,259.455,98,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
NASOGASTRIC LEVIN TUBE 18,2701710,CDM,,,,INPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
NEEDLE  BIOPSY 20MM DISP,2701720,CDM,,,,INPATIENT,,,258.75,103.5,AETNA,AETNA COMMERCIAL,253.575,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
NOSE PROBE,2701750,CDM,,,,INPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGEAL STETH 18FR,2701760,CDM,,,,INPATIENT,,,613.5,245.4,AETNA,AETNA COMMERCIAL,601.23,98,,,OTHER,460.13,601.23,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGEAL STETH 12FR,2701770,CDM,,,,INPATIENT,,,1193.25,477.3,AETNA,AETNA COMMERCIAL,1169.385,98,,,OTHER,894.94,1169.39,PERCENT OF TOTAL BILLED CHARGES
OPTHAMIC BURR,2701800,CDM,,,,INPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES LADIES LG,2701810,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES MEN LG,2701820,CDM,,,,INPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES LADIES MED,2701830,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES MEN MD,2701850,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
MICRODRIP NON VENT,2701860,CDM,,,,INPATIENT,,,22.75,9.1,AETNA,AETNA COMMERCIAL,22.295,98,,,OTHER,17.06,22.3,PERCENT OF TOTAL BILLED CHARGES
MICRO CURVED SCISSOR,2701861,CDM,,,,INPATIENT,,,736.5,294.6,AETNA,AETNA COMMERCIAL,721.77,98,,,OTHER,552.38,721.77,PERCENT OF TOTAL BILLED CHARGES
CURVED SCISSOR,2701862,CDM,,,,INPATIENT,,,557.75,223.1,AETNA,AETNA COMMERCIAL,546.595,98,,,OTHER,418.31,546.6,PERCENT OF TOTAL BILLED CHARGES
KIT PERITIONEAL LAVAGE,2701880,CDM,,,,INPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
TRAY PERCUTANEOUS,2701890,CDM,,,,INPATIENT,,,251.75,100.7,AETNA,AETNA COMMERCIAL,246.715,98,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
ATRIUM SINGLE CHEST DRAIN,2701900,CDM,,,,INPATIENT,,,236,94.4,AETNA,AETNA COMMERCIAL,231.28,98,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
SPLINT SAM,2701920,CDM,,,,INPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
STYLETE SHERI-SLIP 10FR,2701930,CDM,,,,INPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
SKIN TEMP SENSOR,2701940,CDM,,,,INPATIENT,,,20.75,8.3,AETNA,AETNA COMMERCIAL,20.335,98,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 2 X 10,2701960,CDM,271,RC,,INPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 3 X 35,2701970,CDM,,,,INPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 5 X 45,2701980,CDM,,,,INPATIENT,,,177.5,71,AETNA,AETNA COMMERCIAL,173.95,98,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 5 X 30,2701990,CDM,,,,INPATIENT,,,152.25,60.9,AETNA,AETNA COMMERCIAL,149.205,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 4 X 15,2702000,CDM,271,RC,,INPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SPLINT WRIST XSM-XLG LT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
SPLINT WRIST XSM-XLG RT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
STERI CATH CLOSED SUCTION,2702030,CDM,,,,INPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
SUCTION CANNISTER BLUE,2702090,CDM,,,,INPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.25,22.54,PERCENT OF TOTAL BILLED CHARGES
SUCTION DELEE INFANT 10FR,2702100,CDM,,,,INPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
SURGILAV PLUS HANDPIECE,2702110,CDM,,,,INPATIENT,,,362,144.8,AETNA,AETNA COMMERCIAL,354.76,98,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SURGIVAC EVACUATOR KIT,2702120,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
EXTENSTION T CONNECTOR,2702140,CDM,,,,INPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
COLOSTOMY WOUND KIT,2702150,CDM,,,,INPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
CROUP TENT CANOPY,2702280,CDM,,,,INPATIENT,,,103.25,41.3,AETNA,AETNA COMMERCIAL,101.185,98,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
CATH TROCAR 20FR,2702290,CDM,,,,INPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
INFLOW CASSETTE TUBING,2702320,CDM,,,,INPATIENT,,,150.25,60.1,AETNA,AETNA COMMERCIAL,147.245,98,,,OTHER,112.69,147.25,PERCENT OF TOTAL BILLED CHARGES
URI-METER DRAIN BAG,2702330,CDM,,,,INPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
FLEXIBLE WAF. 2-3/4,2702360,CDM,,,,INPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
TROCAR V2,2702370,CDM,,,,INPATIENT,,,727.5,291,AETNA,AETNA COMMERCIAL,712.95,98,,,OTHER,545.63,712.95,PERCENT OF TOTAL BILLED CHARGES
TROCAR 12MM W/REDUCER,2702380,CDM,,,,INPATIENT,,,637,254.8,AETNA,AETNA COMMERCIAL,624.26,98,,,OTHER,477.75,624.26,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSASTEP 12MM,2702390,CDM,,,,INPATIENT,,,514.25,205.7,AETNA,AETNA COMMERCIAL,503.965,98,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
PROBE GUIDE LATERAL,2704000,CDM,,,,INPATIENT,,,53.5,21.4,AETNA,AETNA COMMERCIAL,52.43,98,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
VACUUM SET,2704001,CDM,,,,INPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SITE IDENTIFIER 11G2,2704002,CDM,,,,INPATIENT,,,388.5,155.4,AETNA,AETNA COMMERCIAL,380.73,98,,,OTHER,291.38,380.73,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC PROBE,2704003,CDM,,,,INPATIENT,,,854.25,341.7,AETNA,AETNA COMMERCIAL,837.165,98,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SITE IDENTIFIER 11G,2704004,CDM,,,,INPATIENT,,,369.5,147.8,AETNA,AETNA COMMERCIAL,362.11,98,,,OTHER,277.13,362.11,PERCENT OF TOTAL BILLED CHARGES
PROBE GUIDE FRONTAL,2704005,CDM,,,,INPATIENT,,,49.5,19.8,AETNA,AETNA COMMERCIAL,48.51,98,,,OTHER,37.13,48.51,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
SHAVER BLADE TOMCAT 4.0MM,2704030,CDM,,,,INPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
SHAVER BLADE TOMCAT 5.5MM,2704031,CDM,,,,INPATIENT,,,201.75,80.7,AETNA,AETNA COMMERCIAL,197.715,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH TROCAR 12X100,2704032,CDM,,,,INPATIENT,,,166.25,66.5,AETNA,AETNA COMMERCIAL,162.925,98,,,OTHER,124.69,162.93,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT TWIST 2.0,2704033,CDM,,,,INPATIENT,,,456.75,182.7,AETNA,AETNA COMMERCIAL,447.615,98,,,OTHER,342.56,447.62,PERCENT OF TOTAL BILLED CHARGES
MULTI CLIP APPLIER SM 9 3/8,2704034,CDM,,,,INPATIENT,,,235.75,94.3,AETNA,AETNA COMMERCIAL,231.035,98,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
MULTIPLE CLIP APPLIER 9 3/8,2704035,CDM,,,,INPATIENT,,,237.25,94.9,AETNA,AETNA COMMERCIAL,232.505,98,,,OTHER,177.94,232.51,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSAPORT,2705000,CDM,,,,INPATIENT,,,356.5,142.6,AETNA,AETNA COMMERCIAL,349.37,98,,,OTHER,267.38,349.37,PERCENT OF TOTAL BILLED CHARGES
BLADELESS TROCAR XCEL 5MM,2705001,CDM,,,,INPATIENT,,,180.5,72.2,AETNA,AETNA COMMERCIAL,176.89,98,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
TROCAR CANNULA W/SLEEVE,2705002,CDM,,,,INPATIENT,,,102.25,40.9,AETNA,AETNA COMMERCIAL,100.205,98,,,OTHER,76.69,100.21,PERCENT OF TOTAL BILLED CHARGES
SCISSORS CURVED W/UNIPOLAR,2705003,CDM,,,,INPATIENT,,,272.25,108.9,AETNA,AETNA COMMERCIAL,266.805,98,,,OTHER,204.19,266.81,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT XS,2705004,CDM,,,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT XL,2705005,CDM,,,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE XS,2705006,CDM,,,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE XL,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
TROCAR BLUNT TIP 12MM,2705011,CDM,,,,INPATIENT,,,278.75,111.5,AETNA,AETNA COMMERCIAL,273.175,98,,,OTHER,209.06,273.18,PERCENT OF TOTAL BILLED CHARGES
HARMONIC FOCUS CURVED SHEARS,2705012,CDM,,,,INPATIENT,,,1772.75,709.1,AETNA,AETNA COMMERCIAL,1737.295,98,,,OTHER,1329.56,1737.3,PERCENT OF TOTAL BILLED CHARGES
CANNULA UNIVERSAL SET 5.5MM,2705013,CDM,,,,INPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
BUR ROUND 8 FLUTES 5.5MM,2705014,CDM,,,,INPATIENT,,,203.75,81.5,AETNA,AETNA COMMERCIAL,199.675,98,,,OTHER,152.81,199.68,PERCENT OF TOTAL BILLED CHARGES
OSCILLATING SAW BLADE,2705015,CDM,,,,INPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
SAW BLADE OSCILLATING,2705016,CDM,,,,INPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
SHAVER BUR TAN 5.5MM,2705017,CDM,,,,INPATIENT,,,235,94,AETNA,AETNA COMMERCIAL,230.3,98,,,OTHER,176.25,230.3,PERCENT OF TOTAL BILLED CHARGES
RASP LG TEARCROSS CUT 7X14,2705018,CDM,,,,INPATIENT,,,355.25,142.1,AETNA,AETNA COMMERCIAL,348.145,98,,,OTHER,266.44,348.15,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT COUPLING 3.2X145,2705019,CDM,,,,INPATIENT,,,279.5,111.8,AETNA,AETNA COMMERCIAL,273.91,98,,,OTHER,209.63,273.91,PERCENT OF TOTAL BILLED CHARGES
TAP FOR 3.5MM CORTEX SCREW,2705020,CDM,,,,INPATIENT,,,360.75,144.3,AETNA,AETNA COMMERCIAL,353.535,98,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
LIGASURE IMPACT TISSUE FUSION,2705021,CDM,,,,INPATIENT,,,1893.75,757.5,AETNA,AETNA COMMERCIAL,1855.875,98,,,OTHER,1420.31,1855.88,PERCENT OF TOTAL BILLED CHARGES
MULTICLIP APPLIER 11 1/2 LNGTH,2705022,CDM,,,,INPATIENT,,,237.25,94.9,AETNA,AETNA COMMERCIAL,232.505,98,,,OTHER,177.94,232.51,PERCENT OF TOTAL BILLED CHARGES
HARMONIC ACE PISTOL GRIP TORQ,2705023,CDM,,,,INPATIENT,,,1432.75,573.1,AETNA,AETNA COMMERCIAL,1404.095,98,,,OTHER,1074.56,1404.1,PERCENT OF TOTAL BILLED CHARGES
MULTI CLIP APPLIER SM,2705024,CDM,,,,INPATIENT,,,235.75,94.3,AETNA,AETNA COMMERCIAL,231.035,98,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,282.75,113.1,AETNA,AETNA COMMERCIAL,277.095,98,,,OTHER,212.06,277.1,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,293.75,117.5,AETNA,AETNA COMMERCIAL,287.875,98,,,OTHER,220.31,287.88,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT CANNULATED,2705027,CDM,,,,INPATIENT,,,1392.25,556.9,AETNA,AETNA COMMERCIAL,1364.405,98,,,OTHER,1044.19,1364.41,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,452.75,181.1,AETNA,AETNA COMMERCIAL,443.695,98,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
SAGITTAL SAW BLADE,2705029,CDM,,,,INPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
TRU-CLOSE SUCTION DRAIN,2705032,CDM,,,,INPATIENT,,,109.25,43.7,AETNA,AETNA COMMERCIAL,107.065,98,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
REFROBACIN CEMENT,2705034,CDM,,,,INPATIENT,,,529.2,211.68,AETNA,AETNA COMMERCIAL,518.616,98,,,OTHER,396.9,518.62,PERCENT OF TOTAL BILLED CHARGES
CPAP MASK,2710010,CDM,,,,INPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CPAP VALVE,2710020,CDM,,,,INPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
OXYHOOD DAILY (NSY),2710025,CDM,,,,INPATIENT,,,204.5,81.8,AETNA,AETNA COMMERCIAL,200.41,98,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
OXYHOOD DAILY,2710050,CDM,,,,INPATIENT,,,204.5,81.8,AETNA,AETNA COMMERCIAL,200.41,98,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
CLIP APPLIER LIGACLIP 10X28.9,2720010,CDM,,,,INPATIENT,,,210.5,84.2,AETNA,AETNA COMMERCIAL,206.29,98,,,OTHER,157.88,206.29,PERCENT OF TOTAL BILLED CHARGES
SHLDR ORTHOTIC SHLDR CAP DESN,L3671,HCPCS,274,RC,,INPATIENT,,,1089,435.6,AETNA,AETNA COMMERCIAL,1067.22,98,,,OTHER,816.75,1067.22,PERCENT OF TOTAL BILLED CHARGES
ELBOW ORTHOTIC W/O JOINTS CUST,L3702,HCPCS,274,RC,,INPATIENT,,,694,277.6,AETNA,AETNA COMMERCIAL,680.12,98,,,OTHER,280.5,366.52,PERCENT OF TOTAL BILLED CHARGES
ELB ORTH W/ADJ LOCK JNT PRFAB,L3760,HCPCS,274,RC,,INPATIENT,,,691.75,276.7,AETNA,AETNA COMMERCIAL,677.915,98,,,OTHER,518.81,677.92,PERCENT OF TOTAL BILLED CHARGES
EWHO RIGID W/O JNTS CF,L3763,HCPCS,274,RC,,INPATIENT,,,1562,624.8,AETNA,AETNA COMMERCIAL,1530.76,98,,,OTHER,1171.5,1530.8,PERCENT OF TOTAL BILLED CHARGES
EWHFO RIGID W/O JOINTS CUSTOM,L3765,HCPCS,274,RC,,INPATIENT,,,1616.25,646.5,AETNA,AETNA COMMERCIAL,1583.925,98,,,OTHER,1212.19,1583.93,PERCENT OF TOTAL BILLED CHARGES
WHFO CUSTOM FABRICATED INCL,L3806,HCPCS,274,RC,,INPATIENT,,,1165.68,466.272,AETNA,AETNA COMMERCIAL,1142.3664,98,,,OTHER,422.81,552.48,PERCENT OF TOTAL BILLED CHARGES
"WHFO, RIGID W/O JOINTS",L3808,HCPCS,274,RC,,INPATIENT,,,850,340,AETNA,AETNA COMMERCIAL,833,98,,,OTHER,637.5,833,PERCENT OF TOTAL BILLED CHARGES
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,INPATIENT,,,485.38,194.152,AETNA,AETNA COMMERCIAL,475.6724,98,,,OTHER,364,475.7,PERCENT OF TOTAL BILLED CHARGES
WHFO DYN FLEXOR HINGE WRST/FIN,L3900,HCPCS,274,RC,,INPATIENT,,,1831,732.4,AETNA,AETNA COMMERCIAL,1794.38,98,,,OTHER,1373.25,1794.38,PERCENT OF TOTAL BILLED CHARGES
WHO INCL 1/MORE NONTORSION JOI,L3905,HCPCS,274,RC,,INPATIENT,,,1267.5,507,AETNA,AETNA COMMERCIAL,1242.15,98,,,OTHER,950.63,1242.15,PERCENT OF TOTAL BILLED CHARGES
WHO W/O JOINTS CF,L3906,HCPCS,274,RC,,INPATIENT,,,998,399.2,AETNA,AETNA COMMERCIAL,978.04,98,,,OTHER,748.5,978,PERCENT OF TOTAL BILLED CHARGES
HFO W/O JOINTS CF,L3913,HCPCS,274,RC,,INPATIENT,,,684,273.6,AETNA,AETNA COMMERCIAL,670.32,98,,,OTHER,513,670.3,PERCENT OF TOTAL BILLED CHARGES
HFO INCL 1/MORE NONTORSION JOI,L3921,HCPCS,274,RC,,INPATIENT,,,366,146.4,AETNA,AETNA COMMERCIAL,358.68,98,,,OTHER,274.5,358.68,PERCENT OF TOTAL BILLED CHARGES
HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,274,RC,,INPATIENT,,,276.78,110.712,AETNA,AETNA COMMERCIAL,271.2444,98,,,OTHER,207.6,271.2,PERCENT OF TOTAL BILLED CHARGES
FO W/O JOINTS CF,L3933,HCPCS,274,RC,,INPATIENT,,,490,196,AETNA,AETNA COMMERCIAL,480.2,98,,,OTHER,367.5,480.2,PERCENT OF TOTAL BILLED CHARGES
FINGER ORTHOTIC NONTORSION JOI,L3935,HCPCS,274,RC,,INPATIENT,,,267.75,107.1,AETNA,AETNA COMMERCIAL,262.395,98,,,OTHER,200.81,262.4,PERCENT OF TOTAL BILLED CHARGES
SEWHO ABDJUCTION POSITIONING,L3967,HCPCS,274,RC,,INPATIENT,,,668,267.2,AETNA,AETNA COMMERCIAL,654.64,98,,,OTHER,501,654.64,PERCENT OF TOTAL BILLED CHARGES
TISSUE LOCALIZATION-EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,720,288,AETNA,AETNA COMMERCIAL,705.6,98,,,OTHER,540,705.6,PERCENT OF TOTAL BILLED CHARGES
BULKAMID URETHRAL BULKING SYST,L8603,HCPCS,278,RC,,INPATIENT,,,1871.1,748.44,AETNA,AETNA COMMERCIAL,1833.678,98,,,OTHER,1403.3,1833.7,PERCENT OF TOTAL BILLED CHARGES
MATTRESS V-CUE HILL-ROM,2790024,CDM,,,,INPATIENT,,,118.5,47.4,AETNA,AETNA COMMERCIAL,116.13,98,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
CHROMOGRANIN A,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,AETNA,AETNA COMMERCIAL,183.505,98,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
ANA REFLEX TITER,86039,CPT,300,RC,,OUTPATIENT,,,90.75,36.3,AETNA,AETNA COMMERCIAL,88.935,98,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION REFLEX SERUM,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,AETNA,AETNA COMMERCIAL,213.15,98,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
HEMOCHROMATOSIS HFE GENE,81256,CPT,300,RC,,OUTPATIENT,,,545.75,218.3,AETNA,AETNA COMMERCIAL,534.835,98,,,OTHER,409.31,534.84,PERCENT OF TOTAL BILLED CHARGES
IMMUNDFIXATION REFLEX URINE,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,AETNA,AETNA COMMERCIAL,219.765,98,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
WARFARIN RESPONSE GENOTYPE,0030U,HCPCS,300,RC,,INPATIENT,,,821.83,328.732,AETNA,AETNA COMMERCIAL,805.3934,98,,,OTHER,616.4,805.4,PERCENT OF TOTAL BILLED CHARGES
MEDPRO C (STUDENTS),3000015,CDM,,,,INPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
VENOUS PH ONLY,82800,CPT,300,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
ALUMINUM SERUM,82108,CPT,300,RC,,OUTPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR PSA SCREENING,3000020,CDM,,,,INPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR FSH,3000021,CDM,,,,INPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR A1C,3000022,CDM,,,,INPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR CBC,3000023,CDM,,,,INPATIENT,,,25,10,AETNA,AETNA COMMERCIAL,24.5,98,,,OTHER,18.75,24.5,PERCENT OF TOTAL BILLED CHARGES
DMEA ABO,3000024,CDM,,,,INPATIENT,,,13.5,5.4,AETNA,AETNA COMMERCIAL,13.23,98,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
DMEA RH,3000025,CDM,,,,INPATIENT,,,13.5,5.4,AETNA,AETNA COMMERCIAL,13.23,98,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
DES-GAMMA CARBOXY PROTHROMBIN,83951,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,AETNA,AETNA COMMERCIAL,296.205,98,,,OTHER,226.69,296.21,PERCENT OF TOTAL BILLED CHARGES
MSHG GENE FULL ANALYSIS,81298,CPT,300,RC,,OUTPATIENT,,,1499.5,599.8,AETNA,AETNA COMMERCIAL,1469.51,98,,,OTHER,1124.63,1469.51,PERCENT OF TOTAL BILLED CHARGES
SPECIMEN COLLECTION CAPILLARY,36416,CPT,300,RC,,OUTPATIENT,,,6.25,2.5,AETNA,AETNA COMMERCIAL,6.125,98,,,OTHER,4.69,6.13,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANSFER RBC,82657,CPT,300,RC,,OUTPATIENT,,,479.75,191.9,AETNA,AETNA COMMERCIAL,470.155,98,,,OTHER,359.81,470.16,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY  RBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY WBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L WBC,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATE&ID BY HIGH RESOLTN,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L WBC,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,83909,CPT,300,RC,,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,AETNA,AETNA COMMERCIAL,26.95,98,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,8390959,CPT,300,RC,59,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
DRUGS OF ABUSE SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,293.5,117.4,AETNA,AETNA COMMERCIAL,287.63,98,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 1,80301,CPT,301,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 2,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 3,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 4,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 5,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 6,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 7,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 8,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,138.5,55.4,AETNA,AETNA COMMERCIAL,135.73,98,,,OTHER,103.88,135.73,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,AETNA,AETNA COMMERCIAL,119.7756,98,,,OTHER,91.7,119.8,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,AETNA,AETNA COMMERCIAL,119.7756,98,,,OTHER,91.7,119.8,PERCENT OF TOTAL BILLED CHARGES
VASO INTESTINAL POLYPETIDE,84586,CPT,300,RC,,OUTPATIENT,,,245,98,AETNA,AETNA COMMERCIAL,240.1,98,,,OTHER,183.75,240.1,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE BY PCR,87476,CPT,300,RC,,OUTPATIENT,,,509,203.6,AETNA,AETNA COMMERCIAL,498.82,98,,,OTHER,381.75,498.82,PERCENT OF TOTAL BILLED CHARGES
INSITU HYBRIDIZATION AUTO,88367,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
TUMOR IMMUNOHISTOCHEM,88361,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C RESISTANCE V  PLASMA,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,AETNA,AETNA COMMERCIAL,196.49,98,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
PROTEIN S ACTIVITY,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,AETNA,AETNA COMMERCIAL,231.035,98,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
CHROM ANALY CT 5 CELLS 1 KARY,88261,CPT,300,RC,,OUTPATIENT,,,1072.75,429.1,AETNA,AETNA COMMERCIAL,1051.295,98,,,OTHER,804.56,1051.3,PERCENT OF TOTAL BILLED CHARGES
GONADOTROPIN RELEASING HORMONE,83727,CPT,300,RC,,OUTPATIENT,,,529.75,211.9,AETNA,AETNA COMMERCIAL,519.155,98,,,OTHER,397.31,519.16,PERCENT OF TOTAL BILLED CHARGES
MYH GENETIC MOLECUALR ANALYSIS,81401,CPT,300,RC,,OUTPATIENT,,,398,159.2,AETNA,AETNA COMMERCIAL,390.04,98,,,OTHER,298.5,390.04,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN LIKE IMMUNOREACTIVITY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN FECAL,84488,CPT,300,RC,,OUTPATIENT,,,157.25,62.9,AETNA,AETNA COMMERCIAL,154.105,98,,,OTHER,117.94,154.11,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,88386,CPT,310,RC,,OUTPATIENT,,,735,294,AETNA,AETNA COMMERCIAL,720.3,98,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,AETNA,AETNA COMMERCIAL,720.3,98,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,AETNA,AETNA COMMERCIAL,720.3,98,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,AETNA,AETNA COMMERCIAL,720.3,98,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
5-HIAA ASSAY,83497,CPT,300,RC,,OUTPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,OUTPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
CARBOHYDRATE DEF TRANSFERRIN,82373,CPT,300,RC,,OUTPATIENT,,,101.25,40.5,AETNA,AETNA COMMERCIAL,99.225,98,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
AUTOIMMUNE INNER EAR 68KD,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,AETNA,AETNA COMMERCIAL,279.79,98,,,OTHER,214.13,279.79,PERCENT OF TOTAL BILLED CHARGES
COLLAPSIN RESPONSE MP 5 IGG,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,AETNA,AETNA COMMERCIAL,279.79,98,,,OTHER,214.13,279.79,PERCENT OF TOTAL BILLED CHARGES
ACH R GANGLIONIC NEURONAL ANTI,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
PROTOPORPHYRINS FRAC ERYTHRO,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PHENOBARBITAL,80184,CPT,300,RC,,OUTPATIENT,,,52.5,21,AETNA,AETNA COMMERCIAL,51.45,98,,,OTHER,39.4,51.5,PERCENT OF TOTAL BILLED CHARGES
P GALACTOSE 1 PHOSPHATE,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,AETNA,AETNA COMMERCIAL,33.8492,98,,,OTHER,12.56,16.42,PERCENT OF TOTAL BILLED CHARGES
P CF IMMUNOASSAY,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,AETNA,AETNA COMMERCIAL,33.8492,98,,,OTHER,25.5,33.32,PERCENT OF TOTAL BILLED CHARGES
ZINC PROTOPORPHYRINS,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
P MS-MS EXPANDED SCREEN,83788,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,83788,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,8378859,CPT,300,RC,59,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
NUCLEOTIDASE-5,83915,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
UPD GLUCURONOSYLTRANSFERASE,81350,CPT,300,RC,,OUTPATIENT,,,1251.25,500.5,AETNA,AETNA COMMERCIAL,1226.225,98,,,OTHER,938.44,1226.23,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS  FRACTIONATED,82542,CPT,301,RC,,OUTPATIENT,,,136,54.4,AETNA,AETNA COMMERCIAL,133.28,98,,,OTHER,102,133.28,PERCENT OF TOTAL BILLED CHARGES
ZIPRASIDONE,G0480,HCPCS,300,RC,,BOTH,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS  TOTAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
COENZYME Q10,82542,CPT,301,RC,,OUTPATIENT,,,289.5,115.8,AETNA,AETNA COMMERCIAL,283.71,98,,,OTHER,217.13,283.71,PERCENT OF TOTAL BILLED CHARGES
ESCITALOPRAM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
ANTI-HMGCR AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,256,102.4,AETNA,AETNA COMMERCIAL,250.88,98,,,OTHER,192,250.88,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
BRCA1/BRACA2 FULL GENE ANALYSI,81162,CPT,300,RC,,OUTPATIENT,,,3649.76,1459.904,AETNA,AETNA COMMERCIAL,3576.7648,98,,,OTHER,1546.31,2020.52,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
INHIBIN B,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
17-HYDROXYCORTICOSTEROIDS,83491,CPT,301,RC,,OUTPATIENT,,,166,66.4,AETNA,AETNA COMMERCIAL,162.68,98,,,OTHER,124.5,162.68,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
ZIKAVIRUS IGM,86790,CPT,300,RC,,OUTPATIENT,,,220.5,88.2,AETNA,AETNA COMMERCIAL,216.09,98,,,OTHER,165.38,216.09,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,87300,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,8730091,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
MICROSATELLITE INSTABILITY,81301,CPT,312,RC,,OUTPATIENT,,,697.12,278.848,AETNA,AETNA COMMERCIAL,683.1776,98,,,OTHER,304.13,397.39,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
HLA A HIGH RES BY DNA,81380,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,AETNA,AETNA COMMERCIAL,737.695,98,,,OTHER,564.56,737.7,PERCENT OF TOTAL BILLED CHARGES
CALCULUS (STONE),82365,CPT,300,RC,,OUTPATIENT,,,82.25,32.9,AETNA,AETNA COMMERCIAL,80.605,98,,,OTHER,61.69,80.61,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,AETNA,AETNA COMMERCIAL,104.2034,98,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
HEREDITARY SPHEROCYTOSIS EVAL,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,AETNA,AETNA COMMERCIAL,180.075,98,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,AETNA,AETNA COMMERCIAL,93.1,98,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
Z STACLOT LUPUS ANTICOAGULANT,85598,CPT,300,RC,,OUTPATIENT,,,241.25,96.5,AETNA,AETNA COMMERCIAL,236.425,98,,,OTHER,180.94,236.43,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,AETNA,AETNA COMMERCIAL,93.1,98,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN ANTIGEN,85385,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,AETNA,AETNA COMMERCIAL,212.17,98,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
HYDROXYPROGESTERONE - 17,83498,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,AETNA,AETNA COMMERCIAL,177.625,98,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
"CRYSTINURIA PROFILE,QUANT",82136,CPT,301,RC,,OUTPATIENT,,,235,94,AETNA,AETNA COMMERCIAL,230.3,98,,,OTHER,176.25,230.3,PERCENT OF TOTAL BILLED CHARGES
P HYDROXYPROGESTERONE 17-ALPHA,83498,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,AETNA,AETNA COMMERCIAL,64.925,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
GAMMA HYDROXYBUTYRIC ACID URIN,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,AETNA,AETNA COMMERCIAL,68.7764,98,,,OTHER,41.44,54.15,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B GENOTYPE,87912,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,AETNA,AETNA COMMERCIAL,504.602,98,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES FRAC FREE URINE,82384,CPT,300,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID AMP PROBE,87150,CPT,300,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
Z MICRODILUTION MLC EACH PLATE,87187,CPT,300,RC,,OUTPATIENT,,,91,36.4,AETNA,AETNA COMMERCIAL,89.18,98,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,87188,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID DIRECT PRBE,87149,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
MYCOBACT IDENT BY SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,AETNA,AETNA COMMERCIAL,226.1056,98,,,OTHER,164.25,214.62,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA PLATE,8718891,CPT,300,RC,91,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
D-DIMER,85378,CPT,305,RC,,OUTPATIENT,,,209.25,83.7,AETNA,AETNA COMMERCIAL,205.065,98,,,OTHER,156.94,205.07,PERCENT OF TOTAL BILLED CHARGES
OXALATE PLASMA,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,AETNA,AETNA COMMERCIAL,105.595,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,8718859,CPT,300,RC,59,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
MUCOR IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,AETNA,AETNA COMMERCIAL,32.6634,98,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
JAK2 V617F MUTATION DETECTION,81270,CPT,300,RC,,OUTPATIENT,,,613.25,245.3,AETNA,AETNA COMMERCIAL,600.985,98,,,OTHER,459.94,600.99,PERCENT OF TOTAL BILLED CHARGES
ISO PURIFIED NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,AETNA,AETNA COMMERCIAL,440.51,98,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE 1ST,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,856.5,342.6,AETNA,AETNA COMMERCIAL,839.37,98,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETAION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN,80307,CPT,301,RC,,OUTPATIENT,,,124.28,49.712,AETNA,AETNA COMMERCIAL,121.7944,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
Z B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,AETNA,AETNA COMMERCIAL,73.9508,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z N K CELLS TOTAL COUNT,86357,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,AETNA,AETNA COMMERCIAL,73.9508,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,AETNA,AETNA COMMERCIAL,73.9508,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
Z T CELL ABSOLUTE COUNT RATIO,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,AETNA,AETNA COMMERCIAL,105.595,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
PARALDEHYDE PLASMA,82000,CPT,300,RC,,OUTPATIENT,,,169.75,67.9,AETNA,AETNA COMMERCIAL,166.355,98,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE EA ADD'L,8389691,CPT,300,RC,91,OUTPATIENT,,,393.25,157.3,AETNA,AETNA COMMERCIAL,385.385,98,,,OTHER,294.94,385.39,PERCENT OF TOTAL BILLED CHARGES
T CELL ANTIGEN RECEPTOR GAMMA,81342,CPT,312,RC,,OUTPATIENT,,,870.75,348.3,AETNA,AETNA COMMERCIAL,853.335,98,,,OTHER,653.06,853.34,PERCENT OF TOTAL BILLED CHARGES
ACETONE SERUM QUAL,82009,CPT,301,RC,,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
RBC ENZYMES,83915,CPT,301,RC,,OUTPATIENT,,,797.25,318.9,AETNA,AETNA COMMERCIAL,781.305,98,,,OTHER,597.94,781.31,PERCENT OF TOTAL BILLED CHARGES
FRUCTOSAMINE,82985,CPT,300,RC,,OUTPATIENT,,,82,32.8,AETNA,AETNA COMMERCIAL,80.36,98,,,OTHER,61.5,80.36,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 4,81403,CPT,300,RC,,OUTPATIENT,,,1365,546,AETNA,AETNA COMMERCIAL,1337.7,98,,,OTHER,1023.75,1337.7,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
C-NEURONAL (V-G) K+ CHANNEL AB,83519,CPT,300,RC,,OUTPATIENT,,,219.5,87.8,AETNA,AETNA COMMERCIAL,215.11,98,,,OTHER,164.63,215.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCHOLINE RECEPTOR AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z SLIDE REVIEW MOLECULAR GENE,88387,CPT,310,RC,,OUTPATIENT,,,195,78,AETNA,AETNA COMMERCIAL,191.1,98,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
TSH RECEPTOR ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
MELATONIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
MELANTONIN 24 HR URINE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z ACH RECEPTOR BINDING AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z ACH RECEPTOR BINDING AB,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
HYDROXYLASE 21 ANTIBODIES,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTOR MUSCLE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
DESMOGLEIN 1&3 SERUM,83516,CPT,300,RC,,OUTPATIENT,,,174.6,69.84,AETNA,AETNA COMMERCIAL,171.108,98,,,OTHER,130.95,171.11,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE RIA,83519,CPT,300,RC,,OUTPATIENT,,,1491.5,596.6,AETNA,AETNA COMMERCIAL,1461.67,98,,,OTHER,1118.63,1461.67,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE MULT,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
ACID PHOS TOTAL,84060,CPT,300,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,397,158.8,AETNA,AETNA COMMERCIAL,389.06,98,,,OTHER,297.75,389.06,PERCENT OF TOTAL BILLED CHARGES
INFECT AGT NUCLEIC ACID QUANT,87799,CPT,300,RC,,OUTPATIENT,,,228,91.2,AETNA,AETNA COMMERCIAL,223.44,98,,,OTHER,171,223.44,PERCENT OF TOTAL BILLED CHARGES
Z ANTI HBC TOTAL,86704,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HBS AB QUAL QUANT,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,AETNA,AETNA COMMERCIAL,116.62,98,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
Z HEP A TOTAL ANTIBODIES,86708,CPT,300,RC,,OUTPATIENT,,,32.25,12.9,AETNA,AETNA COMMERCIAL,31.605,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
Z HCV,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
Z HBS ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ACTH LEVEL,82024,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
Z ESTRADIOL ENHANCED,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,AETNA,AETNA COMMERCIAL,202.37,98,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
Z ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
GALECTIN-3,82777,CPT,300,RC,,OUTPATIENT,,,195,78,AETNA,AETNA COMMERCIAL,191.1,98,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
EXTENDEND CORD BLOOD TYPING,86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
REPTILASE TIME,85635,CPT,300,RC,,OUTPATIENT,,,113,45.2,AETNA,AETNA COMMERCIAL,110.74,98,,,OTHER,84.75,110.74,PERCENT OF TOTAL BILLED CHARGES
EVAL FINE NEEDLE ASP ADDL SPEC,88177,CPT,300,RC,,OUTPATIENT,,,66.25,26.5,AETNA,AETNA COMMERCIAL,64.925,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGM, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,AETNA,AETNA COMMERCIAL,191.59,98,,,OTHER,146.63,191.59,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGG, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,AETNA,AETNA COMMERCIAL,191.59,98,,,OTHER,146.63,191.59,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN  SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN BODY FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,AETNA,AETNA COMMERCIAL,66.395,98,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
NMO IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,383.25,153.3,AETNA,AETNA COMMERCIAL,375.585,98,,,OTHER,287.44,375.59,PERCENT OF TOTAL BILLED CHARGES
GRANULOCYTE ANTIBODIES,86021,CPT,300,RC,,OUTPATIENT,,,232.5,93,AETNA,AETNA COMMERCIAL,227.85,98,,,OTHER,174.38,227.85,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS TPMT GENETICS,81401,CPT,300,RC,,OUTPATIENT,,,372.25,148.9,AETNA,AETNA COMMERCIAL,364.805,98,,,OTHER,279.19,364.81,PERCENT OF TOTAL BILLED CHARGES
TPMT GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,716.75,286.7,AETNA,AETNA COMMERCIAL,702.415,98,,,OTHER,537.56,702.42,PERCENT OF TOTAL BILLED CHARGES
CHROMOTOGRAPHY QUANT SINGLE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,AETNA,AETNA COMMERCIAL,125.195,98,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
"17 KETOSTEROID, 24 HR",83582,CPT,301,RC,,OUTPATIENT,,,291,116.4,AETNA,AETNA COMMERCIAL,285.18,98,,,OTHER,218.25,285.18,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATHOLOGY PROC,81401,CPT,300,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATH PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,957.75,383.1,AETNA,AETNA COMMERCIAL,938.595,98,,,OTHER,718.31,938.6,PERCENT OF TOTAL BILLED CHARGES
DEHYDROCHOLESTEROL 7-/8,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
SYNTHETIC CANNABINOIDS,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY VIRUS PCR,87631,CPT,300,RC,,OUTPATIENT,,,557.5,223,AETNA,AETNA COMMERCIAL,546.35,98,,,OTHER,418.13,546.35,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY PANEL PCR,87633,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,AETNA,AETNA COMMERCIAL,816.8888,98,,,OTHER,496.13,648.27,PERCENT OF TOTAL BILLED CHARGES
MPL EXON 10 MUTATION DETECT,81403,CPT,300,RC,,OUTPATIENT,,,797.75,319.1,AETNA,AETNA COMMERCIAL,781.795,98,,,OTHER,598.31,781.8,PERCENT OF TOTAL BILLED CHARGES
CALR MUTATION ANALYSIS MPN,81219,CPT,300,RC,,OUTPATIENT,,,864,345.6,AETNA,AETNA COMMERCIAL,846.72,98,,,OTHER,648,846.72,PERCENT OF TOTAL BILLED CHARGES
MITOTANE,G0480,HCPCS,300,RC,,BOTH,,,165.5,66.2,AETNA,AETNA COMMERCIAL,162.19,98,,,OTHER,124.13,162.19,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
FBNA GENE KM,81403,CPT,300,RC,,OUTPATIENT,,,938.75,375.5,AETNA,AETNA COMMERCIAL,919.975,98,,,OTHER,704.06,919.98,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,8390991,CPT,300,RC,91,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003 91,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE,82542,CPT,301,RC,,OUTPATIENT,,,260.75,104.3,AETNA,AETNA COMMERCIAL,255.535,98,,,OTHER,195.56,255.54,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALDOLASE,82085,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CLOBAZAM,80339,CPT,301,RC,,OUTPATIENT,,,158,63.2,AETNA,AETNA COMMERCIAL,154.84,98,,,OTHER,118.5,154.84,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 9,81408,CPT,300,RC,,OUTPATIENT,,,4000,1600,AETNA,AETNA COMMERCIAL,3920,98,,,OTHER,2155.69,2816.77,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,8390991,CPT,300,RC,91,OUTPATIENT,,,2146.5,858.6,AETNA,AETNA COMMERCIAL,2103.57,98,,,OTHER,1609.88,2103.57,PERCENT OF TOTAL BILLED CHARGES
LYSOZYME SERUM,85549,CPT,300,RC,,OUTPATIENT,,,160,64,AETNA,AETNA COMMERCIAL,156.8,98,,,OTHER,120,156.8,PERCENT OF TOTAL BILLED CHARGES
ALDOSTERONE SERUM,82088,CPT,300,RC,,OUTPATIENT,,,255,102,AETNA,AETNA COMMERCIAL,249.9,98,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
Z EH MUMPS (IMMUNITY),86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,AETNA,AETNA COMMERCIAL,119.07,98,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z EH MEASLES,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
Z EH VARICELLA ZOSTER IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,AETNA,AETNA COMMERCIAL,131.32,98,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
Z EH RUBELLA,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,AETNA,AETNA COMMERCIAL,116.62,98,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
Z EH HIV,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z EH HEPATITIS C VIRUS,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
EH HIV NEEDLESTICK F/U,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HCV NEEDLESTICK F/U,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
EH STREP A ANTIGEN,3000455,CDM,,,,INPATIENT,,,32.25,12.9,AETNA,AETNA COMMERCIAL,31.605,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
EH STREP CULTURE,3000456,CDM,300,RC,,INPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
HEMOLYSINS/AGGLUTININS,86941,CPT,300,RC,,OUTPATIENT,,,187,74.8,AETNA,AETNA COMMERCIAL,183.26,98,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
ITRACONAZOLE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FTA ABS IGG BY IFA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,AETNA,AETNA COMMERCIAL,104.37,98,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
TBNK QN,86355,CPT,300,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO,86357,CPT,300,RC,,OUTPATIENT,,,214.75,85.9,AETNA,AETNA COMMERCIAL,210.455,98,,,OTHER,161.06,210.46,PERCENT OF TOTAL BILLED CHARGES
BAL,86359,CPT,300,RC,,OUTPATIENT,,,240,96,AETNA,AETNA COMMERCIAL,235.2,98,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR FUNCT,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,AETNA,AETNA COMMERCIAL,47.53,98,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,300,RC,,OUTPATIENT,,,169,67.6,AETNA,AETNA COMMERCIAL,165.62,98,,,OTHER,126.75,165.62,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE ISO,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,AETNA,AETNA COMMERCIAL,163.17,98,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,AETNA,AETNA COMMERCIAL,47.53,98,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
FECAL FATS QUANT 24 48 72 HR,82710,CPT,301,RC,,OUTPATIENT,,,159,63.6,AETNA,AETNA COMMERCIAL,155.82,98,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
HEROIN METOBOLITC,80356,CPT,300,RC,,OUTPATIENT,,,285,114,AETNA,AETNA COMMERCIAL,279.3,98,,,OTHER,213.75,279.3,PERCENT OF TOTAL BILLED CHARGES
BONE ALKALINE PHOSPHATASE,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,AETNA,AETNA COMMERCIAL,163.17,98,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
ALLERGENS-SINGLE ASSAY,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN HAZELNUT TEST,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1 ANTITRYPSIN GENOTYPING,81332,CPT,300,RC,,OUTPATIENT,,,435.25,174.1,AETNA,AETNA COMMERCIAL,426.545,98,,,OTHER,326.44,426.55,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1-ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
"FENTANYL WITH METABOLITE,URINE",G0480,HCPCS,300,RC,,BOTH,,,369,147.6,AETNA,AETNA COMMERCIAL,361.62,98,,,OTHER,276.75,361.62,PERCENT OF TOTAL BILLED CHARGES
Z ALPHA 1 ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
A1A PHENOTYPE,82104,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,AETNA,AETNA COMMERCIAL,43.365,98,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
A1A,82103,CPT,301,RC,,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
ALPHA SUBUNIT PITUITARY TM,83520,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
PROSTAGLANDIN,84150,CPT,300,RC,,OUTPATIENT,,,142,56.8,AETNA,AETNA COMMERCIAL,139.16,98,,,OTHER,106.5,139.16,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,580,232,AETNA,AETNA COMMERCIAL,568.4,98,,,OTHER,435,568.4,PERCENT OF TOTAL BILLED CHARGES
HYDROXYPROLINE  TOTAL URINE,83505,CPT,301,RC,,OUTPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
ALPHA FETO PROTEIN BODY FLUIDS,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,AETNA,AETNA COMMERCIAL,183.505,98,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
ALPHA FETO PROTEIN,82105,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,AETNA,AETNA COMMERCIAL,163.17,98,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
CA 72 4,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,AETNA,AETNA COMMERCIAL,183.505,98,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
AFP,82106,CPT,300,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ACETYLOCHOLINESTERASE ASSAY,82013,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
AMNIOTIC FLUID SCAN,82143,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ELECTROPHORECTIC TEST,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z ELECTROPHORECTIC TEST,8266491,CPT,301,RC,91,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
ETHYLENE GLYCOL LEVEL,82693,CPT,300,RC,,OUTPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
INSULIN ANTIBODY  SERUM,86337,CPT,302,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
APTT MIX 1:1,85732,CPT,300,RC,,OUTPATIENT,,,163.5,65.4,AETNA,AETNA COMMERCIAL,160.23,98,,,OTHER,122.63,160.23,PERCENT OF TOTAL BILLED CHARGES
EUGLOBULIN LYSIS TIME,85360,CPT,300,RC,,OUTPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
LATEX IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,AETNA,AETNA COMMERCIAL,145.775,98,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,AETNA,AETNA COMMERCIAL,156.065,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
P HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION PANEL B,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,AETNA,AETNA COMMERCIAL,151.165,98,,,OTHER,115.69,151.17,PERCENT OF TOTAL BILLED CHARGES
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION PANEL A,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,AETNA,AETNA COMMERCIAL,151.165,98,,,OTHER,115.69,151.17,PERCENT OF TOTAL BILLED CHARGES
FUNGAL D2 SEQUENCING ID,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,AETNA,AETNA COMMERCIAL,226.1056,98,,,OTHER,164.25,214.62,PERCENT OF TOTAL BILLED CHARGES
AMEBIASIS ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,AETNA,AETNA COMMERCIAL,121.03,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
THYROTROPIN RELEASING HORMONE,83519,CPT,300,RC,,OUTPATIENT,,,373.75,149.5,AETNA,AETNA COMMERCIAL,366.275,98,,,OTHER,280.31,366.28,PERCENT OF TOTAL BILLED CHARGES
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN - TROUGH,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS,80197,CPT,300,RC,,OUTPATIENT,,,433.75,173.5,AETNA,AETNA COMMERCIAL,425.075,98,,,OTHER,325.31,425.08,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN PEAK,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
KRAS ADDITIONAL VARIANT,81276,CPT,300,RC,,OUTPATIENT,,,386.5,154.6,AETNA,AETNA COMMERCIAL,378.77,98,,,OTHER,230.25,300.86,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRACTION NUCLIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,65.25,26.1,AETNA,AETNA COMMERCIAL,63.945,98,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z IODINE,83789,CPT,300,RC,,OUTPATIENT,,,300,120,AETNA,AETNA COMMERCIAL,294,98,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,306,122.4,AETNA,AETNA COMMERCIAL,299.88,98,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
Z AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,2677.25,1070.9,AETNA,AETNA COMMERCIAL,2623.705,98,,,OTHER,2007.94,2623.71,PERCENT OF TOTAL BILLED CHARGES
Z CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,68.85,27.54,AETNA,AETNA COMMERCIAL,67.473,98,,,OTHER,51.6,67.5,PERCENT OF TOTAL BILLED CHARGES
GENOMIC SEQ HEMATOLYMPHOID DNA,81450,CPT,310,RC,,OUTPATIENT,,,1519.06,607.624,AETNA,AETNA COMMERCIAL,1488.6788,98,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HLA I&II TYPING LR,81370,CPT,300,RC,,OUTPATIENT,,,1000,400,AETNA,AETNA COMMERCIAL,980,98,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,AETNA,AETNA COMMERCIAL,99.715,98,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,AETNA,AETNA COMMERCIAL,99.715,98,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,300,RC,,OUTPATIENT,,,110.25,44.1,AETNA,AETNA COMMERCIAL,108.045,98,,,OTHER,82.69,108.05,PERCENT OF TOTAL BILLED CHARGES
DRVVT DILUTED,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE  RBC,82482,CPT,301,RC,,OUTPATIENT,,,177.5,71,AETNA,AETNA COMMERCIAL,173.95,98,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGG,86651,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGG CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGM CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE ENCEP IGG CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE EHCEP IGM CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGM,86651,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
AMYLASE (SO),82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
17 HYROXYPREGNEN,84143,CPT,300,RC,,OUTPATIENT,,,211,84.4,AETNA,AETNA COMMERCIAL,206.78,98,,,OTHER,158.25,206.78,PERCENT OF TOTAL BILLED CHARGES
SPINOCEREBELLAR ATAXIA TYPE 1,81178,CPT,300,RC,,OUTPATIENT,,,716,286.4,AETNA,AETNA COMMERCIAL,701.68,98,,,OTHER,537,701.68,PERCENT OF TOTAL BILLED CHARGES
DPYD GENE ANALYSIS,81232,CPT,300,RC,,OUTPATIENT,,,1123,449.2,AETNA,AETNA COMMERCIAL,1100.54,98,,,OTHER,842.25,1100.54,PERCENT OF TOTAL BILLED CHARGES
GI PATHOGEN 6-11 TARGETS,87506,CPT,300,RC,,OUTPATIENT,,,525.98,210.392,AETNA,AETNA COMMERCIAL,515.4604,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
PARIETAL CELL ANTIBODIES  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR BASEMENT MEM AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTORS,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY ANALYTE-QUANT,8625691,CPT,300,RC,91,OUTPATIENT,,,138.5,55.4,AETNA,AETNA COMMERCIAL,135.73,98,,,OTHER,103.88,135.73,PERCENT OF TOTAL BILLED CHARGES
ANTI KU,83516,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
MULTIPLEX PROBE STAIN EA,88374,CPT,300,RC,,OUTPATIENT,,,426,170.4,AETNA,AETNA COMMERCIAL,417.48,98,,,OTHER,319.5,417.48,PERCENT OF TOTAL BILLED CHARGES
URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,AETNA,AETNA COMMERCIAL,105.595,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
Z URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
"HUMAN EPIDIDYMIS PROTEIN 4,SER",86305,CPT,302,RC,,OUTPATIENT,,,277,110.8,AETNA,AETNA COMMERCIAL,271.46,98,,,OTHER,207.75,271.46,PERCENT OF TOTAL BILLED CHARGES
UR FENTANYL CON,80299,CPT,300,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
GLYCOMARK,84378,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,AETNA,AETNA COMMERCIAL,197.715,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,U0003,HCPCS,300,RC,,BOTH,,,180,72,AETNA,AETNA COMMERCIAL,176.4,98,,,OTHER,135,176.4,PERCENT OF TOTAL BILLED CHARGES
COVID-19 IGG,U0002,HCPCS,302,RC,,BOTH,,,86,34.4,AETNA,AETNA COMMERCIAL,84.28,98,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
COVID-19 PCR TEST,U0003,HCPCS,300,RC,,INPATIENT,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
INFEC AGEN DETEC AMPLI PROBE,U0005,HCPCS,300,RC,,INPATIENT,,,24,9.6,AETNA,AETNA COMMERCIAL,23.52,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C GENOTYPE,87902,CPT,300,RC,,OUTPATIENT,,,678.75,271.5,AETNA,AETNA COMMERCIAL,665.175,98,,,OTHER,509.06,665.18,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C AMPLIFIED PROBE,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,AETNA,AETNA COMMERCIAL,319.725,98,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
HEPARIN ANTI-XA,85520,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,AETNA,AETNA COMMERCIAL,238.63,98,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C MEDICARE SCREEN,G0472,HCPCS,300,RC,,INPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
TISSUE TRANSGLUTAMINASE AB IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) ELISHA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
ANDROSTENEDIONE,82157,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C RNA AMP PROBE,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,AETNA,AETNA COMMERCIAL,454.72,98,,,OTHER,348,454.72,PERCENT OF TOTAL BILLED CHARGES
MYELOPEROXIDASE,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
PROTEINASE 3 ANTIBODY,8351659,CPT,,,59,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE,82542,CPT,301,RC,,OUTPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGG,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
F ACTIN,83516,CPT,300,RC,,OUTPATIENT,,,220,88,AETNA,AETNA COMMERCIAL,215.6,98,,,OTHER,165,215.6,PERCENT OF TOTAL BILLED CHARGES
PRADER-WILLI/ANGELMAN SYN,81331,CPT,300,RC,,OUTPATIENT,,,500.5,200.2,AETNA,AETNA COMMERCIAL,490.49,98,,,OTHER,375.38,490.49,PERCENT OF TOTAL BILLED CHARGES
METHDIOXYAMPH,G0480,HCPCS,300,RC,,BOTH,,,56.25,22.5,AETNA,AETNA COMMERCIAL,55.125,98,,,OTHER,42.19,55.13,PERCENT OF TOTAL BILLED CHARGES
ANGIOTENSIN CONVERTING ENZYME,82164,CPT,300,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NICOTINE/COTININE META URINE,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,AETNA,AETNA COMMERCIAL,181.79,98,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
CYCLIC CITRULLINATED  PEP AB,86200,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,AETNA,AETNA COMMERCIAL,109.515,98,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
CYCLIC AMP URINARY EXCRETAION,82030,CPT,300,RC,,OUTPATIENT,,,213.5,85.4,AETNA,AETNA COMMERCIAL,209.23,98,,,OTHER,160.13,209.23,PERCENT OF TOTAL BILLED CHARGES
CSF P1433 PROTEIN SPINAL FLUID,82528,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,AETNA,AETNA COMMERCIAL,150.675,98,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES PLASMA,82384,CPT,300,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY TITER (COOMBS TEST),86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
ANTIMITOCHONDRIAL M2 AB  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGG  IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN ANTIBODY IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN ANTIBODIES IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGG (MAYO),86147,CPT,300,RC,,OUTPATIENT,,,50.9,20.36,AETNA,AETNA COMMERCIAL,49.882,98,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGM (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,50.9,20.36,AETNA,AETNA COMMERCIAL,49.882,98,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGG (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
ANTI MULLERIAN HORMONE,83520,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
QUANTIFERON-TB GOLD BLOOD,86481,CPT,300,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,147.56,192.82,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83516,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
HUMAN ANTI - MOUSE AB ELISA,83520,CPT,300,RC,,OUTPATIENT,,,304.25,121.7,AETNA,AETNA COMMERCIAL,298.165,98,,,OTHER,228.19,298.17,PERCENT OF TOTAL BILLED CHARGES
ANTI DNA AB SINGLE STRAND,86226,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CULTURE STREP (THROAT),87081,CPT,306,RC,,OUTPATIENT,,,29.25,11.7,AETNA,AETNA COMMERCIAL,28.665,98,,,OTHER,21.94,28.67,PERCENT OF TOTAL BILLED CHARGES
ASSAY CELLULAR FUNCTION,86352,CPT,300,RC,,OUTPATIENT,,,323.75,129.5,AETNA,AETNA COMMERCIAL,317.275,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
E. COLI 0157,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
COVID-19 POC RAPID,87635,CPT,300,RC,,OUTPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH AG DFA,87270,CPT,300,RC,,OUTPATIENT,,,107.25,42.9,AETNA,AETNA COMMERCIAL,105.105,98,,,OTHER,80.44,105.11,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE SERUM ASSAY,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH BY DNA PROBE,87490,CPT,300,RC,,OUTPATIENT,,,96.25,38.5,AETNA,AETNA COMMERCIAL,94.325,98,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
NEISSERIA GONORRHEA DNA PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,AETNA,AETNA COMMERCIAL,89.67,98,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH DNA AMP PROBE,87491,CPT,306,RC,,OUTPATIENT,,,96.25,38.5,AETNA,AETNA COMMERCIAL,94.325,98,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
GONORRHEA DNA AMP PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,AETNA,AETNA COMMERCIAL,89.67,98,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
N GONORHEA ANTIBODY SERUM,86609,CPT,300,RC,,OUTPATIENT,,,192,76.8,AETNA,AETNA COMMERCIAL,188.16,98,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
GLUTERIC ACIDS,82544,CPT,300,RC,,OUTPATIENT,,,379.25,151.7,AETNA,AETNA COMMERCIAL,371.665,98,,,OTHER,284.44,371.67,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR PANEL,3001000,CDM,,,,INPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR HSCRP,3001002,CDM,,,,INPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR VITAMIN D,3001004,CDM,,,,INPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
PBG DEAMINASE WB,82657,CPT,300,RC,,OUTPATIENT,,,190.25,76.1,AETNA,AETNA COMMERCIAL,186.445,98,,,OTHER,142.69,186.45,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME PERIPHERAL BLOOD,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,AETNA,AETNA COMMERCIAL,944.72,98,,,OTHER,723,944.72,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOMONAL IN SITU HYBRID,88272,CPT,310,RC,,OUTPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
HIV-1 P24 ANTIGEN,87390,CPT,306,RC,,OUTPATIENT,,,153.25,61.3,AETNA,AETNA COMMERCIAL,150.185,98,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
CITRATES ASSAY,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,AETNA,AETNA COMMERCIAL,167.58,98,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
ZONISAMIDE,80203,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
CLOSTRIDIUM DIFFICLE TOXIN PCR,87493,CPT,300,RC,,OUTPATIENT,,,266,106.4,AETNA,AETNA COMMERCIAL,260.68,98,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,AETNA,AETNA COMMERCIAL,167.58,98,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLETHANOL,G0480,HCPCS,300,RC,,BOTH,,,153.25,61.3,AETNA,AETNA COMMERCIAL,150.185,98,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS,88269,CPT,311,RC,,OUTPATIENT,,,894.75,357.9,AETNA,AETNA COMMERCIAL,876.855,98,,,OTHER,671.06,876.86,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,AETNA,AETNA COMMERCIAL,527.73,98,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
ANALYZE 20-25 CELLS,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,AETNA,AETNA COMMERCIAL,914.83,98,,,OTHER,700.13,914.83,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULTURE NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,616.75,246.7,AETNA,AETNA COMMERCIAL,604.415,98,,,OTHER,462.56,604.42,PERCENT OF TOTAL BILLED CHARGES
TISSUE PROCESSING FOR CULTURE,87176,CPT,300,RC,,OUTPATIENT,,,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME 15-20  CELLS,88262,CPT,310,RC,,OUTPATIENT,,,1042,416.8,AETNA,AETNA COMMERCIAL,1021.16,98,,,OTHER,781.5,1021.16,PERCENT OF TOTAL BILLED CHARGES
"CHROMOSOMAL MICROARRAY,CONGEN",81229,CPT,300,RC,,OUTPATIENT,,,3083,1233.2,AETNA,AETNA COMMERCIAL,3021.34,98,,,OTHER,2312.25,3021.34,PERCENT OF TOTAL BILLED CHARGES
CULTURE GROUP B STREP,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
PYRUVATE KINASE ERYTHROCYTES,84220,CPT,300,RC,,OUTPATIENT,,,145.75,58.3,AETNA,AETNA COMMERCIAL,142.835,98,,,OTHER,109.31,142.84,PERCENT OF TOTAL BILLED CHARGES
ANA,86038,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CEREVISIAE IGA,83520,CPT,300,RC,,OUTPATIENT,,,90,36,AETNA,AETNA COMMERCIAL,88.2,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CEREVISIAE IGG,83520,CPT,300,RC,,OUTPATIENT,,,90,36,AETNA,AETNA COMMERCIAL,88.2,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREENING,86255,CPT,300,RC,,OUTPATIENT,,,90,36,AETNA,AETNA COMMERCIAL,88.2,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,8625591,CPT,300,RC,91,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
TRANSFORMING GRWTH FACTOR BETA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SCLERODERMA ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLOUR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,8352059,CPT,301,RC,59,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
RNA POLYMERASE III AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS,83520,CPT,300,RC,,OUTPATIENT,,,289.75,115.9,AETNA,AETNA COMMERCIAL,283.955,98,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
CANNABINOIDS CONFIRM,G0480,HCPCS,300,RC,,BOTH,,,100,40,AETNA,AETNA COMMERCIAL,98,98,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
URINE PROTEIN,84156,CPT,301,RC,,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
KIT GENE ANALYS D816 VARIANT,81273,CPT,300,RC,,OUTPATIENT,,,1125.75,450.3,AETNA,AETNA COMMERCIAL,1103.235,98,,,OTHER,844.31,1103.24,PERCENT OF TOTAL BILLED CHARGES
TGFBR1 GENE KNOWN MUTATION,81403,CPT,300,RC,,OUTPATIENT,,,1361.75,544.7,AETNA,AETNA COMMERCIAL,1334.515,98,,,OTHER,1021.31,1334.52,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,AETNA,AETNA COMMERCIAL,440.51,98,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAGNOSTICS,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC AMPLI EACH,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
GENETIC EXAMINATION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE ADD,8390959,CPT,300,RC,59,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC ADD'L,8381959,CPT,300,RC,59,OUTPATIENT,,,449.5,179.8,AETNA,AETNA COMMERCIAL,440.51,98,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC TRANSFER,83897,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,AETNA,AETNA COMMERCIAL,145.775,98,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CMV IGG ANTIBODY,86644,CPT,302,RC,,OUTPATIENT,,,119.75,47.9,AETNA,AETNA COMMERCIAL,117.355,98,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
VENLAFAXINE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,129.75,51.9,AETNA,AETNA COMMERCIAL,127.155,98,,,OTHER,97.31,127.16,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,1524.5,609.8,AETNA,AETNA COMMERCIAL,1494.01,98,,,OTHER,1143.38,1494.01,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,132.5,53,AETNA,AETNA COMMERCIAL,129.85,98,,,OTHER,99.38,129.85,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,8638291,CPT,300,RC,91,OUTPATIENT,,,132.5,53,AETNA,AETNA COMMERCIAL,129.85,98,,,OTHER,99.38,129.85,PERCENT OF TOTAL BILLED CHARGES
ADH (VASOPRESSIN),84588,CPT,300,RC,,OUTPATIENT,,,372,148.8,AETNA,AETNA COMMERCIAL,364.56,98,,,OTHER,279,364.56,PERCENT OF TOTAL BILLED CHARGES
Z LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,AETNA,AETNA COMMERCIAL,135.24,98,,,OTHER,103.5,135.24,PERCENT OF TOTAL BILLED CHARGES
Z APOLIPOROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z LP(A) CHOLESTEROL ELECTROPHO,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
CMV CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,AETNA,AETNA COMMERCIAL,226.135,98,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
CMV DNA QUANTITATIVE BY PCR,87497,CPT,300,RC,,OUTPATIENT,,,408.5,163.4,AETNA,AETNA COMMERCIAL,400.33,98,,,OTHER,306.38,400.33,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE W/ID IMM STAIN,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
VIRAL SMEAR SHELL VIAL,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z ANTISTREPTOLYSIN O,86060,CPT,300,RC,,OUTPATIENT,,,19.75,7.9,AETNA,AETNA COMMERCIAL,19.355,98,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULUTRE  LYMPHOCYTE,88230,CPT,310,RC,,OUTPATIENT,,,553,221.2,AETNA,AETNA COMMERCIAL,541.94,98,,,OTHER,199.31,260.44,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME ANALYSIS 15-20,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,AETNA,AETNA COMMERCIAL,944.72,98,,,OTHER,723,944.72,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,158,63.2,AETNA,AETNA COMMERCIAL,154.84,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
AFP L3% TOTAL AFP,82107,CPT,300,RC,,OUTPATIENT,,,422.75,169.1,AETNA,AETNA COMMERCIAL,414.295,98,,,OTHER,317.06,414.3,PERCENT OF TOTAL BILLED CHARGES
STREP GRP A AMP PROBE TECH,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,AETNA,AETNA COMMERCIAL,68.7764,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A/B PCR,87502,CPT,306,RC,,OUTPATIENT,,,191.6,76.64,AETNA,AETNA COMMERCIAL,187.768,98,,,OTHER,91.5,119.56,PERCENT OF TOTAL BILLED CHARGES
RSV AMPLIFIED PROBE TECHNIQUE,87634,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,AETNA,AETNA COMMERCIAL,137.592,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN ANTIGEN,85301,CPT,305,RC,,OUTPATIENT,,,186.5,74.6,AETNA,AETNA COMMERCIAL,182.77,98,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS FUMIGATUS,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FUNGUS ANTIBODY,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS ANTIGEN,87305,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,AETNA,AETNA COMMERCIAL,135.975,98,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS IGM ANTIBODIES,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION(MAYO),87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
YEAST ID PANEL,87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,91.5,36.6,AETNA,AETNA COMMERCIAL,89.67,98,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN URINE,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,AETNA,AETNA COMMERCIAL,244.02,98,,,OTHER,186.75,244.02,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS BLOOD,86890,CPT,300,RC,,OUTPATIENT,,,563.5,225.4,AETNA,AETNA COMMERCIAL,552.23,98,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN SERUM,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,AETNA,AETNA COMMERCIAL,244.02,98,,,OTHER,186.75,244.02,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTEIN 1 AB IGA,86146,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGG,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGM,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
BETA-2-MICROGLOBULIN,82232,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BETA-2 TRANSFERRIN BODY FLUID,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,AETNA,AETNA COMMERCIAL,219.765,98,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
RISPERIDONE,G0480,HCPCS,300,RC,,BOTH,,,185.25,74.1,AETNA,AETNA COMMERCIAL,181.545,98,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
EA ADD'L SINGLE PROBE STAIN,88364,CPT,300,RC,,OUTPATIENT,,,547.5,219,AETNA,AETNA COMMERCIAL,536.55,98,,,OTHER,410.63,536.55,PERCENT OF TOTAL BILLED CHARGES
MULTIPLER PROBE STAIN PROC,88377,CPT,300,RC,,OUTPATIENT,,,622.75,249.1,AETNA,AETNA COMMERCIAL,610.295,98,,,OTHER,467.06,610.3,PERCENT OF TOTAL BILLED CHARGES
HCG QUANTATATIVE,84702,CPT,301,RC,,OUTPATIENT,,,194.25,77.7,AETNA,AETNA COMMERCIAL,190.365,98,,,OTHER,145.69,190.37,PERCENT OF TOTAL BILLED CHARGES
B TYPE NATRIURECTIC PEPTIDE,83880,CPT,301,RC,,OUTPATIENT,,,475.5,190.2,AETNA,AETNA COMMERCIAL,465.99,98,,,OTHER,356.63,465.99,PERCENT OF TOTAL BILLED CHARGES
BETA-HYDROXYBUTYRIC ACID,82010,CPT,300,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
BETA-GLOBIN GENE SEQUENCING B,81364,CPT,300,RC,,OUTPATIENT,,,797,318.8,AETNA,AETNA COMMERCIAL,781.06,98,,,OTHER,597.75,781.06,PERCENT OF TOTAL BILLED CHARGES
COCAINE & METABOLITES DETECT,G0480,HCPCS,300,RC,,BOTH,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
DIRECT COOMBS,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
Z PRE DAT,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
Z POST DAT,8688091,CPT,300,RC,91,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
DNA ANTIBODY IGG,86225,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN DIRECT,82248,CPT,301,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,786.75,314.7,AETNA,AETNA COMMERCIAL,771.015,98,,,OTHER,590.06,771.02,PERCENT OF TOTAL BILLED CHARGES
CRMP S IGG WESTERN BLOT,84182,CPT,300,RC,,OUTPATIENT,,,192,76.8,AETNA,AETNA COMMERCIAL,188.16,98,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
Z URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
MERCURY  URINE,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,AETNA,AETNA COMMERCIAL,109.27,98,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN  NEONATAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BIOTINIDASE SERUM,82261,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
P BIOTINIDASE,82261,CPT,300,RC,,OUTPATIENT,,,33.74,13.496,AETNA,AETNA COMMERCIAL,33.0652,98,,,OTHER,6.94,9.07,PERCENT OF TOTAL BILLED CHARGES
BLEEDING TIME,85002,CPT,305,RC,,OUTPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FUNGUS ANTIBODY ADD'L,8667191,CPT,300,RC,91,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
MEASLES RUBEOLA AB IGM,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
MEASLES RUBEOLA AB IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB  CF,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,AETNA,AETNA COMMERCIAL,78.89,98,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
CLOMIPRAMINE & METABOLITE,82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,AETNA,AETNA COMMERCIAL,78.89,98,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
PREALBUMIN,84134,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,AETNA,AETNA COMMERCIAL,64.925,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB,8661291,CPT,300,RC,91,OUTPATIENT,,,80.5,32.2,AETNA,AETNA COMMERCIAL,78.89,98,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
ACYLCARNITINE QUANTITATIVE,82017,CPT,301,RC,,OUTPATIENT,,,176.5,70.6,AETNA,AETNA COMMERCIAL,172.97,98,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
BORDETELLA PERTUSSIS AB IGG,86615,CPT,300,RC,,OUTPATIENT,,,178.5,71.4,AETNA,AETNA COMMERCIAL,174.93,98,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
BORDETELLA PERTUSSIS AB IGA,86615,CPT,300,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CADMIUM BLOOD,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,AETNA,AETNA COMMERCIAL,60.515,98,,,OTHER,46.31,60.52,PERCENT OF TOTAL BILLED CHARGES
INFECTIOUS AGENT DETECTION APT,87801,CPT,300,RC,,OUTPATIENT,,,231,92.4,AETNA,AETNA COMMERCIAL,226.38,98,,,OTHER,173.25,226.38,PERCENT OF TOTAL BILLED CHARGES
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGG BY CF,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGG BY IMMUN,8663591,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGM BY IMMUN,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN (BUN),84520,CPT,301,RC,,OUTPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
BILE ACIDS FRACTIONATE TOTAL,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
IODINE URINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
MANGANESE SERUM,83785,CPT,300,RC,,OUTPATIENT,,,184.75,73.9,AETNA,AETNA COMMERCIAL,181.055,98,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
IODINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANSFERESE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
CALPROTECTIN FECAL,83993,CPT,300,RC,,OUTPATIENT,,,435,174,AETNA,AETNA COMMERCIAL,426.3,98,,,OTHER,326.25,426.3,PERCENT OF TOTAL BILLED CHARGES
MALARIA ANTIBODY SCREEN,86750,CPT,300,RC,,OUTPATIENT,,,344.25,137.7,AETNA,AETNA COMMERCIAL,337.365,98,,,OTHER,258.19,337.37,PERCENT OF TOTAL BILLED CHARGES
STREP B DNA AMP PROBE,87653,CPT,300,RC,,OUTPATIENT,,,252.75,101.1,AETNA,AETNA COMMERCIAL,247.695,98,,,OTHER,189.56,247.7,PERCENT OF TOTAL BILLED CHARGES
CULTURE SCREEN,87081,CPT,306,RC,,OUTPATIENT,,,14.25,5.7,AETNA,AETNA COMMERCIAL,13.965,98,,,OTHER,10.69,13.97,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
HEPARIN CO FACTOR II,85130,CPT,300,RC,,OUTPATIENT,,,338.5,135.4,AETNA,AETNA COMMERCIAL,331.73,98,,,OTHER,253.88,331.73,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS A ANTIBODY IGM,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,AETNA,AETNA COMMERCIAL,124.215,98,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
C-PEPTIDE,84681,CPT,301,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGG,86628,CPT,300,RC,,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGM,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGA,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
CANDIDA ALBICANS ANTIGEN DETEC,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
C-REACTIVE PROTEIN,86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
C-REACTIVE PROTEIN (BABY),86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
OPIATES DRUG AND METABOLITES,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
SHIGA TOXIN 1,87427,CPT,300,RC,,OUTPATIENT,,,41.5,16.6,AETNA,AETNA COMMERCIAL,40.67,98,,,OTHER,31.13,40.67,PERCENT OF TOTAL BILLED CHARGES
OPIATE CONFIRM MECONIUM,80361,CPT,300,RC,,OUTPATIENT,,,219.75,87.9,AETNA,AETNA COMMERCIAL,215.355,98,,,OTHER,164.81,215.36,PERCENT OF TOTAL BILLED CHARGES
SHIGA TOXIN 2,8742759,CPT,300,RC,59,OUTPATIENT,,,41.5,16.6,AETNA,AETNA COMMERCIAL,40.67,98,,,OTHER,31.13,40.67,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOCOCCUS AG SCREEN,SERUM",87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,AETNA,AETNA COMMERCIAL,138.18,98,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CA 125,86304,CPT,300,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
C2 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
CA 15-3,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
CA 27.29,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
CA19-9 (GI),86301,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
C4ADES,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
C3A LEVEL,86160,CPT,300,RC,,OUTPATIENT,,,208.5,83.4,AETNA,AETNA COMMERCIAL,204.33,98,,,OTHER,156.38,204.33,PERCENT OF TOTAL BILLED CHARGES
LIVER CYTOSOL AUTOANTIBODIES,86376,CPT,300,RC,,OUTPATIENT,,,269,107.6,AETNA,AETNA COMMERCIAL,263.62,98,,,OTHER,201.75,263.62,PERCENT OF TOTAL BILLED CHARGES
CORTISOL-FREE,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
CORTISOL SALIVA,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
PANTOTHENIC ACID (VIT B5),84591,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,AETNA,AETNA COMMERCIAL,179.095,98,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
CALCITONIN,82308,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
CORD BLOOD ARTERIAL,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CORD BLOOD VENOUS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CORD DRUG SCREEN,80301,CPT,301,RC,,OUTPATIENT,,,379.75,151.9,AETNA,AETNA COMMERCIAL,372.155,98,,,OTHER,284.81,372.16,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREEN SINGLE DRUG CLASS,80302,CPT,301,RC,,OUTPATIENT,,,109.5,43.8,AETNA,AETNA COMMERCIAL,107.31,98,,,OTHER,82.13,107.31,PERCENT OF TOTAL BILLED CHARGES
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,AETNA,AETNA COMMERCIAL,96.53,98,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
METHEMOGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN A2 AND F,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,AETNA,AETNA COMMERCIAL,156.065,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
CALCIUM TOTAL,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,AETNA,AETNA COMMERCIAL,41.65,98,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
Z CALCIUM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,AETNA,AETNA COMMERCIAL,41.65,98,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
NON DRUG ANALYTE MASS SPEC,82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
PREGABALIN (LYRICA),80366,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,AETNA,AETNA COMMERCIAL,74.97,98,,,OTHER,57.38,74.97,PERCENT OF TOTAL BILLED CHARGES
URINE QUANTITATIVE TIMED SPEC,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,AETNA,AETNA COMMERCIAL,74.97,98,,,OTHER,57.38,74.97,PERCENT OF TOTAL BILLED CHARGES
VOLUME MEASUREMENT TIMED COLL,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
BENZODIAZEPINE CONFIRM URINE,G0483,HCPCS,301,RC,,BOTH,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
CYP2C9 GENE COM VARIANTS,81227,CPT,300,RC,,OUTPATIENT,,,1059.5,423.8,AETNA,AETNA COMMERCIAL,1038.31,98,,,OTHER,794.63,1038.31,PERCENT OF TOTAL BILLED CHARGES
VKORC1 GENE,81355,CPT,300,RC,,OUTPATIENT,,,176.4,70.56,AETNA,AETNA COMMERCIAL,172.872,98,,,OTHER,1.31,1.72,PERCENT OF TOTAL BILLED CHARGES
TRICHOMONAS VAGINALIS AMP RNA,87661,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,AETNA,AETNA COMMERCIAL,238.63,98,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
CARBON DIOXIDE (CO2),82374,CPT,301,RC,,OUTPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
URINE CALCIUM  RANDOM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,AETNA,AETNA COMMERCIAL,41.65,98,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,AETNA,AETNA COMMERCIAL,96.53,98,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CAROTENE,82380,CPT,301,RC,,OUTPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
Z DNA,86225,CPT,300,RC,,OUTPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
Z ENA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SSA,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SSB,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SM,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z RNP,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SC/70,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z JO1,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ANA 2,86038,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID NON URINE/OR,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID NON URI/PERITONEAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CEA,82378,CPT,301,RC,,OUTPATIENT,,,423.71,169.484,AETNA,AETNA COMMERCIAL,415.2358,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
CSF CELL CT W/DIFF,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
VDRL CSF,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,AETNA,AETNA COMMERCIAL,65.66,98,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
CELL CT/DIFF BODY FLUID,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
CYANIDE ASSAY,82600,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
PROCALCITONIN SERUM,84145,CPT,300,RC,,OUTPATIENT,,,212.5,85,AETNA,AETNA COMMERCIAL,208.25,98,,,OTHER,159.38,208.25,PERCENT OF TOTAL BILLED CHARGES
SOMATIC HYPERMUTATION IN BCLL,81263,CPT,300,RC,,OUTPATIENT,,,948,379.2,AETNA,AETNA COMMERCIAL,929.04,98,,,OTHER,711,929.04,PERCENT OF TOTAL BILLED CHARGES
CYLERT (PEMOLINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
PYRUVIC ACID B,84210,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,AETNA,AETNA COMMERCIAL,180.075,98,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
OLIGOCLONAL BAND SERUM,83916,CPT,301,RC,,OUTPATIENT,,,83.5,33.4,AETNA,AETNA COMMERCIAL,81.83,98,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
Z IGG SERUM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
SEROQUEL (QUETIAPINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z IGG CSF,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z OLIGOCLONAL BAND CSF,8391691,CPT,300,RC,91,OUTPATIENT,,,83.5,33.4,AETNA,AETNA COMMERCIAL,81.83,98,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
Z ALBUMIN SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z ALBUMIN SPINAL FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,AETNA,AETNA COMMERCIAL,66.395,98,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
CYSTICERCUS ANTIBODY CFS,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
BRAF GENE ANALYSIS,81210,CPT,300,RC,,OUTPATIENT,,,661.5,264.6,AETNA,AETNA COMMERCIAL,648.27,98,,,OTHER,496.13,648.27,PERCENT OF TOTAL BILLED CHARGES
CERULOPLASMIN,82390,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS QUAL BY PCR,87496,CPT,300,RC,,OUTPATIENT,,,204.5,81.8,AETNA,AETNA COMMERCIAL,200.41,98,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS ANTIBODY IGM,86645,CPT,300,RC,,OUTPATIENT,,,159.25,63.7,AETNA,AETNA COMMERCIAL,156.065,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
Z HERPES SIMPLEX NON SPEC TYPE,86694,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,AETNA,AETNA COMMERCIAL,36.015,98,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
Z RUBELLA IGM,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z CMV IGM,86645,CPT,300,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
LEPTIN LEVEL,83520,CPT,300,RC,,OUTPATIENT,,,263.75,105.5,AETNA,AETNA COMMERCIAL,258.475,98,,,OTHER,197.81,258.48,PERCENT OF TOTAL BILLED CHARGES
CYTOLOGY SPUTUM/FLUIDS,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
POSACONAZOLE,80187,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,AETNA,AETNA COMMERCIAL,312.13,98,,,OTHER,238.88,312.13,PERCENT OF TOTAL BILLED CHARGES
CYTOLOGY URINE,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
HLA B5701 GENOTY PHARMACOGENOM,81381,CPT,300,RC,,OUTPATIENT,,,405,162,AETNA,AETNA COMMERCIAL,396.9,98,,,OTHER,303.75,396.9,PERCENT OF TOTAL BILLED CHARGES
CD20 TOTAL COUNT,86356,CPT,300,RC,,OUTPATIENT,,,272.25,108.9,AETNA,AETNA COMMERCIAL,266.805,98,,,OTHER,204.19,266.81,PERCENT OF TOTAL BILLED CHARGES
ABSOLUTE CD4 & CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,AETNA,AETNA COMMERCIAL,105.595,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
LYSE CELLS FOR NUCLEIC EXTRACT,83907,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,AETNA,AETNA COMMERCIAL,135.975,98,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
Z T CELLS  TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,AETNA,AETNA COMMERCIAL,73.9508,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
Z CD4 & CD8 ABSOLUTE COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,AETNA,AETNA COMMERCIAL,105.595,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
PROPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
NORPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
DEXTROSTIX,82948,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE PCX REAGENT STRIP,82962,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
CHLORIDE,82435,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,AETNA,AETNA COMMERCIAL,29.4,98,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
CSF CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METABOLITES,82542,CPT,301,RC,,OUTPATIENT,,,465.75,186.3,AETNA,AETNA COMMERCIAL,456.435,98,,,OTHER,349.31,456.44,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,8249191,CPT,300,RC,91,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
DIHYDROTESTOSTRONE ASSEY,G0480,HCPCS,300,RC,,BOTH,,,258.75,103.5,AETNA,AETNA COMMERCIAL,253.575,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
DIHYDROPYRIMIDINE DEHYDROGENAS,81400,CPT,300,RC,,OUTPATIENT,,,557.5,223,AETNA,AETNA COMMERCIAL,546.35,98,,,OTHER,418.13,546.35,PERCENT OF TOTAL BILLED CHARGES
INSULIN-LIKE GROWTH FACTOR-2,83519,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,AETNA,AETNA COMMERCIAL,205.31,98,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE SERUM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
DIPTHERIA ANTIBODY,86648,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
DIPTHERIA TOXOID IGG AB,86317,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
PHENOTHIAZINE,82542,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,AETNA,AETNA COMMERCIAL,67.375,98,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
CHOLESTEROL,82465,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METABOLITES,80299,CPT,300,RC,,OUTPATIENT,,,417,166.8,AETNA,AETNA COMMERCIAL,408.66,98,,,OTHER,312.75,408.66,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEINS  BLOOD,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
PROTEIN ELECTROPHORESIS BDY FL,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,AETNA,AETNA COMMERCIAL,150.675,98,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN ELECTROPHORESIS,84165,CPT,300,RC,,OUTPATIENT,,,20,8,AETNA,AETNA COMMERCIAL,19.6,98,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
IG PARAPROTEIN QUAL BLD/UR,0077U,HCPCS,300,RC,,INPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.8,51.9,PERCENT OF TOTAL BILLED CHARGES
ENCAINIDE,82542,CPT,301,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS PANEL ACUTE,80074,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,AETNA,AETNA COMMERCIAL,189.875,98,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
ESTRIOL SERUM,82677,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
ETHOSUXIMIDE (ZARONTIN),80168,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR IX,85250,CPT,305,RC,,OUTPATIENT,,,371.75,148.7,AETNA,AETNA COMMERCIAL,364.315,98,,,OTHER,278.81,364.32,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR V,85220,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
FACTOR V LEIDEN,81241,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,AETNA,AETNA COMMERCIAL,197.715,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
FACTOR VIII INHIBITOR,85335,CPT,300,RC,,OUTPATIENT,,,287.25,114.9,AETNA,AETNA COMMERCIAL,281.505,98,,,OTHER,215.44,281.51,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR VII,85230,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR VIII,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,AETNA,AETNA COMMERCIAL,271.95,98,,,OTHER,208.13,271.95,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR II ACTIVITY,85210,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
HAGEMAN COAGULATION FACTOR XII,85280,CPT,305,RC,,OUTPATIENT,,,200.25,80.1,AETNA,AETNA COMMERCIAL,196.245,98,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
COLD AGGLUTININ TITER,86156,CPT,302,RC,,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C3,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C1Q,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C2 ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C4,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT FACTOR B,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,AETNA,AETNA COMMERCIAL,129.115,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT TOTAL (CH5O),86162,CPT,300,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA ANTIBODY IGG,86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
COPPER LEVEL,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
COPPER URINE 24 HR,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CORTISOL,82533,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
CPK TOTAL ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,AETNA,AETNA COMMERCIAL,96.53,98,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CPK MB FRACTION,82553,CPT,301,RC,,OUTPATIENT,,,281,112.4,AETNA,AETNA COMMERCIAL,275.38,98,,,OTHER,210.75,275.38,PERCENT OF TOTAL BILLED CHARGES
Z CPK ISO,82552,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
Z CK ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,AETNA,AETNA COMMERCIAL,96.53,98,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),86632,CPT,300,RC,,OUTPATIENT,,,35.75,14.3,AETNA,AETNA COMMERCIAL,35.035,98,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,AETNA,AETNA COMMERCIAL,35.035,98,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,AETNA,AETNA COMMERCIAL,35.035,98,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CREATININE ASSAY,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,OUTPATIENT,,,239,95.6,AETNA,AETNA COMMERCIAL,234.22,98,,,OTHER,179.25,234.22,PERCENT OF TOTAL BILLED CHARGES
CRP HIGH SENSITIVITY,86141,CPT,302,RC,,OUTPATIENT,,,125.75,50.3,AETNA,AETNA COMMERCIAL,123.235,98,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSB,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SM,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA RNP,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SCL 70,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA JO1,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,AETNA,AETNA COMMERCIAL,63.945,98,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
Z URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE KETONES,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE COCAINE CONFIRMATORY,80353,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
CRYOFIBRINOGEN,82585,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,AETNA,AETNA COMMERCIAL,36.015,98,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
CRYOGLOBULIN,82595,CPT,300,RC,,OUTPATIENT,,,32,12.8,AETNA,AETNA COMMERCIAL,31.36,98,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
FATS URINE STAIN,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,AETNA,AETNA COMMERCIAL,66.885,98,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
FATS URINE QUALITATIVE,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,AETNA,AETNA COMMERCIAL,66.885,98,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
NMR LIPOPROTEIN PROFILE,83704,CPT,301,RC,,OUTPATIENT,,,100,40,AETNA,AETNA COMMERCIAL,98,98,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
FELBATOL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
SIROLIMUS,8019559,CPT,,,59,OUTPATIENT,,,402.25,160.9,AETNA,AETNA COMMERCIAL,394.205,98,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,8718191,CPT,306,RC,91,OUTPATIENT,,,101.75,40.7,AETNA,AETNA COMMERCIAL,99.715,98,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
DNA RNA SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,361,144.4,AETNA,AETNA COMMERCIAL,353.78,98,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
ANAEROBIC ISOLATE  ID,87076,CPT,306,RC,,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTES STOOL,83630,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CLOZAPINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
CULTURE SPECIMEN BACTERIA,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CLOTEST,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"MYCOBACTERIAL CULTURE, BLOOD",87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
TB TEST,3003032,CDM,,,,INPATIENT,,,36.75,14.7,AETNA,AETNA COMMERCIAL,36.015,98,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
VECTRA,3003033,CDM,,,,OUTPATIENT,,,29.25,11.7,AETNA,AETNA COMMERCIAL,28.665,98,,,OTHER,21.94,28.67,PERCENT OF TOTAL BILLED CHARGES
CULTURE SMEAR GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,AETNA,AETNA COMMERCIAL,226.135,98,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
VIRUS ISO/TISS CUL/OBSV/ID(SO),87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,AETNA,AETNA COMMERCIAL,226.135,98,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
VIRUS EA ISO ID  TISS CUL  SO,87253,CPT,300,RC,,OUTPATIENT,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HANTA VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
HANTA VIRUS IGM,8679091,CPT,300,RC,91,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
JC VIRUS,87799,CPT,300,RC,,OUTPATIENT,,,543,217.2,AETNA,AETNA COMMERCIAL,532.14,98,,,OTHER,407.25,532.14,PERCENT OF TOTAL BILLED CHARGES
ST LOUIS ENCEPHALITIS IGG,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
ST LOUIS ENCEPHALITIS IGM,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC (X28),8600391,CPT,300,RC,91,OUTPATIENT,,,994.25,397.7,AETNA,AETNA COMMERCIAL,974.365,98,,,OTHER,745.69,974.37,PERCENT OF TOTAL BILLED CHARGES
Z VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z VIRUS IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
FLUID CRYSTALS EXAM,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,AETNA,AETNA COMMERCIAL,84.28,98,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
B PERTUSSIS SMEAR BY DFA,87265,CPT,306,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
SMEAR BLOOD-PARASITES,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,AETNA,AETNA COMMERCIAL,105.35,98,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
CULTURE AFB,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
SMEAR INTER ONLY  W/WO CELL CT,85097,CPT,310,RC,,OUTPATIENT,,,1307.81,523.124,AETNA,AETNA COMMERCIAL,1281.6538,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
CYCLOSPORA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,AETNA,AETNA COMMERCIAL,105.35,98,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
MICROSPORIDIA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,AETNA,AETNA COMMERCIAL,105.35,98,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
SMITH (ENA) ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
JO 1 ANTIBODY   IGG,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
SEPARTN BY GEL ELECTROPHORESIS,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
ENTROVIRUS PANEL II,86658,CPT,300,RC,,OUTPATIENT,,,1295.25,518.1,AETNA,AETNA COMMERCIAL,1269.345,98,,,OTHER,971.44,1269.35,PERCENT OF TOTAL BILLED CHARGES
FIBRINOLYSINS/COAG SCR REPORT,85390,CPT,300,RC,,OUTPATIENT,,,57,22.8,AETNA,AETNA COMMERCIAL,55.86,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
CULTURE AEROBIC,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS TOTAL AB,0064U,CPT,300,RC,,OUTPATIENT,,,120,48,AETNA,AETNA COMMERCIAL,117.6,98,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
CULTURE ANAEROBIC,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,AETNA,AETNA COMMERCIAL,180.81,98,,,OTHER,138.38,180.81,PERCENT OF TOTAL BILLED CHARGES
CULTURE AFB W/DEFINITIVE ID,87118,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,AETNA,AETNA COMMERCIAL,172.97,98,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
CULTURE BLOOD,8704091,CPT,306,RC,91,OUTPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE IGG,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE IGM,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,AETNA,AETNA COMMERCIAL,110.495,98,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
CULTURE BLOOD MULTIPLE SITES,8704059,CPT,306,RC,59,OUTPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
ENTEROVIRUS DETECTION RT-PCR,87498,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,AETNA,AETNA COMMERCIAL,172.97,98,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE VIRUS AB IGM CSF,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,AETNA,AETNA COMMERCIAL,110.495,98,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE VIRUS AB IGG CSF,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
ENTEROVIRUS RNA QUAL RT PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN-BARR VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
WEST NILE VIRUS  RNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,395,158,AETNA,AETNA COMMERCIAL,387.1,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
PHEUMOCYSTIS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
CREATININE BODY FLUID,82570,CPT,301,RC,,OUTPATIENT,,,102.5,41,AETNA,AETNA COMMERCIAL,100.45,98,,,OTHER,76.88,100.45,PERCENT OF TOTAL BILLED CHARGES
BK VIRUS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
CREATININE OTHER SOURCE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,AETNA,AETNA COMMERCIAL,63.945,98,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
BK VIRUS PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
MALARIA MODLECULAR DETECT PCR,87798,CPT,306,RC,,OUTPATIENT,,,255.75,102.3,AETNA,AETNA COMMERCIAL,250.635,98,,,OTHER,191.81,250.64,PERCENT OF TOTAL BILLED CHARGES
AFB SMEAR,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
AFB SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SIGNAL RECOGNITION PROTEIN,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,AETNA,AETNA COMMERCIAL,305.27,98,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,8827591,CPT,310,RC,91,OUTPATIENT,,,311.5,124.6,AETNA,AETNA COMMERCIAL,305.27,98,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS FRAGILE X,88248,CPT,310,RC,,OUTPATIENT,,,1778.75,711.5,AETNA,AETNA COMMERCIAL,1743.175,98,,,OTHER,1334.06,1743.18,PERCENT OF TOTAL BILLED CHARGES
CULTURE BODY FLUID,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CHROM & DNA ANAL FRAGILE-X,81243,CPT,310,RC,,OUTPATIENT,,,375,150,AETNA,AETNA COMMERCIAL,367.5,98,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS ANALY 100-300,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,AETNA,AETNA COMMERCIAL,305.27,98,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS/MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CYTOGENECTICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,AETNA,AETNA COMMERCIAL,333.69,98,,,OTHER,255.38,333.69,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANLY TISSUE CULT,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,AETNA,AETNA COMMERCIAL,652.435,98,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
G-6 PD,82955,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CYSTICERCOSIS IGG SERUM,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
QUANTITATION THERAPY DRUG,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW ANALYSIS,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR ANTIBODIES IGA&IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLIAD ANTIBODY - IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GLIADIN IGG ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GLIADIN IGA ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 1,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 2,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 3,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 4,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 5,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 6,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INTERLEUKIN 8,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INTERLEUKIN 6,83520,CPT,300,RC,,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
STREP A ANTIGEN,87880,CPT,300,RC,,OUTPATIENT,,,38.75,15.5,AETNA,AETNA COMMERCIAL,37.975,98,,,OTHER,29.06,37.98,PERCENT OF TOTAL BILLED CHARGES
CULTURE FUNGAL,87101,CPT,306,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
GROUP B STREP ANTIGEN - SERUM,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCUS ANTIGEN CSF,87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,AETNA,AETNA COMMERCIAL,138.18,98,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE BLOOD FUNGUS,87103,CPT,300,RC,,OUTPATIENT,,,127,50.8,AETNA,AETNA COMMERCIAL,124.46,98,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
Z SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCUS ANTIGEN LTX AGGLU,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,AETNA,AETNA COMMERCIAL,152.39,98,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
CULTURE GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CULTURE GENITAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
Z CADMIUM,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,AETNA,AETNA COMMERCIAL,60.515,98,,,OTHER,46.31,60.52,PERCENT OF TOTAL BILLED CHARGES
Z ARSENIC,82175,CPT,301,RC,,OUTPATIENT,,,54.75,21.9,AETNA,AETNA COMMERCIAL,53.655,98,,,OTHER,41.06,53.66,PERCENT OF TOTAL BILLED CHARGES
Z MERCURY  QUANTITATIVE,83825,CPT,301,RC,,OUTPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
Z LEAD,83655,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI (DCMH),86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,AETNA,AETNA COMMERCIAL,109.515,98,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI ANTIGEN,87338,CPT,306,RC,,OUTPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI IGM,86677,CPT,302,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CADASIL,81406,CPT,300,RC,,OUTPATIENT,,,3619,1447.6,AETNA,AETNA COMMERCIAL,3546.62,98,,,OTHER,2714.25,3546.62,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG ISO/EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGG,86677,CPT,302,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGA,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGM,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
HEMAGLOBIN PLASMA,83051,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN BARR VIRUS IGG ERLY AG,86663,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,AETNA,AETNA COMMERCIAL,109.515,98,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
SMEAR EXAM W/MANUAL DIFF,85007,CPT,305,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN-BARR VIRUS PANEL 2,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
HEMOGRAM,85027,CPT,305,RC,,OUTPATIENT,,,58.75,23.5,AETNA,AETNA COMMERCIAL,57.575,98,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN BARR VIRUS AB VIRAL,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
PLATELET  AUTO,85049,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
PLATELET NEUTRALIZATION,85597,CPT,300,RC,,OUTPATIENT,,,178,71.2,AETNA,AETNA COMMERCIAL,174.44,98,,,OTHER,133.5,174.44,PERCENT OF TOTAL BILLED CHARGES
PLATELET ANTIBODIES SERUM,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,AETNA,AETNA COMMERCIAL,326.83,98,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
HIV 1-2 AG AB EVAL,G0475,HCPCS,300,RC,,BOTH,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
HIV 1 ANTIBODY RAPID SCREEN,86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
HIV 1 ANTIBODY DIFFERENTIATION,86701,CPT,300,RC,,OUTPATIENT,,,174.5,69.8,AETNA,AETNA COMMERCIAL,171.01,98,,,OTHER,130.88,171.01,PERCENT OF TOTAL BILLED CHARGES
MONO SCREEN,86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,AETNA,AETNA COMMERCIAL,109.515,98,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS BY PCR,87529,CPT,300,RC,,OUTPATIENT,,,105,42,AETNA,AETNA COMMERCIAL,102.9,98,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS TYPE 2,86696,CPT,300,RC,,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS TYPE 1,86695,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX AMPLIFIED PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,AETNA,AETNA COMMERCIAL,102.9,98,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
HSV AB IGM BY IFA,86694,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
AMPLIFIED PROBE TECHE EA ORGNS,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
HISTONE ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
TYSABRI IMMUNOGENICITY,83516,CPT,300,RC,,OUTPATIENT,,,547,218.8,AETNA,AETNA COMMERCIAL,536.06,98,,,OTHER,410.25,536.06,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION DIAGNOS,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.9,151.4,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION,G0432,HCPCS,300,RC,,BOTH,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HIV-1 GENOTYPE REFLEX TO PHENO,87901,CPT,300,RC,,OUTPATIENT,,,1378.75,551.5,AETNA,AETNA COMMERCIAL,1351.175,98,,,OTHER,1034.06,1351.18,PERCENT OF TOTAL BILLED CHARGES
HIV-1 PHENOTYPIC RESIST PRE,87900,CPT,300,RC,,OUTPATIENT,,,673.5,269.4,AETNA,AETNA COMMERCIAL,660.03,98,,,OTHER,505.13,660.03,PERCENT OF TOTAL BILLED CHARGES
HIV-1,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HIV ANTIBODY TYPE 2 SCREEN,86702,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE HEALTH HIV (SOURCE),86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1/2 CONFIRMATORY EVAL,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,AETNA,AETNA COMMERCIAL,181.545,98,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE SGPT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1 CONFIRMATION BY IFA,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,AETNA,AETNA COMMERCIAL,181.545,98,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
CULTURE STOOL,87045,CPT,306,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
HIV RNA QUANT BY PCR,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,AETNA,AETNA COMMERCIAL,439.285,98,,,OTHER,336.19,439.29,PERCENT OF TOTAL BILLED CHARGES
MOLECU DIAG ISOLATION/EXTRACTI,83890,CPT,301,RC,,OUTPATIENT,,,1153,461.2,AETNA,AETNA COMMERCIAL,1129.94,98,,,OTHER,864.75,1129.94,PERCENT OF TOTAL BILLED CHARGES
HIV ULTRA SENSITIVE RNA QNT,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,AETNA,AETNA COMMERCIAL,439.285,98,,,OTHER,336.19,439.29,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID BACTERIA,87077,CPT,306,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
HLA-A&B PHENOTYPE,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,AETNA,AETNA COMMERCIAL,632.835,98,,,OTHER,484.31,632.84,PERCENT OF TOTAL BILLED CHARGES
CULTURE URINE,87088,CPT,306,RC,,OUTPATIENT,,,130.5,52.2,AETNA,AETNA COMMERCIAL,127.89,98,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
HLA B 5701,81381,CPT,300,RC,,OUTPATIENT,,,755.25,302.1,AETNA,AETNA COMMERCIAL,740.145,98,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
CULTURE VIRUS NON RESPIRATORY,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,AETNA,AETNA COMMERCIAL,226.135,98,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
HLA TYPING  DR/DQ,86817,CPT,300,RC,,OUTPATIENT,,,485.25,194.1,AETNA,AETNA COMMERCIAL,475.545,98,,,OTHER,363.94,475.55,PERCENT OF TOTAL BILLED CHARGES
HOMOCYSTINE TOTAL,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,AETNA,AETNA COMMERCIAL,183.75,98,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
HOMOVANILLIC ACID URINE,83150,CPT,300,RC,,OUTPATIENT,,,167.25,66.9,AETNA,AETNA COMMERCIAL,163.905,98,,,OTHER,125.44,163.91,PERCENT OF TOTAL BILLED CHARGES
BENZENE BLOOD,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
HYPOGLYCEMIC AGENT SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PM SCL ANTIBODY ID,86331,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
CYCLOSPORINE ASSAY,80158,CPT,300,RC,,OUTPATIENT,,,330,132,AETNA,AETNA COMMERCIAL,323.4,98,,,OTHER,247.5,323.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNOELECTRO-SERUM (IFE),86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,AETNA,AETNA COMMERCIAL,213.15,98,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
INHIBIN A TUMOR MARKER,86336,CPT,300,RC,,OUTPATIENT,,,117,46.8,AETNA,AETNA COMMERCIAL,114.66,98,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,AETNA,AETNA COMMERCIAL,213.15,98,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION CRYOGLOBULIN,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,AETNA,AETNA COMMERCIAL,213.15,98,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
IGA,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DHEA-S,82627,CPT,301,RC,,OUTPATIENT,,,216.5,86.6,AETNA,AETNA COMMERCIAL,212.17,98,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
IGD,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DHEA,82626,CPT,300,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
DESIPRAMINE (NORPRAMINE),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM,80177,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
ANCA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
MUMPS VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,AETNA,AETNA COMMERCIAL,226.135,98,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM (VALIUM),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IGG,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,AETNA,AETNA COMMERCIAL,54.635,98,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,AETNA,AETNA COMMERCIAL,54.635,98,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
DIGITOXIN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
IGM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
ALPRAZOLAM (XANAX),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IBUPROFEN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
LORAZAPAM SERUM,80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
DULOXETINE (CYMBALTA),G0480,HCPCS,300,RC,,BOTH,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGA),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGG),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGM),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN,80162,CPT,301,RC,,OUTPATIENT,,,150.75,60.3,AETNA,AETNA COMMERCIAL,147.735,98,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
Z ANTITHROMBIN III ACTIVITY,85300,CPT,300,RC,,OUTPATIENT,,,88.75,35.5,AETNA,AETNA COMMERCIAL,86.975,98,,,OTHER,66.56,86.98,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,159.75,63.9,AETNA,AETNA COMMERCIAL,156.555,98,,,OTHER,119.81,156.56,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S ANTIGEN  FREE,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,AETNA,AETNA COMMERCIAL,231.035,98,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
Z D DIMER,85379,CPT,300,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
Z PLASMINOGEN ACTIVITY,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
Z PT (PROTIME),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
Z DRVVT MIX,85613,CPT,305,RC,,OUTPATIENT,,,70.75,28.3,AETNA,AETNA COMMERCIAL,69.335,98,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
Z THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,AETNA,AETNA COMMERCIAL,109.025,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
Z APTT,85730,CPT,300,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,8390391,CPT,300,RC,91,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,8391291,CPT,300,RC,91,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
HAEMOPHILUS INFLUENZA B IGG,86684,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,AETNA,AETNA COMMERCIAL,107.065,98,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A&B VIRUS ANTIBODIES,86710,CPT,302,RC,,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
NORPACE (DISOPRYAMIDE),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
QUANTITATION THERAPEUTIC DRUG,80299,CPT,300,RC,,OUTPATIENT,,,382.25,152.9,AETNA,AETNA COMMERCIAL,374.605,98,,,OTHER,286.69,374.61,PERCENT OF TOTAL BILLED CHARGES
INSULIN GROWTH BINDING,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INSULIN GROWTH FACTOR I,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,AETNA,AETNA COMMERCIAL,192.57,98,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
DOXEPINE SERUM,80166,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,AETNA,AETNA COMMERCIAL,212.17,98,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN  TOTAL,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
INSULIN  FREE,83527,CPT,301,RC,,OUTPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
CALCIUM IONIZED,82330,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ISLET CELL ANITBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
DNASE-B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
Z DNASE B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,39.5,15.8,AETNA,AETNA COMMERCIAL,38.71,98,,,OTHER,29.63,38.71,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIP/OTC GASTRIC,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIP/OTC PLASMA,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
L/S FETAL LUNG,83661,CPT,301,RC,,OUTPATIENT,,,101,40.4,AETNA,AETNA COMMERCIAL,98.98,98,,,OTHER,75.75,98.98,PERCENT OF TOTAL BILLED CHARGES
DRUG MISC MED TOX LABORATORIES,99999,CPT,300,RC,,OUTPATIENT,,,286,114.4,AETNA,AETNA COMMERCIAL,280.28,98,,,OTHER,214.5,280.28,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREEN URINE (MEDTOX),3003900,CDM,,,,INPATIENT,,,42,16.8,AETNA,AETNA COMMERCIAL,41.16,98,,,OTHER,31.5,41.16,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIPTION/OTC URIN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREENING ETOH,80320,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREENING BARBITURATES,80345,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
DRAWING FEE-SPEC KIT,36415,CPT,300,RC,,OUTPATIENT,,,50.75,20.3,AETNA,AETNA COMMERCIAL,49.735,98,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B DNA QUALITATIVE,87516,CPT,306,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
LDH TOTAL DIRECT,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
EOSINOPHIL COUNT,85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,AETNA,AETNA COMMERCIAL,135.24,98,,,OTHER,103.5,135.24,PERCENT OF TOTAL BILLED CHARGES
EOSINOPHILS URINE,87205,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN ELECTROPHORESIS,83700,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,AETNA,AETNA COMMERCIAL,359.17,98,,,OTHER,274.88,359.17,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN WITH LDL HDL PART,83704,CPT,301,RC,,OUTPATIENT,,,212.75,85.1,AETNA,AETNA COMMERCIAL,208.495,98,,,OTHER,159.56,208.5,PERCENT OF TOTAL BILLED CHARGES
LOW DENSITY LIPOPROTEIN,83721,CPT,301,RC,,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
LH LUTEINIZING HORMONE,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,AETNA,AETNA COMMERCIAL,171.99,98,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
LUTEINIZING HORMONE BY ICMA,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,AETNA,AETNA COMMERCIAL,171.99,98,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
"HLA CLASS II TYPING, LOW RESOL",81376,CPT,300,RC,,OUTPATIENT,,,244.44,97.776,AETNA,AETNA COMMERCIAL,239.5512,98,,,OTHER,155.63,203.35,PERCENT OF TOTAL BILLED CHARGES
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,OUTPATIENT,,,521.25,208.5,AETNA,AETNA COMMERCIAL,510.825,98,,,OTHER,390.94,510.83,PERCENT OF TOTAL BILLED CHARGES
ASCORBIC ACID BLOOD,82180,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,AETNA,AETNA COMMERCIAL,137.445,98,,,OTHER,105.19,137.45,PERCENT OF TOTAL BILLED CHARGES
METHYLENETETRAHYDROFOLATE REDC,81291,CPT,300,RC,,OUTPATIENT,,,571,228.4,AETNA,AETNA COMMERCIAL,559.58,98,,,OTHER,428.25,559.58,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCREEN,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
METHYLMALONIC ACID URINE,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,AETNA,AETNA COMMERCIAL,181.79,98,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
EBNA,86664,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
METHYLMALONIC ACID  SERUM,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,AETNA,AETNA COMMERCIAL,181.79,98,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
Z SIGNAL AMPLIFICATION,83908,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
Z SIGNAL AMPLIFICATION,8390891,CPT,300,RC,91,OUTPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
EBV IGG,86665,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,AETNA,AETNA COMMERCIAL,43.365,98,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
EBV IGM,8666591,CPT,300,RC,91,OUTPATIENT,,,44.25,17.7,AETNA,AETNA COMMERCIAL,43.365,98,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
EBV DNA DETECTION BY PCR,87799,CPT,300,RC,,OUTPATIENT,,,270.25,108.1,AETNA,AETNA COMMERCIAL,264.845,98,,,OTHER,202.69,264.85,PERCENT OF TOTAL BILLED CHARGES
EBV BY PCR QUALITATIVE,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
ERYTHROPOIETIN,82668,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
ESTRADIOL,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,AETNA,AETNA COMMERCIAL,202.37,98,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
HER-2/NEU QUANTITATIVE,83950,CPT,300,RC,,OUTPATIENT,,,482.75,193.1,AETNA,AETNA COMMERCIAL,473.095,98,,,OTHER,362.06,473.1,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEN ASSOC PHOSPLIPSE A2,83698,CPT,300,RC,,OUTPATIENT,,,280.5,112.2,AETNA,AETNA COMMERCIAL,274.89,98,,,OTHER,210.38,274.89,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL ETHANOL,80307,CPT,301,RC,,OUTPATIENT,,,182.75,73.1,AETNA,AETNA COMMERCIAL,179.095,98,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
SEDATIVE HYPNOTIC PANEL URINE,80301,CPT,301,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
MERCURY QUANTITATIVE BLOOD,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,AETNA,AETNA COMMERCIAL,109.27,98,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC ELASTASE,82656,CPT,300,RC,,OUTPATIENT,,,342.75,137.1,AETNA,AETNA COMMERCIAL,335.895,98,,,OTHER,257.06,335.9,PERCENT OF TOTAL BILLED CHARGES
FECAL FATS QUAL,82705,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB SCREEN CONFIRM,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,AETNA,AETNA COMMERCIAL,71.785,98,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,AETNA,AETNA COMMERCIAL,71.785,98,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB,86622,CPT,300,RC,,OUTPATIENT,,,73.25,29.3,AETNA,AETNA COMMERCIAL,71.785,98,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
FERN TEST,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,AETNA,AETNA COMMERCIAL,84.28,98,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
METHADONE ASSAY,80358,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
HEAVY METAL-QUANTITATIVE,83018,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
NICKEL SERUM,83885,CPT,300,RC,,OUTPATIENT,,,221.5,88.6,AETNA,AETNA COMMERCIAL,217.07,98,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
TITANIUM SERUM,83018,CPT,300,RC,,OUTPATIENT,,,258.75,103.5,AETNA,AETNA COMMERCIAL,253.575,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
CHROMIUM SERUM,82495,CPT,300,RC,,OUTPATIENT,,,181.25,72.5,AETNA,AETNA COMMERCIAL,177.625,98,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
METHANOL LEVEL,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
METHEMAGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CYTOCHROME P450 2D6,81226,CPT,300,RC,,OUTPATIENT,,,942.25,376.9,AETNA,AETNA COMMERCIAL,923.405,98,,,OTHER,706.69,923.41,PERCENT OF TOTAL BILLED CHARGES
CTTICGRINE P450 3A4V GENOTYPE,81230,CPT,300,RC,,OUTPATIENT,,,787.5,315,AETNA,AETNA COMMERCIAL,771.75,98,,,OTHER,590.63,771.75,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
R FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
FETAL FIBRONECTIN,82731,CPT,300,RC,,OUTPATIENT,,,427.5,171,AETNA,AETNA COMMERCIAL,418.95,98,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
FETOMATERNAL BLEED FLOW CYTO,88184,CPT,300,RC,,OUTPATIENT,,,851.25,340.5,AETNA,AETNA COMMERCIAL,834.225,98,,,OTHER,638.44,834.23,PERCENT OF TOTAL BILLED CHARGES
METHYLPHENIDATE (RITALIN),82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FETAL HEMOGLOBIN APT,83033,CPT,300,RC,,OUTPATIENT,,,23.25,9.3,AETNA,AETNA COMMERCIAL,22.785,98,,,OTHER,17.44,22.79,PERCENT OF TOTAL BILLED CHARGES
FLECAINIDE (TAMBOCOR),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FLUOXETINE (PROZAC),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FLUNITRAZEPAM (ROHYPNOL),82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
SERTRALINE ZOLOFT,82542,CPT,301,RC,,OUTPATIENT,,,181.75,72.7,AETNA,AETNA COMMERCIAL,178.115,98,,,OTHER,136.31,178.12,PERCENT OF TOTAL BILLED CHARGES
ASYMMETRIC DIMETHYL ARGININE,82542,CPT,301,RC,,OUTPATIENT,,,230.5,92.2,AETNA,AETNA COMMERCIAL,225.89,98,,,OTHER,172.88,225.89,PERCENT OF TOTAL BILLED CHARGES
FLUPHENAZINE,84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,AETNA,AETNA COMMERCIAL,67.375,98,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
FOLATE,82746,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
FOLATE RBC,82747,CPT,301,RC,,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
METHYLENE BLUE,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
FREE T3,84481,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
T3 REVERSE,84482,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CARNITINE FREE  TOTAL QUANT,82379,CPT,301,RC,,OUTPATIENT,,,382,152.8,AETNA,AETNA COMMERCIAL,374.36,98,,,OTHER,286.5,374.36,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN-URINE-QUANT,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,AETNA,AETNA COMMERCIAL,88.935,98,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
MICROSCOPIC EXAM URINE,81015,CPT,307,RC,,OUTPATIENT,,,38.5,15.4,AETNA,AETNA COMMERCIAL,37.73,98,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
MICROALBUMINURIA 24HR,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,AETNA,AETNA COMMERCIAL,88.935,98,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
COXSACKIE B VIRUS ANTIBODIES,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,AETNA,AETNA COMMERCIAL,67.865,98,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
Z Q FEVER AB IGG,86638,CPT,300,RC,,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
Z Q FEVER AB IGM,8663891,CPT,300,RC,91,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
Q FEVER PCR,87798,CPT,306,RC,,OUTPATIENT,,,603.75,241.5,AETNA,AETNA COMMERCIAL,591.675,98,,,OTHER,452.81,591.68,PERCENT OF TOTAL BILLED CHARGES
FSH FOLLICLE STIMULATING HARMO,83001,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CARBAPENEMASE TEST,87185,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,AETNA,AETNA COMMERCIAL,263.375,98,,,OTHER,201.56,263.38,PERCENT OF TOTAL BILLED CHARGES
GGT GLUTAMYLTRANSFERASE ASSAY,82977,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
GASTRIN,82941,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
GASTROCULT,82271,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
GASTROINTESTINAL PATHOGENS,87507,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,AETNA,AETNA COMMERCIAL,816.8888,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST (GTT) 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,AETNA,AETNA COMMERCIAL,133.77,98,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
MRSA NASAL SURVEILLANCE CULT,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
GENTAMYCIN PEAK,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN TROUGH,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE SCREENING 1 HOUR,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TOLERANCE 2 HOUR,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,AETNA,AETNA COMMERCIAL,133.77,98,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADD BEYOND 3 SPECIMEN,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON,82943,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,AETNA,AETNA COMMERCIAL,177.625,98,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE 2HR POST/GLUCOSE,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (2),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (3),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (4),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
BFL AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
BFL GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
BFL LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BFL TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CSF LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (5),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TEST ADD SAMPLE,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,AETNA,AETNA COMMERCIAL,133.77,98,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST EA ADD'L SPEC,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
CSF GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE RANDOM,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE FASTING,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE - INSULIN RATIO,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
MUCOPOLYSACCHARIDES  QUAL,83866,CPT,301,RC,,OUTPATIENT,,,236,94.4,AETNA,AETNA COMMERCIAL,231.28,98,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE 2HR POST/MEAL,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
NEUROMYELITIS OPTICA EVAL,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
NEURONAL CELL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
NEURON SPECIFIC ENOLASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
TUMOR NECROSIS FACTOR - ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
PLASMINOGEN ACTIVATOR INH ANTI,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
VASCULAR ENDOTHELIAL GROWTH,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
TRYPTASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE,80299,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z SULFATIDE AUTOANTIBODY,83520,CPT,300,RC,,OUTPATIENT,,,443,177.2,AETNA,AETNA COMMERCIAL,434.14,98,,,OTHER,332.25,434.14,PERCENT OF TOTAL BILLED CHARGES
Z SULFATIDE AUTOANTIBODY,8352091,CPT,300,RC,91,OUTPATIENT,,,443,177.2,AETNA,AETNA COMMERCIAL,434.14,98,,,OTHER,332.25,434.14,PERCENT OF TOTAL BILLED CHARGES
NEUTROPHIL CYTOLOGY ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGA,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,AETNA,AETNA COMMERCIAL,153.125,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
NORTRIPTYLINE LEVEL,G0480,HCPCS,300,RC,,BOTH,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE (ZYPREXA),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
ORGANIC ACIDS  PLASMA,83918,CPT,301,RC,,OUTPATIENT,,,527.75,211.1,AETNA,AETNA COMMERCIAL,517.195,98,,,OTHER,395.81,517.2,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC POLYPEPTIDE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
SECRETIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE METABOLIC PANEL,80053,CPT,301,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE ANTIBODY ASSMNT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE DIGESTIVE STOOL,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,AETNA,AETNA COMMERCIAL,180.81,98,,,OTHER,138.38,180.81,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
PRENATAL PANEL,80055,CPT,300,RC,,OUTPATIENT,,,484.25,193.7,AETNA,AETNA COMMERCIAL,474.565,98,,,OTHER,363.19,474.57,PERCENT OF TOTAL BILLED CHARGES
Z HGB UNSTABLE SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,25.75,10.3,AETNA,AETNA COMMERCIAL,25.235,98,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
HCG URINE QUALATATIVE,81025,CPT,300,RC,,OUTPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,96.25,38.5,AETNA,AETNA COMMERCIAL,94.325,98,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
FRANCISELLA TULARENSIS DFA,87299,CPT,306,RC,,OUTPATIENT,,,273.75,109.5,AETNA,AETNA COMMERCIAL,268.275,98,,,OTHER,205.31,268.28,PERCENT OF TOTAL BILLED CHARGES
GRAM STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
HALDOL (HALOPERIDOL),80173,CPT,300,RC,,OUTPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCAL AG,87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR X,85260,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
COAG FACTOR X1 ACTIVITY,85270,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,AETNA,AETNA COMMERCIAL,167.09,98,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE DEAMINASE FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE DEAMINASE BLOOD,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,AETNA,AETNA COMMERCIAL,125.195,98,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
CHYMOTRYSIN FECAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
CHOLESTEROL BODY FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
HAPTOGLOBIN,83010,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
ELECTROLYTE PANEL,80051,CPT,301,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B19 AG IGG,8674791,CPT,300,RC,91,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B19 AB IGM,86747,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B-19 PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN LATEX,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
LATEX TYPING FOR SALMONELLA,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PECAN-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DOG DANDER IGG,86001,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN COCONUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FOOD & GRAIN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HCG SERUM-QUAL,84703,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PERITONEAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ALPHA GALACTOSIDASE,82657,CPT,300,RC,,OUTPATIENT,,,255.75,102.3,AETNA,AETNA COMMERCIAL,250.635,98,,,OTHER,191.81,250.64,PERCENT OF TOTAL BILLED CHARGES
PERITONEAL FLUID  LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
ALPHA-GLOBIN GENE ANALYSIS,81269,CPT,300,RC,,OUTPATIENT,,,502,200.8,AETNA,AETNA COMMERCIAL,491.96,98,,,OTHER,376.5,491.96,PERCENT OF TOTAL BILLED CHARGES
PERITONEAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PANCREATIC,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN WALNUT-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC X20,8600391,CPT,300,RC,91,OUTPATIENT,,,710,284,AETNA,AETNA COMMERCIAL,695.8,98,,,OTHER,532.5,695.8,PERCENT OF TOTAL BILLED CHARGES
HDL CHOLESTEROL,83718,CPT,301,RC,,OUTPATIENT,,,130.5,52.2,AETNA,AETNA COMMERCIAL,127.89,98,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
NASAL EOSINOPHIL SMEAR,89190,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DAIRY & GRAIN PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DAIRY & GRAIN,8600391,CPT,300,RC,91,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
R LEUKEMIA IMMUNOTYPING,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE HISTAMINE RELEASE,86343,CPT,300,RC,,OUTPATIENT,,,240,96,AETNA,AETNA COMMERCIAL,235.2,98,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO CELL SURF 1ST MRK,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO EA ADD'L MARKER,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,563.75,225.5,AETNA,AETNA COMMERCIAL,552.475,98,,,OTHER,422.81,552.48,PERCENT OF TOTAL BILLED CHARGES
FIBRIN SPLIT PRODUCTS,85362,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,AETNA,AETNA COMMERCIAL,52.185,98,,,OTHER,39.94,52.19,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,AETNA,AETNA COMMERCIAL,52.185,98,,,OTHER,39.94,52.19,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,130.75,52.3,AETNA,AETNA COMMERCIAL,128.135,98,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
FATTY ACID PROFILE ESSENTIAL,82542,CPT,301,RC,,OUTPATIENT,,,233.25,93.3,AETNA,AETNA COMMERCIAL,228.585,98,,,OTHER,174.94,228.59,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FOOD MEAT PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PEANUT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FLAXSEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PISTACHIO,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SESAME SEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SOYBEAN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HEMOSIDERIN,83070,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PHENCYCLIDINE LEVEL,83992,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
PHENYLALANINE,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
HAAB IGM ANTIBODY,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,AETNA,AETNA COMMERCIAL,124.215,98,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
PHLEBOTOMY  THERAPEUTIC,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,AETNA,AETNA COMMERCIAL,260.68,98,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,AETNA,AETNA COMMERCIAL,116.62,98,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,57,22.8,AETNA,AETNA COMMERCIAL,55.86,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
Z PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,14.25,5.7,AETNA,AETNA COMMERCIAL,13.965,98,,,OTHER,10.69,13.97,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB A,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,AETNA,AETNA COMMERCIAL,140.63,98,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB G,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,AETNA,AETNA COMMERCIAL,140.63,98,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
FETAL LUNG MATURITY,83663,CPT,300,RC,,OUTPATIENT,,,293.5,117.4,AETNA,AETNA COMMERCIAL,287.63,98,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
Z PHOSPHATIDYLGLYCEROL,84081,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB M,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,AETNA,AETNA COMMERCIAL,140.63,98,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
HEPITITIS B ANTIGEN CONFIRMATN,87341,CPT,300,RC,,OUTPATIENT,,,102.5,41,AETNA,AETNA COMMERCIAL,100.45,98,,,OTHER,76.88,100.45,PERCENT OF TOTAL BILLED CHARGES
FILARIA IGG 4 ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT METHOD CULT TYPING,87158,CPT,300,RC,,OUTPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS BE ANTIGEN,87350,CPT,306,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
BAND 3 FLUORESCENCE STAIN RBC,88184,CPT,300,RC,,OUTPATIENT,,,837.25,334.9,AETNA,AETNA COMMERCIAL,820.505,98,,,OTHER,627.94,820.51,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B VIRAL DNA  QUANT,87517,CPT,300,RC,,OUTPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS BE ANTIBODY,86707,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B CORE ANTIBODY,86704,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B CORE AB IGM,86705,CPT,300,RC,,OUTPATIENT,,,180.5,72.2,AETNA,AETNA COMMERCIAL,176.89,98,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS AB,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS RNA QUANT,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,AETNA,AETNA COMMERCIAL,454.72,98,,,OTHER,348,454.72,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS RNA QUAL PCR,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,AETNA,AETNA COMMERCIAL,319.725,98,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D ANTIGEN,87380,CPT,300,RC,,OUTPATIENT,,,321.75,128.7,AETNA,AETNA COMMERCIAL,315.315,98,,,OTHER,241.31,315.32,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D TOTAL AB,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D VIRUS AB IGM,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS E ANTIBODY IGM,86790,CPT,300,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS E ANTIBODY IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PLEURAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
SYNOVIAL FLUID T.P.,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SYNOVIAL FLUID GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
PORPHOBILINGEN QUANT,84110,CPT,301,RC,,OUTPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C FIBRO,81596,CPT,300,RC,,OUTPATIENT,,,390,156,AETNA,AETNA COMMERCIAL,382.2,98,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
HCV-RIBA SUPP,86804,CPT,300,RC,,OUTPATIENT,,,348.5,139.4,AETNA,AETNA COMMERCIAL,341.53,98,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
HEP C RNA NSC DRUG RESISTANCE,87902,CPT,300,RC,,OUTPATIENT,,,1007.25,402.9,AETNA,AETNA COMMERCIAL,987.105,98,,,OTHER,755.44,987.11,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBLIN ELECTRO(EVALUATION,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,AETNA,AETNA COMMERCIAL,156.065,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
HUNTINGTON DISEASE,81271,CPT,300,RC,,OUTPATIENT,,,592,236.8,AETNA,AETNA COMMERCIAL,580.16,98,,,OTHER,444,580.16,PERCENT OF TOTAL BILLED CHARGES
H PYLORI BREATH TEST,83013,CPT,300,RC,,OUTPATIENT,,,279.75,111.9,AETNA,AETNA COMMERCIAL,274.155,98,,,OTHER,209.81,274.16,PERCENT OF TOTAL BILLED CHARGES
"HB VARIANT BY MASS SPEC, B",83789,CPT,300,RC,,OUTPATIENT,,,261.5,104.6,AETNA,AETNA COMMERCIAL,256.27,98,,,OTHER,196.13,256.27,PERCENT OF TOTAL BILLED CHARGES
HLA-B27,86812,CPT,300,RC,,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
HUMAN GROWTH HORMONE,83003,CPT,301,RC,,OUTPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
SEX HORMONE BINDING GLOBULIN,84270,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
HUMAN PAPILLOMAVIRUS HIGH RISK,87624,CPT,300,RC,,OUTPATIENT,,,256.5,102.6,AETNA,AETNA COMMERCIAL,251.37,98,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
IMIPRAMINE (TROFANIL),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
NEPHELOMETRY EA ANALYTE,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,AETNA,AETNA COMMERCIAL,128.38,98,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
IGE,82785,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ANTI PLATELET DIRECT ASSAY,86023,CPT,300,RC,,OUTPATIENT,,,196,78.4,AETNA,AETNA COMMERCIAL,192.08,98,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,175,70,AETNA,AETNA COMMERCIAL,171.5,98,,,OTHER,131.25,171.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOB LIGHT CHAINS,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,AETNA,AETNA COMMERCIAL,128.38,98,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOB LIGHT CHAINS,8388391,CPT,300,RC,91,OUTPATIENT,,,131,52.4,AETNA,AETNA COMMERCIAL,128.38,98,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
INDIA INK,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
INDIRECT COOMBS,86885,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
INSULIN,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
IRON BINDING CAPACITY  TOTAL,83550,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,AETNA,AETNA COMMERCIAL,57.575,98,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
IRON,83540,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS QUANT 24 HR,84120,CPT,301,RC,,OUTPATIENT,,,188,75.2,AETNA,AETNA COMMERCIAL,184.24,98,,,OTHER,141,184.24,PERCENT OF TOTAL BILLED CHARGES
BROMIDE  BLOOD,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
KOH PREP,87220,CPT,306,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
HLA CLASS II MOLECULAR TYPING,81375,CPT,300,RC,,OUTPATIENT,,,483,193.2,AETNA,AETNA COMMERCIAL,473.34,98,,,OTHER,362.25,473.34,PERCENT OF TOTAL BILLED CHARGES
HLA CLASS I MOLECULAR TYPING,81372,CPT,300,RC,,OUTPATIENT,,,807.18,322.872,AETNA,AETNA COMMERCIAL,791.0364,98,,,OTHER,386.44,504.95,PERCENT OF TOTAL BILLED CHARGES
PROINSULIN ASSAY,84206,CPT,301,RC,,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PROPAFENONE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
THC CONFIRMATION URINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
PSA-FREE   DIAGNOSTIC,84154,CPT,301,RC,,OUTPATIENT,,,158.25,63.3,AETNA,AETNA COMMERCIAL,155.085,98,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
PSA SCREENING,G0103,HCPCS,301,RC,,INPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PSA COMPLEXED (DIRECT METHOD),84152,CPT,301,RC,,OUTPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
PSEUDOCHOLINESTERASE TOTAL,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
PSEUDOCHOLINESTERASE  DIB INH,82638,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
LACTIC ACID,83605,CPT,301,RC,,OUTPATIENT,,,130,52,AETNA,AETNA COMMERCIAL,127.4,98,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
LACTIC ACID CSF,83605,CPT,301,RC,,OUTPATIENT,,,130,52,AETNA,AETNA COMMERCIAL,127.4,98,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
THC SCREEN AND CONFIRMATION,80349,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,AETNA,AETNA COMMERCIAL,263.375,98,,,OTHER,201.56,263.38,PERCENT OF TOTAL BILLED CHARGES
Z TOTAL PSA,84153,CPT,301,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
LAMOTRIGINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
LAMELLAR BODY COUNT,83664,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,AETNA,AETNA COMMERCIAL,104.37,98,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
LDH ISOENZYMES,83625,CPT,301,RC,,OUTPATIENT,,,100.75,40.3,AETNA,AETNA COMMERCIAL,98.735,98,,,OTHER,75.56,98.74,PERCENT OF TOTAL BILLED CHARGES
LACTATE ENZYME LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PURKINJE CELL ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PYRIDINIUM CROSSLINKS-TOTAL,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
PYRIDINIUM CROSSLINKS-T&DEOXY,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN  URINE QUANIT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,AETNA,AETNA COMMERCIAL,455.7,98,,,OTHER,348.75,455.7,PERCENT OF TOTAL BILLED CHARGES
SERUM CTX,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
R.P.R.,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,AETNA,AETNA COMMERCIAL,65.66,98,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
CHORIONIC GONAD BETA SUBUNIT,84704,CPT,300,RC,,OUTPATIENT,,,70.75,28.3,AETNA,AETNA COMMERCIAL,69.335,98,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
NICOTINE METABOLITES SERUM,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,AETNA,AETNA COMMERCIAL,181.79,98,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
HLA-B TYPING LOW RESOLUTION,81373,CPT,300,RC,,OUTPATIENT,,,254.86,101.944,AETNA,AETNA COMMERCIAL,249.7628,98,,,OTHER,159.19,208.01,PERCENT OF TOTAL BILLED CHARGES
HLA TYPING A B C,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,AETNA,AETNA COMMERCIAL,632.835,98,,,OTHER,484.31,632.84,PERCENT OF TOTAL BILLED CHARGES
ISOLATION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
PCR PRODUCTS # FOR DETECTION,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
PROBES (96),83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION (2),83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,3105.75,1242.3,AETNA,AETNA COMMERCIAL,3043.635,98,,,OTHER,2329.31,3043.64,PERCENT OF TOTAL BILLED CHARGES
ROTAVIRUS,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,AETNA,AETNA COMMERCIAL,147.49,98,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
ROTAVIRUS AG  EIA,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,AETNA,AETNA COMMERCIAL,147.49,98,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
ADENOVIRUS AG EIA,87301,CPT,302,RC,,OUTPATIENT,,,130.5,52.2,AETNA,AETNA COMMERCIAL,127.89,98,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
ADENOVIRUS AB BY CF,86603,CPT,300,RC,,OUTPATIENT,,,496.25,198.5,AETNA,AETNA COMMERCIAL,486.325,98,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
FUNGAL SENSITIVITY (MAYO),87186,CPT,306,RC,,OUTPATIENT,,,172,68.8,AETNA,AETNA COMMERCIAL,168.56,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
LEAD LEVEL BLOOD,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,AETNA,AETNA COMMERCIAL,90.16,98,,,OTHER,69,90.16,PERCENT OF TOTAL BILLED CHARGES
HF LEAD WITH DEMOGRAPHICS,83655,CPT,301,RC,,OUTPATIENT,,,38.75,15.5,AETNA,AETNA COMMERCIAL,37.975,98,,,OTHER,29.06,37.98,PERCENT OF TOTAL BILLED CHARGES
LEAD URINE,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,AETNA,AETNA COMMERCIAL,90.16,98,,,OTHER,69,90.16,PERCENT OF TOTAL BILLED CHARGES
LEFLUNOMIDE METABOLITE S,80299,CPT,300,RC,,OUTPATIENT,,,318.75,127.5,AETNA,AETNA COMMERCIAL,312.375,98,,,OTHER,239.06,312.38,PERCENT OF TOTAL BILLED CHARGES
NORWALK LIKE VIRUS (NOROVIRUS),87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,AETNA,AETNA COMMERCIAL,135.975,98,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA CULTURE,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA PNEUMOPHILA,86713,CPT,302,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA SPECIES BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA PNEUMO AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,AETNA,AETNA COMMERCIAL,129.36,98,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,OUTPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
EHRLICHIA CHAFFEENSIS AB,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
ANAPLASMA PHAGOCYTOPHILIUM IGG,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,AETNA,AETNA COMMERCIAL,159.495,98,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,AETNA,AETNA COMMERCIAL,159.495,98,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,AETNA,AETNA COMMERCIAL,159.495,98,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
ANTIBIOTIC SENSITIVITY  MIC,87186XU,CPT,306,RC,XU,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
CHROME ANALY CLT PROC FEE (AF),88235,CPT,311,RC,,OUTPATIENT,,,569.75,227.9,AETNA,AETNA COMMERCIAL,558.355,98,,,OTHER,427.31,558.36,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE ALK PHOS,85540,CPT,305,RC,,OUTPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
MYOGLOBIN SERUM,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE,80176,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,AETNA,AETNA COMMERCIAL,104.37,98,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
LIPASE,83690,CPT,300,RC,,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
LITHIUM,80178,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,AETNA,AETNA COMMERCIAL,99.715,98,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
LISTERIA AB,86609,CPT,300,RC,,OUTPATIENT,,,63.75,25.5,AETNA,AETNA COMMERCIAL,62.475,98,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
HEPATIC FUNCTION PANEL (LIVER),80076,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE SEROLOGY SERUM,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE ANTIBODY  CSF,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CERERISIAL PANEL,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,AETNA,AETNA COMMERCIAL,108.78,98,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
PIGEON BREEDERS DISEASE,86671,CPT,300,RC,,OUTPATIENT,,,60,24,AETNA,AETNA COMMERCIAL,58.8,98,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,AETNA,AETNA COMMERCIAL,87.465,98,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM URINE,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,AETNA,AETNA COMMERCIAL,87.465,98,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
Z URINE MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM RBC'S,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,AETNA,AETNA COMMERCIAL,87.465,98,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
MALARIAL THICK/THIN SMEAR,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,AETNA,AETNA COMMERCIAL,105.35,98,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
MAPROTILINE (LUDIOMIL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
HEXAGONAL PHASE CONFIRM,85597,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
DRVVT CONFIRM,8559759,CPT,300,RC,59,OUTPATIENT,,,206.75,82.7,AETNA,AETNA COMMERCIAL,202.615,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
DRVVT 1:1 MIX,8561359,CPT,300,RC,59,OUTPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
SINEMET,82491,CPT,300,RC,,OUTPATIENT,,,402.5,161,AETNA,AETNA COMMERCIAL,394.45,98,,,OTHER,301.88,394.45,PERCENT OF TOTAL BILLED CHARGES
B-D GLUCAN,87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,AETNA,AETNA COMMERCIAL,135.975,98,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES (TOTAL),83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,AETNA,AETNA COMMERCIAL,205.31,98,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES PLASMA,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,AETNA,AETNA COMMERCIAL,205.31,98,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES FRACT URINE RNDM,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,AETNA,AETNA COMMERCIAL,205.31,98,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
SMOOTH MUSCLE ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CELONTIN (METHSUXIMIDE),83858,CPT,301,RC,,OUTPATIENT,,,175.75,70.3,AETNA,AETNA COMMERCIAL,172.235,98,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
ARRAY COMP GENOMIC HYBRID,81228,CPT,300,RC,,OUTPATIENT,,,1800,720,AETNA,AETNA COMMERCIAL,1764,98,,,OTHER,884.06,1155.18,PERCENT OF TOTAL BILLED CHARGES
MEXILETINE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z SYPHILIS AB IGG,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,AETNA,AETNA COMMERCIAL,65.66,98,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
Z SYPHILIS AB IGM,8659259,CPT,300,RC,59,OUTPATIENT,,,67,26.8,AETNA,AETNA COMMERCIAL,65.66,98,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS ANTIBODY IGG,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,AETNA,AETNA COMMERCIAL,104.37,98,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS AB TP-PA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,AETNA,AETNA COMMERCIAL,104.37,98,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
AFB (TUBERCLE BAC) EA DRUG,87190,CPT,306,RC,,OUTPATIENT,,,264.75,105.9,AETNA,AETNA COMMERCIAL,259.455,98,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
SOTALOL,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,AETNA,AETNA COMMERCIAL,172.48,98,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
FECES PORPHYRINS ASSAY,84126,CPT,301,RC,,OUTPATIENT,,,333,133.2,AETNA,AETNA COMMERCIAL,326.34,98,,,OTHER,249.75,326.34,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE TRANSFERRIN RECEPTOR,84238,CPT,300,RC,,OUTPATIENT,,,200.25,80.1,AETNA,AETNA COMMERCIAL,196.245,98,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE LIVER ANTIGEN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
RPR TITER S,86593,CPT,300,RC,,OUTPATIENT,,,32,12.8,AETNA,AETNA COMMERCIAL,31.36,98,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
BARR BODIES (SEX CHROMATIN ID),88130,CPT,311,RC,,OUTPATIENT,,,155.75,62.3,AETNA,AETNA COMMERCIAL,152.635,98,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
BLOOD BANK PROC DEVIATION,86079,CPT,302,RC,,OUTPATIENT,,,158.25,63.3,AETNA,AETNA COMMERCIAL,155.085,98,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
ENTAMOEBA HISTOLYTICA,87337,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
STOOL PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
MUMPS IGG  SCREEN,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,AETNA,AETNA COMMERCIAL,119.07,98,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z MUMPS VIRUS AB  IGG,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,AETNA,AETNA COMMERCIAL,119.07,98,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z MUMPS VIRUS AB IGM,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,AETNA,AETNA COMMERCIAL,119.07,98,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
HEP A TOTAL WITH REFLEX,86708,CPT,300,RC,,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PNEUMONIAE AB,86738,CPT,300,RC,,OUTPATIENT,,,98,39.2,AETNA,AETNA COMMERCIAL,96.04,98,,,OTHER,73.5,96.04,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PNEUMONIAE IGM,8673891,CPT,300,RC,91,OUTPATIENT,,,98,39.2,AETNA,AETNA COMMERCIAL,96.04,98,,,OTHER,73.5,96.04,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PHEUMONIAC CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,AETNA,AETNA COMMERCIAL,218.05,98,,,OTHER,166.88,218.05,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA HOMINIS CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,AETNA,AETNA COMMERCIAL,218.05,98,,,OTHER,166.88,218.05,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLIC ACID,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
MYOGLOBIN URINE,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
MYELIN ASSOC GLYCOPROTEIN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MYELIN ASSOC GLYCOPROTEIN,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
"MYELIN ASSOC GLYCOPROTEIN, IGM",84181,CPT,300,RC,,OUTPATIENT,,,255,102,AETNA,AETNA COMMERCIAL,249.9,98,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
N TELOPEPTIDE URINE,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
N TELOPEPTIDE  SERUM,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
NAPA,80192,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME,86063,CPT,302,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME SCREEN,86403,CPT,300,RC,,OUTPATIENT,,,159,63.6,AETNA,AETNA COMMERCIAL,155.82,98,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME TITER,86406,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,AETNA,AETNA COMMERCIAL,121.03,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI CULT SENS,87081,CPT,306,RC,,OUTPATIENT,,,114,45.6,AETNA,AETNA COMMERCIAL,111.72,98,,,OTHER,85.5,111.72,PERCENT OF TOTAL BILLED CHARGES
TETANUS ANTIBODY,86317,CPT,300,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY  SERUM,83930,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY  URINE,83935,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
Z URINE OSMOLALITY,83935,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
PLASMINOGEN,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
FFP THAWING EA UNIT,86927,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
EVEROLIMUS,80169,CPT,300,RC,,OUTPATIENT,,,433.25,173.3,AETNA,AETNA COMMERCIAL,424.585,98,,,OTHER,324.94,424.59,PERCENT OF TOTAL BILLED CHARGES
VORICONAZOLE,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
VORICONAZOLE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,147.5,59,AETNA,AETNA COMMERCIAL,144.55,98,,,OTHER,110.63,144.55,PERCENT OF TOTAL BILLED CHARGES
PT MIX 1:1,85611,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
PTT (PARTIAL THROMBO TIME),85730,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID TRIGLYCERIDE,84478,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,AETNA,AETNA COMMERCIAL,319.725,98,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
Z BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
Z ELECTROPHORETIC TECHNIQUE,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,AETNA,AETNA COMMERCIAL,151.41,98,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z SPECTROPHOTOMETRY ANALYTE,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
Z SPECTROPHOTOMETRY ANALYTE,8431191,CPT,300,RC,91,OUTPATIENT,,,86.25,34.5,AETNA,AETNA COMMERCIAL,84.525,98,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
Z TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
MICROSOMAL ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
THYROID PEROXIDASE ANTIBODY,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
Z ANTITHYROID MICROSOMAL ANTBD,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
LIVER-KIDNEY MICROSOMAL ANTBDS,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,AETNA,AETNA COMMERCIAL,120.295,98,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
Z THYROGLOBULIN AB,86376,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID ALBUMIN,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,AETNA,AETNA COMMERCIAL,66.395,98,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,38.5,15.4,AETNA,AETNA COMMERCIAL,37.73,98,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID BILIRUBIN,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PH  URINE,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITOL,80184,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
NEWBORN SCREENING 1,S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,AETNA,AETNA COMMERCIAL,137.935,98,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
NEWBORN SCREENING 2 (PKU),S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,AETNA,AETNA COMMERCIAL,137.935,98,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
P PHENYLALANINE (PKU),84030,CPT,300,RC,,OUTPATIENT,,,15,6,AETNA,AETNA COMMERCIAL,14.7,98,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
DILUTE RUSSELL VIPER VENOM,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,AETNA,AETNA COMMERCIAL,127.645,98,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
DILANTIN (PHENYTOIN),80185,CPT,301,RC,,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
DILANTIN FREE (PHENYTOIN),80186,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CARBAMAZEPINE (TEGRETOL),80156,CPT,301,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
PIN WORM EXAM,87172,CPT,306,RC,,OUTPATIENT,,,67.25,26.9,AETNA,AETNA COMMERCIAL,65.905,98,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
CBC WITH AUTO DIFF,85025,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,AETNA,AETNA COMMERCIAL,66.885,98,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
AFB SPECIAL STAINS,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
TOPIRIMATE,80201,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,AETNA,AETNA COMMERCIAL,149.205,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM (K) SERUM,84132,CPT,301,RC,,OUTPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM,84999,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,AETNA,AETNA COMMERCIAL,67.375,98,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
Z TOXOPLASMA  IGM,86778,CPT,300,RC,,OUTPATIENT,,,49.5,19.8,AETNA,AETNA COMMERCIAL,48.51,98,,,OTHER,37.13,48.51,PERCENT OF TOTAL BILLED CHARGES
TOXOCARA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
FASCIOLA HEPATICA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
ECHINOCOCCUS GRANULOSUS AB IGG,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGM,86778,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,AETNA,AETNA COMMERCIAL,149.205,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
PREGNENOLONE,84140,CPT,300,RC,,OUTPATIENT,,,264.75,105.9,AETNA,AETNA COMMERCIAL,259.455,98,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
Z PRIMIDONE (MYSOLINE),80188,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
Z PHENOBARB,80184,CPT,300,RC,,OUTPATIENT,,,54.75,21.9,AETNA,AETNA COMMERCIAL,53.655,98,,,OTHER,41.06,53.66,PERCENT OF TOTAL BILLED CHARGES
PROCAINAMIDE ASSAY,80190,CPT,300,RC,,OUTPATIENT,,,130,52,AETNA,AETNA COMMERCIAL,127.4,98,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
PROGESTERONE,84144,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
PROLACTIN,84146,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
TRICHOMONAS,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
PSA  TOTAL DIAGNOSTIC,84153,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PROSTATIC ACID PHOSPHATASE,84066,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,258.25,103.3,AETNA,AETNA COMMERCIAL,253.085,98,,,OTHER,193.69,253.09,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C ANTIGEN,85302,CPT,300,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
PROTEIN S TOTAT  REFLEX,85305,CPT,300,RC,,OUTPATIENT,,,203.5,81.4,AETNA,AETNA COMMERCIAL,199.43,98,,,OTHER,152.63,199.43,PERCENT OF TOTAL BILLED CHARGES
"MACROPROLACTIN, S",84146,CPT,300,RC,,OUTPATIENT,,,133,53.2,AETNA,AETNA COMMERCIAL,130.34,98,,,OTHER,99.75,130.34,PERCENT OF TOTAL BILLED CHARGES
"URINE PROTEIN, TOTAL",84156,CPT,301,RC,,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
URINE ELECTROPHORESIS PROTEIN,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,AETNA,AETNA COMMERCIAL,150.675,98,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
TRICYCLIC ANTIDEPRESSANT,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S TOTAL,85305,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S FREE,85306,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
I-STAT PT (INR),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,AETNA,AETNA COMMERCIAL,46.305,98,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
PROTROMBIN G20210A MUTATION B,81240,CPT,300,RC,,OUTPATIENT,,,246,98.4,AETNA,AETNA COMMERCIAL,241.08,98,,,OTHER,184.5,241.08,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
TROPONIN QUANTATIVE,84484,CPT,301,RC,,OUTPATIENT,,,170.25,68.1,AETNA,AETNA COMMERCIAL,166.845,98,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
HPGDE DNA EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,354,141.6,AETNA,AETNA COMMERCIAL,346.92,98,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR ISOLATION/EXTRACTN,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
PTH INTACT MOLECULE CALCIUM,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,AETNA,AETNA COMMERCIAL,297.92,98,,,OTHER,228,297.92,PERCENT OF TOTAL BILLED CHARGES
Z PARATHORMONE,83970,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,AETNA,AETNA COMMERCIAL,107.065,98,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID HORMONE,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,AETNA,AETNA COMMERCIAL,297.92,98,,,OTHER,228,297.92,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID HORMONE RELATED PE,82397,CPT,301,RC,,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z CREATININE,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
THYROID IMMUNOGLOBULINS TSI,84445,CPT,301,RC,,OUTPATIENT,,,526.25,210.5,AETNA,AETNA COMMERCIAL,515.725,98,,,OTHER,394.69,515.73,PERCENT OF TOTAL BILLED CHARGES
LEISHMANIASIS AB,86717,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,AETNA,AETNA COMMERCIAL,137.445,98,,,OTHER,105.19,137.45,PERCENT OF TOTAL BILLED CHARGES
TULAREMIA ANTIBODY,86000,CPT,302,RC,,OUTPATIENT,,,159,63.6,AETNA,AETNA COMMERCIAL,155.82,98,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
QUINIDINE,80194,CPT,300,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
TYROSINE ASSAY,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,AETNA,AETNA COMMERCIAL,146.755,98,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
SMEAR CYTOPATHOLOGY,88161,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
OSMOTIC FRAGILITY,85555,CPT,305,RC,,OUTPATIENT,,,292,116.8,AETNA,AETNA COMMERCIAL,286.16,98,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
OSMOTIC FRAGILITY RBC,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,AETNA,AETNA COMMERCIAL,180.075,98,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
RENIN ACTIVITY,84244,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
RESP SYNCYTIAL VIRUS ANTIBODY,86756,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
RETICULOCYTE COUNT,85045,CPT,305,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
RSV ANTIGEN,87807,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,AETNA,AETNA COMMERCIAL,196.49,98,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
RETICULIN ANTIBODY  IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
RHEUMATOID FACTOR,86431,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
RABIES ANTIBODY,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA HENSELAE IGG,86611,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA HENSELAE IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA QUINTANA IGG,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA QUINTANA IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,AETNA,AETNA COMMERCIAL,36.995,98,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
E. HISTOLYTICA ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,AETNA,AETNA COMMERCIAL,121.03,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
TRYPANOSOMA CRUZI AB IGG,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,AETNA,AETNA COMMERCIAL,121.03,98,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
RUBELLA IGG ANTIBODY,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,AETNA,AETNA COMMERCIAL,98.49,98,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
RUBEOLA IGG ANTIBODY,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
MEASLES  IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,AETNA,AETNA COMMERCIAL,130.83,98,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
SALICYLATE,80307,CPT,301,RC,,OUTPATIENT,,,290.75,116.3,AETNA,AETNA COMMERCIAL,284.935,98,,,OTHER,218.06,284.94,PERCENT OF TOTAL BILLED CHARGES
CLINICAL CHEMISTRY TEST,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,AETNA,AETNA COMMERCIAL,104.125,98,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
CANCER TYPE INDEX,84999,CPT,301,RC,,OUTPATIENT,,,6049,2419.6,AETNA,AETNA COMMERCIAL,5928.02,98,,,OTHER,4536.75,5928.02,PERCENT OF TOTAL BILLED CHARGES
ESR (AUTO),85652,CPT,305,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
SEMEN ANALYSIS COMPLETE,89320,CPT,309,RC,,OUTPATIENT,,,202.5,81,AETNA,AETNA COMMERCIAL,198.45,98,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
SERUM KILLING LEVEL  PEAK,87197,CPT,300,RC,,OUTPATIENT,,,362,144.8,AETNA,AETNA COMMERCIAL,354.76,98,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SERUM KILLING LEVEL  TROUGH,87197,CPT,300,RC,,OUTPATIENT,,,240.5,96.2,AETNA,AETNA COMMERCIAL,235.69,98,,,OTHER,180.38,235.69,PERCENT OF TOTAL BILLED CHARGES
SEROTONIN,84260,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,AETNA,AETNA COMMERCIAL,139.895,98,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
SELENIUM,84255,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN A,83695,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
SEMEN ANALYSIS  POST VAS,89321,CPT,300,RC,,OUTPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
SGPT EMPLOYEE,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,AETNA,AETNA COMMERCIAL,50.225,98,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
SICKLE CELL,85660,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
SS-A,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
SS-B,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,AETNA,AETNA COMMERCIAL,59.29,98,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
ORGANIC ACID SCREEN URINE,83919,CPT,301,RC,,OUTPATIENT,,,217.25,86.9,AETNA,AETNA COMMERCIAL,212.905,98,,,OTHER,162.94,212.91,PERCENT OF TOTAL BILLED CHARGES
SODIUM (NA) SERUM,84295,CPT,301,RC,,OUTPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
Z SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,AETNA,AETNA COMMERCIAL,71.54,98,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
URINE PHOSPHORUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,114.25,45.7,AETNA,AETNA COMMERCIAL,111.965,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE SODIUM 24 HR,84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,AETNA,AETNA COMMERCIAL,71.54,98,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
Z URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,167.75,67.1,AETNA,AETNA COMMERCIAL,164.395,98,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
Z URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,25.2,10.08,AETNA,AETNA COMMERCIAL,24.696,98,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
URINE TOXIC SCREEN,80306,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY EA DRUG CLASS,8030159,CPT,300,RC,59,OUTPATIENT,,,190.5,76.2,AETNA,AETNA COMMERCIAL,186.69,98,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
SOMATOSTATIN,84307,CPT,301,RC,,OUTPATIENT,,,442.75,177.1,AETNA,AETNA COMMERCIAL,433.895,98,,,OTHER,332.06,433.9,PERCENT OF TOTAL BILLED CHARGES
SOMATOMEDIN-C,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,AETNA,AETNA COMMERCIAL,192.57,98,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
BFL-SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,70.75,28.3,AETNA,AETNA COMMERCIAL,69.335,98,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
URINE CHEM STRIP AUTO,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE NEISSERIA GONORRHEA DNA,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,AETNA,AETNA COMMERCIAL,89.67,98,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
Z URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z URINE PHOSPHOROUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
SPERM ANTIBODY,89325,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,AETNA,AETNA COMMERCIAL,179.095,98,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
URINE VOLUME MEASUREMENT,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
Z URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
AMINOLEVULENIC ACID 24 HR URIN,82135,CPT,301,RC,,OUTPATIENT,,,101.25,40.5,AETNA,AETNA COMMERCIAL,99.225,98,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCREEN  PLASMA QUAL,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN  PLASMA QUANT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,AETNA,AETNA COMMERCIAL,455.7,98,,,OTHER,348.75,455.7,PERCENT OF TOTAL BILLED CHARGES
AMINOLEVULENIC ACID (ALA),82135,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
AMNIODARONE LEVEL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
AMITRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
AMITRIPTYLINE NORTRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,55.25,22.1,AETNA,AETNA COMMERCIAL,54.145,98,,,OTHER,41.44,54.15,PERCENT OF TOTAL BILLED CHARGES
AMPHETAMINE SCREEN SERUM,G0480,HCPCS,300,RC,,BOTH,,,298.25,119.3,AETNA,AETNA COMMERCIAL,292.285,98,,,OTHER,223.69,292.29,PERCENT OF TOTAL BILLED CHARGES
ARSENIC LEVEL,82175,CPT,301,RC,,OUTPATIENT,,,129,51.6,AETNA,AETNA COMMERCIAL,126.42,98,,,OTHER,96.75,126.42,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE ASSAY,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,AETNA,AETNA COMMERCIAL,77.175,98,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE ASSAY,8214559,CPT,300,RC,59,OUTPATIENT,,,56.25,22.5,AETNA,AETNA COMMERCIAL,55.125,98,,,OTHER,42.19,55.13,PERCENT OF TOTAL BILLED CHARGES
AMPHENTAMINES ANALYSIS SERUM,G0480,HCPCS,300,RC,,BOTH,,,177.5,71,AETNA,AETNA COMMERCIAL,173.95,98,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
FECES EXAM (MEAT FIBERS),89160,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
AMNISURE FOR ROM,84112,CPT,300,RC,,OUTPATIENT,,,196.25,78.5,AETNA,AETNA COMMERCIAL,192.325,98,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLOOD SCREENING,82270,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLOOD DIAGNOSTIC,82272,CPT,301,RC,,OUTPATIENT,,,47,18.8,AETNA,AETNA COMMERCIAL,46.06,98,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLD IMM,G0328,HCPCS,300,RC,,BOTH,,,206.25,82.5,AETNA,AETNA COMMERCIAL,202.125,98,,,OTHER,154.69,202.13,PERCENT OF TOTAL BILLED CHARGES
BLOOD VISCOSITY EXAM,85810,CPT,305,RC,,OUTPATIENT,,,170.25,68.1,AETNA,AETNA COMMERCIAL,166.845,98,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
FACTOR XIII QUALITATIVE,85291,CPT,305,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN TEST,85366,CPT,300,RC,,OUTPATIENT,,,165.5,66.2,AETNA,AETNA COMMERCIAL,162.19,98,,,OTHER,124.13,162.19,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PHEUM IGG 7 SER,86317,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PNEUM IGG 23 SER,8631759,CPT,300,RC,59,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
Z STREPTOCOCCUS PHEUM IGG 7SER,8631759,CPT,300,RC,59,OUTPATIENT,,,426.75,170.7,AETNA,AETNA COMMERCIAL,418.215,98,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
STREP PHEUMONIAE AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,AETNA,AETNA COMMERCIAL,129.36,98,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PNEUMO AG CSF,87899,CPT,300,RC,,OUTPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z VITAMIN A,84590,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B1 (THIAMINE),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,AETNA,AETNA COMMERCIAL,167.58,98,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
T3 UPTAKE,84479,CPT,300,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,AETNA,AETNA COMMERCIAL,192.57,98,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,77,30.8,AETNA,AETNA COMMERCIAL,75.46,98,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE BIOAVAILABLE,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,AETNA,AETNA COMMERCIAL,100.5088,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,AETNA,AETNA COMMERCIAL,192.57,98,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,AETNA,AETNA COMMERCIAL,160.475,98,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B6,84207,CPT,301,RC,,OUTPATIENT,,,179.25,71.7,AETNA,AETNA COMMERCIAL,175.665,98,,,OTHER,134.44,175.67,PERCENT OF TOTAL BILLED CHARGES
THEOPHYLLINE,80198,CPT,301,RC,,OUTPATIENT,,,212,84.8,AETNA,AETNA COMMERCIAL,207.76,98,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
THIOCYANATE ASSAY,84430,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,AETNA,AETNA COMMERCIAL,182.77,98,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
THIORIDAZINE (MELLARIL),84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,AETNA,AETNA COMMERCIAL,67.375,98,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
THIOTHIXENE (NAVANE),82491,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,AETNA,AETNA COMMERCIAL,109.025,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN ASSAY (SO),84432,CPT,301,RC,,OUTPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN AB,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,AETNA,AETNA COMMERCIAL,121.52,98,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
Z TYPHUS FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,AETNA,AETNA COMMERCIAL,54.635,98,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z TYPHUS FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,AETNA,AETNA COMMERCIAL,54.635,98,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,83893,CPT,300,RC,,OUTPATIENT,,,29.75,11.9,AETNA,AETNA COMMERCIAL,29.155,98,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,AETNA,AETNA COMMERCIAL,29.155,98,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,AETNA,AETNA COMMERCIAL,29.155,98,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,AETNA,AETNA COMMERCIAL,57.575,98,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
FACTOR VIII COAGULATION,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,AETNA,AETNA COMMERCIAL,271.95,98,,,OTHER,208.13,271.95,PERCENT OF TOTAL BILLED CHARGES
THCY,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,AETNA,AETNA COMMERCIAL,183.75,98,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
ISOLATION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION X2,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
APC,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,AETNA,AETNA COMMERCIAL,196.49,98,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
TSH - THYROID STIMU HORMONE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,83900,CPT,300,RC,,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
P TSH,84443,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
TSH SENSITIVE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,AETNA,AETNA COMMERCIAL,120.54,98,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
FREE T4 THYROXINE,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
P THYROXINE (T4),84437,CPT,300,RC,,OUTPATIENT,,,18.5,7.4,AETNA,AETNA COMMERCIAL,18.13,98,,,OTHER,13.88,18.13,PERCENT OF TOTAL BILLED CHARGES
TOTAL T4,84436,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
T4 FREE BY DIALYSIS,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
THYROXINE BINDING GLOBULIN,84442,CPT,300,RC,,OUTPATIENT,,,169,67.6,AETNA,AETNA COMMERCIAL,165.62,98,,,OTHER,126.75,165.62,PERCENT OF TOTAL BILLED CHARGES
TOBRAMYCIN PEAK,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TOBRAMYCIN TROUGH,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,AETNA,AETNA COMMERCIAL,74.48,98,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TOCAINIDE QUANT SERUM,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,AETNA,AETNA COMMERCIAL,28.42,98,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANITBODY,86235,CPT,300,RC,,OUTPATIENT,,,45.5,18.2,AETNA,AETNA COMMERCIAL,44.59,98,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANITBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,AETNA,AETNA COMMERCIAL,44.59,98,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,AETNA,AETNA COMMERCIAL,44.59,98,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,AETNA,AETNA COMMERCIAL,44.59,98,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,AETNA,AETNA COMMERCIAL,33.8492,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,AETNA,AETNA COMMERCIAL,33.8492,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
TOTAL PROTEIN,84155,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,AETNA,AETNA COMMERCIAL,33.8492,98,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
CSF TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN URINE QUALIT,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
LEUCINE AMINOPEPTIDASE,83670,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,AETNA,AETNA COMMERCIAL,196.49,98,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
Z VITAMIN E,84446,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CORTISON BINDING GLOBULIN,84449,CPT,300,RC,,OUTPATIENT,,,203.75,81.5,AETNA,AETNA COMMERCIAL,199.675,98,,,OTHER,152.81,199.68,PERCENT OF TOTAL BILLED CHARGES
NEPHELOMETRY ASSAY NOT SPEC,83916,CPT,301,RC,,OUTPATIENT,,,131,52.4,AETNA,AETNA COMMERCIAL,128.38,98,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND MULTIMERIC,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,AETNA,AETNA COMMERCIAL,261.905,98,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
RISTOCETIN,85245,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,AETNA,AETNA COMMERCIAL,189.875,98,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR MULTI,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,AETNA,AETNA COMMERCIAL,261.905,98,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR ANTIGEN,85246,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR ACTIVITY,85397,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,AETNA,AETNA COMMERCIAL,312.13,98,,,OTHER,238.88,312.13,PERCENT OF TOTAL BILLED CHARGES
TOTAL PROTEIN URINE TIMED 24HR,84156,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
TRIIODOTHYRONINE T3; (TT-3),84480,CPT,301,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
TRANSFERRIN,84466,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,AETNA,AETNA COMMERCIAL,59.535,98,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
TRAZODONE (DESYREL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
OXYCARBAZAPINE (TRILIPTAL),80183,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,AETNA,AETNA COMMERCIAL,134.505,98,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
COXSACKIE A9 VIRUS ANTIBODY,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,AETNA,AETNA COMMERCIAL,67.865,98,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN URINE,84540,CPT,301,RC,,OUTPATIENT,,,150.5,60.2,AETNA,AETNA COMMERCIAL,147.49,98,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
Z URINE UREA NITROGEN,84540,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,AETNA,AETNA COMMERCIAL,15.827,98,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN CLEARANCE,84545,CPT,300,RC,,OUTPATIENT,,,145,58,AETNA,AETNA COMMERCIAL,142.1,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
URIC ACID,84550,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
APO E GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,313.25,125.3,AETNA,AETNA COMMERCIAL,306.985,98,,,OTHER,234.94,306.99,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN A1,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  PLEURAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  SYNOVIAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  URINE RANDOM,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  URINE TIMED,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,AETNA,AETNA COMMERCIAL,87.955,98,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URINALYSIS/COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,71.25,28.5,AETNA,AETNA COMMERCIAL,69.825,98,,,OTHER,53.44,69.83,PERCENT OF TOTAL BILLED CHARGES
VALPROIC ACID (DEPAKENE),80164,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,AETNA,AETNA COMMERCIAL,68.355,98,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN PEAK/TROUGH,80202,CPT,301,RC,,OUTPATIENT,,,314.75,125.9,AETNA,AETNA COMMERCIAL,308.455,98,,,OTHER,236.06,308.46,PERCENT OF TOTAL BILLED CHARGES
VON WB DZ INTERP,85390,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,AETNA,AETNA COMMERCIAL,296.205,98,,,OTHER,226.69,296.21,PERCENT OF TOTAL BILLED CHARGES
VON WB FACTOR MULT,85247,CPT,300,RC,,OUTPATIENT,,,390,156,AETNA,AETNA COMMERCIAL,382.2,98,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
VANILLYLMANDELIC ACID,84585,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,AETNA,AETNA COMMERCIAL,79.135,98,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER IGG&IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,AETNA,AETNA COMMERCIAL,131.32,98,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS AB IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,AETNA,AETNA COMMERCIAL,131.32,98,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS,87290,CPT,306,RC,,OUTPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER AB-IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,AETNA,AETNA COMMERCIAL,131.32,98,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
LIQUID BASED PREPARATION,88174,CPT,300,RC,,OUTPATIENT,,,240,96,AETNA,AETNA COMMERCIAL,235.2,98,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
Z OVA PARASITES DIRECT SMEARS,87177,CPT,306,RC,,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z SMEAR COMPLEX STAIN,87209,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
MACROSCOPIC ARTHROPOD EXAM,87168,CPT,300,RC,,OUTPATIENT,,,57,22.8,AETNA,AETNA COMMERCIAL,55.86,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
MACROSCOPIC PARASITE EXAM,87169,CPT,300,RC,,OUTPATIENT,,,57,22.8,AETNA,AETNA COMMERCIAL,55.86,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
PARAKEET DROPPINGS BY GEL DIFF,86331,CPT,300,RC,,OUTPATIENT,,,106.25,42.5,AETNA,AETNA COMMERCIAL,104.125,98,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
KRAS GENE 7 MUTATION PANEL TMR,81275,CPT,300,RC,,OUTPATIENT,,,1314.75,525.9,AETNA,AETNA COMMERCIAL,1288.455,98,,,OTHER,986.06,1288.46,PERCENT OF TOTAL BILLED CHARGES
KPC PCR,87150,CPT,300,RC,,OUTPATIENT,,,185.5,74.2,AETNA,AETNA COMMERCIAL,181.79,98,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
VIT D 1  25 DIHDROXY,82652,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
VIT D  HYDROXY,82306,CPT,300,RC,,OUTPATIENT,,,103.25,41.3,AETNA,AETNA COMMERCIAL,101.185,98,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN K1,84597,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,AETNA,AETNA COMMERCIAL,200.655,98,,,OTHER,153.56,200.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B12,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
VIT B2 RIBOFLAVIN,84252,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PERNICIOUS ANEMIA CASCADE,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,AETNA,AETNA COMMERCIAL,140.385,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CLOSTRIDIUM DIFFICLE TOXIN,87324,CPT,306,RC,,OUTPATIENT,,,30.82,12.328,AETNA,AETNA COMMERCIAL,30.2036,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
CRYPTOSPORIDIUM,87328,CPT,306,RC,,OUTPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
GIARDIA,87329,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,AETNA,AETNA COMMERCIAL,43.365,98,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOSPORIDIUM ANTIGEN, FECES",87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
WET PREP,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,AETNA,AETNA COMMERCIAL,70.805,98,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
WBC (WHITE BLOOD COUNT),85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
MANUAL SMEAR EXAM  NO DIFF,85008,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
HEMATOCRIT,85014,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,AETNA,AETNA COMMERCIAL,24.01,98,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
ZINC,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ZINC  URINE,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
D-XYLOSE,84620,CPT,301,RC,,OUTPATIENT,,,184.75,73.9,AETNA,AETNA COMMERCIAL,181.055,98,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
RENAL FUNCTION PANEL,80069,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,AETNA,AETNA COMMERCIAL,182.77,98,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA B,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,AETNA,AETNA COMMERCIAL,50.96,98,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE INFLUENZAE A,3008987,CDM,,,,INPATIENT,,,25.75,10.3,AETNA,AETNA COMMERCIAL,25.235,98,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE INFLUENZAE B,3008988,CDM,,,,INPATIENT,,,25.75,10.3,AETNA,AETNA COMMERCIAL,25.235,98,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
GIEMSA STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA VIRUS ANTIBODY IGG,86710,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA VIRUS ANTIBODY IGM,8671059,CPT,300,RC,59,OUTPATIENT,,,47.75,19.1,AETNA,AETNA COMMERCIAL,46.795,98,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
ANTI-NEURONAL NUCLEAR ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A H1N1 BY PCR,87502,CPT,306,RC,,OUTPATIENT,,,592,236.8,AETNA,AETNA COMMERCIAL,580.16,98,,,OTHER,444,580.16,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A H1N1 BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A H1N1 BY PCR,8779891,CPT,300,RC,91,OUTPATIENT,,,225.75,90.3,AETNA,AETNA COMMERCIAL,221.235,98,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
KIT MUTATION EX 811&17,81272,CPT,300,RC,,OUTPATIENT,,,659.02,263.608,AETNA,AETNA COMMERCIAL,645.8396,98,,,OTHER,494.3,645.8,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATE & ID BY HIGH RESLTN,8390959,CPT,300,RC,59,OUTPATIENT,,,1601.75,640.7,AETNA,AETNA COMMERCIAL,1569.715,98,,,OTHER,1201.31,1569.72,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,AETNA,AETNA COMMERCIAL,26.95,98,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,AETNA,AETNA COMMERCIAL,26.95,98,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,AETNA,AETNA COMMERCIAL,26.95,98,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,83905,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,8390559,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,83906,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,8390659,CPT,300,RC,59,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,83901,CPT,300,RC,,OUTPATIENT,,,78,31.2,AETNA,AETNA COMMERCIAL,76.44,98,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,AETNA,AETNA COMMERCIAL,38.955,98,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
BRCA1 2 GENE ANALYSIS,81162,CPT,300,RC,,OUTPATIENT,,,3017.9,1207.16,AETNA,AETNA COMMERCIAL,2957.542,98,,,OTHER,2263.4,2957.5,PERCENT OF TOTAL BILLED CHARGES
FECAL WBC STAIN,89055,CPT,300,RC,,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,AETNA,AETNA COMMERCIAL,254.555,98,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
NATURAL KILLER CELLS,86357,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,AETNA,AETNA COMMERCIAL,254.555,98,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,AETNA,AETNA COMMERCIAL,254.555,98,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
ABSOLUTE CD4/CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,276.5,110.6,AETNA,AETNA COMMERCIAL,270.97,98,,,OTHER,207.38,270.97,PERCENT OF TOTAL BILLED CHARGES
NATURAL KILLER CYTOTOXICITY,86805,CPT,300,RC,,OUTPATIENT,,,379.02,151.608,AETNA,AETNA COMMERCIAL,371.4396,98,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
HTLV I/II AB S,86790,CPT,300,RC,,OUTPATIENT,,,95.25,38.1,AETNA,AETNA COMMERCIAL,93.345,98,,,OTHER,71.44,93.35,PERCENT OF TOTAL BILLED CHARGES
HTLV I/II AB CONFIRMATION S,86689,CPT,300,RC,,OUTPATIENT,,,494.75,197.9,AETNA,AETNA COMMERCIAL,484.855,98,,,OTHER,371.06,484.86,PERCENT OF TOTAL BILLED CHARGES
URINE TRAMADOL AND METABOLITE,80373,CPT,300,RC,,OUTPATIENT,,,100.6,40.24,AETNA,AETNA COMMERCIAL,98.588,98,,,OTHER,75.45,98.59,PERCENT OF TOTAL BILLED CHARGES
CAROTENE BETA,82380,CPT,301,RC,,OUTPATIENT,,,184.13,73.652,AETNA,AETNA COMMERCIAL,180.4474,98,,,OTHER,138.1,180.45,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS IGG AVIDITY,86644,CPT,302,RC,,OUTPATIENT,,,217.82,87.128,AETNA,AETNA COMMERCIAL,213.4636,98,,,OTHER,163.37,213.46,PERCENT OF TOTAL BILLED CHARGES
NRAS GENE VARIANTS EXON 2&3,81311,CPT,300,RC,,OUTPATIENT,,,622.5,249,AETNA,AETNA COMMERCIAL,610.05,98,,,OTHER,466.88,610.05,PERCENT OF TOTAL BILLED CHARGES
M-PROT ISO MALD TOF CHARGE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,AETNA,AETNA COMMERCIAL,146.02,98,,,OTHER,111.8,146,PERCENT OF TOTAL BILLED CHARGES
ALL BLACK/WHITE PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GREEN PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CARROT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL AVOCADO IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL ONION IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GARLIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL LENTIL IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GREEN STRING BEAN IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CHILI PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL OLIVE FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CURRY IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GINGER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL LETTUCE IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,AETNA,AETNA COMMERCIAL,35.77,98,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANS NUDIX15,0034U,HCPCS,300,RC,,INPATIENT,,,494,197.6,AETNA,AETNA COMMERCIAL,484.12,98,,,OTHER,370.5,484.1,PERCENT OF TOTAL BILLED CHARGES
CHROMO MICRO AUTO STILL,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,AETNA,AETNA COMMERCIAL,3365.32,98,,,OTHER,2575.5,3365.3,PERCENT OF TOTAL BILLED CHARGES
HLA I LOW RESOLUTION ONE ANTI,81374,CPT,300,RC,,OUTPATIENT,,,255,102,AETNA,AETNA COMMERCIAL,249.9,98,,,OTHER,191.3,249.9,PERCENT OF TOTAL BILLED CHARGES
GALACTOSEMIA GALT GENE PANEL,81401,CPT,300,RC,,OUTPATIENT,,,1259,503.6,AETNA,AETNA COMMERCIAL,1233.82,98,,,OTHER,944.3,1233.8,PERCENT OF TOTAL BILLED CHARGES
PT MIX 1:1,81448,CPT,300,RC,,OUTPATIENT,,,1169.8,467.92,AETNA,AETNA COMMERCIAL,1146.404,98,,,OTHER,877.4,1146.4,PERCENT OF TOTAL BILLED CHARGES
M PROTEIN ISOTYPE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,AETNA,AETNA COMMERCIAL,146.02,98,,,OTHER,111.8,146,PERCENT OF TOTAL BILLED CHARGES
BIRT HOGG DUB SYNDROME,81479,CPT,300,RC,,OUTPATIENT,,,1896.79,758.716,AETNA,AETNA COMMERCIAL,1858.8542,98,,,OTHER,1422.6,1858.9,PERCENT OF TOTAL BILLED CHARGES
PHARMACOGENOMICS PANEL V,0029U,HCPCS,300,RC,,INPATIENT,,,1484.54,593.816,AETNA,AETNA COMMERCIAL,1454.8492,98,,,OTHER,1113.4,1454.8,PERCENT OF TOTAL BILLED CHARGES
ZMOPATH PROCEDURE LEVEL 7,81406,CPT,300,RC,,OUTPATIENT,,,1650,660,AETNA,AETNA COMMERCIAL,1617,98,,,OTHER,1237.5,1617,PERCENT OF TOTAL BILLED CHARGES
ZUNLISTED MOLECULAR PATHOLOGY,81479,CPT,300,RC,,OUTPATIENT,,,550,220,AETNA,AETNA COMMERCIAL,539,98,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
CHROMO MICRO AUTO STILL FFPE,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,AETNA,AETNA COMMERCIAL,3365.32,98,,,OTHER,2575.5,3365.3,PERCENT OF TOTAL BILLED CHARGES
OUT-PT/OBS RESPIRATORY PANEL,87631,CPT,300,RC,,OUTPATIENT,,,285.26,114.104,AETNA,AETNA COMMERCIAL,279.5548,98,,,OTHER,213.9,279.6,PERCENT OF TOTAL BILLED CHARGES
ZINC TRANSPORT 8 AB,86341,CPT,302,RC,,OUTPATIENT,,,665.19,266.076,AETNA,AETNA COMMERCIAL,651.8862,98,,,OTHER,498.9,651.9,PERCENT OF TOTAL BILLED CHARGES
ALPHA-2-MCAROGLOBULIN,83883,CPT,301,RC,,OUTPATIENT,,,27.2,10.88,AETNA,AETNA COMMERCIAL,26.656,98,,,OTHER,20.4,26.7,PERCENT OF TOTAL BILLED CHARGES
Z HHTGG GENEIC PANEL 1,81406,CPT,300,RC,,OUTPATIENT,,,3779.96,1511.984,AETNA,AETNA COMMERCIAL,3704.3608,98,,,OTHER,2835,3704.4,PERCENT OF TOTAL BILLED CHARGES
Z HHTGG GENEIC PANEL 2,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,AETNA,AETNA COMMERCIAL,4333.1778,98,,,OTHER,3316.2,4333.2,PERCENT OF TOTAL BILLED CHARGES
NCDA GENE PANEL,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,AETNA,AETNA COMMERCIAL,4333.1778,98,,,OTHER,3316.2,4333.2,PERCENT OF TOTAL BILLED CHARGES
MUMPS PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,AETNA,AETNA COMMERCIAL,661.5,98,,,OTHER,506.3,661.5,PERCENT OF TOTAL BILLED CHARGES
MEASLES PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,AETNA,AETNA COMMERCIAL,661.5,98,,,OTHER,506.3,661.5,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,AETNA,AETNA COMMERCIAL,102.165,98,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
"THALLIUM, BLOOD",83018,CPT,300,RC,,OUTPATIENT,,,327,130.8,AETNA,AETNA COMMERCIAL,320.46,98,,,OTHER,245.3,320.5,PERCENT OF TOTAL BILLED CHARGES
HISTAMINE PLASMA,83088,CPT,301,RC,,OUTPATIENT,,,176.25,70.5,AETNA,AETNA COMMERCIAL,172.725,98,,,OTHER,132.19,172.73,PERCENT OF TOTAL BILLED CHARGES
HOMOCYSTEINE TOTAL URINE,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,AETNA,AETNA COMMERCIAL,183.75,98,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
FAMILIIAL AMYLOIDOSIS REFLEX,82542,CPT,301,RC,,OUTPATIENT,,,332,132.8,AETNA,AETNA COMMERCIAL,325.36,98,,,OTHER,249,325.4,PERCENT OF TOTAL BILLED CHARGES
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,18.6,7.44,AETNA,AETNA COMMERCIAL,18.228,98,,,OTHER,14,18.2,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
ESTRADIOL SERUM,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,AETNA,AETNA COMMERCIAL,202.37,98,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN MASS SPECT MAYO,84432,CPT,301,RC,,OUTPATIENT,,,362.8,145.12,AETNA,AETNA COMMERCIAL,355.544,98,,,OTHER,272.1,355.5,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
BENZODIAZEPINE CONFIRM URINE,G0480,HCPCS,300,RC,,INPATIENT,,,228.86,91.544,AETNA,AETNA COMMERCIAL,224.2828,98,,,OTHER,171.6,224.3,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & WRITTEN REPRT,86078,CPT,300,RC,,OUTPATIENT,,,136.5,54.6,AETNA,AETNA COMMERCIAL,133.77,98,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC ELASTASE SERUM,83519,CPT,300,RC,,OUTPATIENT,,,390,156,AETNA,AETNA COMMERCIAL,382.2,98,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
MODECULE NUCLEIC AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC AMPLIFICATION,8389859,CPT,301,RC,59,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,171.75,68.7,AETNA,AETNA COMMERCIAL,168.315,98,,,OTHER,128.81,168.32,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,83898,CPT,300,RC,,OUTPATIENT,,,171.75,68.7,AETNA,AETNA COMMERCIAL,168.315,98,,,OTHER,128.81,168.32,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z REVERSE TRANSCRIPTION,83902,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,AETNA,AETNA COMMERCIAL,139.895,98,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR ISOLATION/EXTRACTION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,AETNA,AETNA COMMERCIAL,82.32,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,AETNA,AETNA COMMERCIAL,43.855,98,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
HMG-COA REDUCTASE AB,82397,CPT,301,RC,,OUTPATIENT,,,274,109.6,AETNA,AETNA COMMERCIAL,268.52,98,,,OTHER,205.5,268.5,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,8390359,CPT,300,RC,59,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY FECES,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,AETNA,AETNA COMMERCIAL,104.125,98,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
ALDOSTERONE URINE,82088,CPT,300,RC,,OUTPATIENT,,,255,102,AETNA,AETNA COMMERCIAL,249.9,98,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
NIACIN (NICOTINIC ACID),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,AETNA,AETNA COMMERCIAL,167.58,98,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGEST,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
SODIUM QUANTITATIVE FECES,84302,CPT,301,RC,,OUTPATIENT,,,144.75,57.9,AETNA,AETNA COMMERCIAL,141.855,98,,,OTHER,108.56,141.86,PERCENT OF TOTAL BILLED CHARGES
CYSTIC FIBROSIS MUTATION ANALY,81220,CPT,300,RC,,OUTPATIENT,,,1113.2,445.28,AETNA,AETNA COMMERCIAL,1090.936,98,,,OTHER,301.88,394.45,PERCENT OF TOTAL BILLED CHARGES
CYSTATIN C,82610,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,AETNA,AETNA COMMERCIAL,200.655,98,,,OTHER,153.56,200.66,PERCENT OF TOTAL BILLED CHARGES
MTHFR MUTATION DETECTION,81291,CPT,300,RC,,OUTPATIENT,,,447.5,179,AETNA,AETNA COMMERCIAL,438.55,98,,,OTHER,335.63,438.55,PERCENT OF TOTAL BILLED CHARGES
UR PROSTAGLANDIN D2 (PG D2),84150,CPT,300,RC,,OUTPATIENT,,,603,241.2,AETNA,AETNA COMMERCIAL,590.94,98,,,OTHER,452.3,590.9,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,AETNA,AETNA COMMERCIAL,65.0034,98,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,AETNA,AETNA COMMERCIAL,65.0034,98,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,AETNA,AETNA COMMERCIAL,65.0034,98,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
SEROTONIN RELEASE ASSAY,82542,CPT,301,RC,,OUTPATIENT,,,447,178.8,AETNA,AETNA COMMERCIAL,438.06,98,,,OTHER,335.3,438.1,PERCENT OF TOTAL BILLED CHARGES
QUAD SCREEN (SECOND TRIMESTER),81511,CPT,300,RC,,OUTPATIENT,,,307,122.8,AETNA,AETNA COMMERCIAL,300.86,98,,,OTHER,147.75,193.06,PERCENT OF TOTAL BILLED CHARGES
Z AFP,82105,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z ESTRIOL,82677,CPT,301,RC,,OUTPATIENT,,,66,26.4,AETNA,AETNA COMMERCIAL,64.68,98,,,OTHER,49.5,64.68,PERCENT OF TOTAL BILLED CHARGES
Z HCG,84702,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,AETNA,AETNA COMMERCIAL,40.915,98,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z INHIBIN,86336,CPT,300,RC,,OUTPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,215,86,AETNA,AETNA COMMERCIAL,210.7,98,,,OTHER,161.3,210.7,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,210,84,AETNA,AETNA COMMERCIAL,205.8,98,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PRIMIDONE,80188,CPT,300,RC,,OUTPATIENT,,,52.5,21,AETNA,AETNA COMMERCIAL,51.45,98,,,OTHER,39.4,51.5,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,122,48.8,AETNA,AETNA COMMERCIAL,119.56,98,,,OTHER,91.5,119.6,PERCENT OF TOTAL BILLED CHARGES
OSTEOCALCIN SERUM,83937,CPT,301,RC,,OUTPATIENT,,,211.3,84.52,AETNA,AETNA COMMERCIAL,207.074,98,,,OTHER,158.5,207.1,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.3,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
CAROTENE BETA (LS),82380,CPT,301,RC,,OUTPATIENT,,,184,73.6,AETNA,AETNA COMMERCIAL,180.32,98,,,OTHER,138,180.3,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN COMPLEX,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,AETNA,AETNA COMMERCIAL,238.14,98,,,OTHER,182.3,238.1,PERCENT OF TOTAL BILLED CHARGES
ANTI MDA 5 AB,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,AETNA,AETNA COMMERCIAL,238.14,98,,,OTHER,182.3,238.1,PERCENT OF TOTAL BILLED CHARGES
ANTI MI 2 AB,83516,CPT,300,RC,,OUTPATIENT,,,164,65.6,AETNA,AETNA COMMERCIAL,160.72,98,,,OTHER,123,160.7,PERCENT OF TOTAL BILLED CHARGES
PHOSPHOLIPASE A2 RECEPTOR,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN B SINGLE,82172,CPT,301,RC,,OUTPATIENT,,,42.18,16.872,AETNA,AETNA COMMERCIAL,41.3364,98,,,OTHER,31.6,41.3,PERCENT OF TOTAL BILLED CHARGES
MECONIUM DRUG PANEL,80307,CPT,301,RC,,OUTPATIENT,,,224.25,89.7,AETNA,AETNA COMMERCIAL,219.765,98,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE,G0480,HCPCS,300,RC,,BOTH,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z COCAINE & METABOLITES,80353,CPT,301,RC,,OUTPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z CANNABINOIDS,80349,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z OPIATES,80361,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,AETNA,AETNA COMMERCIAL,55.615,98,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z PHENCYCLIDINE,8010191,CPT,300,RC,91,OUTPATIENT,,,70.5,28.2,AETNA,AETNA COMMERCIAL,69.09,98,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
MYASTHENIA GRAVIS MUSK REFLEX,83519,CPT,300,RC,,OUTPATIENT,,,195,78,AETNA,AETNA COMMERCIAL,191.1,98,,,OTHER,146.3,191.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB AB S CHARGE,82397,CPT,301,RC,,OUTPATIENT,,,236,94.4,AETNA,AETNA COMMERCIAL,231.28,98,,,OTHER,177,231.3,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS EVALUATION WB,84311,CPT,300,RC,,OUTPATIENT,,,164,65.6,AETNA,AETNA COMMERCIAL,160.72,98,,,OTHER,123,160.7,PERCENT OF TOTAL BILLED CHARGES
TISSUE NECROSIS FACTOR ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,486,194.4,AETNA,AETNA COMMERCIAL,476.28,98,,,OTHER,364.5,476.3,PERCENT OF TOTAL BILLED CHARGES
MELANOCYTE STM HOR ALPHA,83519,CPT,300,RC,,OUTPATIENT,,,305.67,122.268,AETNA,AETNA COMMERCIAL,299.5566,98,,,OTHER,229.3,299.6,PERCENT OF TOTAL BILLED CHARGES
PRI MEMBRANOUS NEPHROPATH DIAG,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
OBSTETRIC PROFILE,80081,CPT,301,RC,,OUTPATIENT,,,149.72,59.888,AETNA,AETNA COMMERCIAL,146.7256,98,,,OTHER,112.3,146.7,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN STABILITY SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,85,34,AETNA,AETNA COMMERCIAL,83.3,98,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
PROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,165,66,AETNA,AETNA COMMERCIAL,161.7,98,,,OTHER,123.8,161.7,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,95,38,AETNA,AETNA COMMERCIAL,93.1,98,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,160,64,AETNA,AETNA COMMERCIAL,156.8,98,,,OTHER,120,156.8,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,85,34,AETNA,AETNA COMMERCIAL,83.3,98,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,85,34,AETNA,AETNA COMMERCIAL,83.3,98,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,95,38,AETNA,AETNA COMMERCIAL,93.1,98,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,185,74,AETNA,AETNA COMMERCIAL,181.3,98,,,OTHER,138.8,181.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,140,56,AETNA,AETNA COMMERCIAL,137.2,98,,,OTHER,105,137.2,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLETHANOL CONFIRM B,80321,CPT,300,RC,,OUTPATIENT,,,126,50.4,AETNA,AETNA COMMERCIAL,123.48,98,,,OTHER,94.5,123.5,PERCENT OF TOTAL BILLED CHARGES
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,OUTPATIENT,,,258.4,103.36,AETNA,AETNA COMMERCIAL,253.232,98,,,OTHER,193.8,253.2,PERCENT OF TOTAL BILLED CHARGES
IL 2 RECEPTOR SOLUBLE,83520,CPT,300,RC,,OUTPATIENT,,,144.31,57.724,AETNA,AETNA COMMERCIAL,141.4238,98,,,OTHER,108.2,141.4,PERCENT OF TOTAL BILLED CHARGES
FLUORIDE PLASMA,82735,CPT,301,RC,,OUTPATIENT,,,135,54,AETNA,AETNA COMMERCIAL,132.3,98,,,OTHER,101.3,132.3,PERCENT OF TOTAL BILLED CHARGES
CLOBAZAM AND METABOLITE,80339,CPT,301,RC,,OUTPATIENT,,,228.86,91.544,AETNA,AETNA COMMERCIAL,224.2828,98,,,OTHER,171.6,224.3,PERCENT OF TOTAL BILLED CHARGES
NIACIN (NICOTINIC ACID),84591,CPT,300,RC,,OUTPATIENT,,,210,84,AETNA,AETNA COMMERCIAL,205.8,98,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
ZPROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,553,221.2,AETNA,AETNA COMMERCIAL,541.94,98,,,OTHER,414.8,541.9,PERCENT OF TOTAL BILLED CHARGES
QUANTITATE BY HPLC,83021,CPT,301,RC,,OUTPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
QUANTITATE BY ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
UR PHENCYCLIDINE CONFIMATION,83992,CPT,301,RC,,OUTPATIENT,,,120,48,AETNA,AETNA COMMERCIAL,117.6,98,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
UR AMMONIUM RANDOM,82140,CPT,301,RC,,OUTPATIENT,,,538.66,215.464,AETNA,AETNA COMMERCIAL,527.8868,98,,,OTHER,404,527.9,PERCENT OF TOTAL BILLED CHARGES
Z BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,16.92,6.768,AETNA,AETNA COMMERCIAL,16.5816,98,,,OTHER,12.7,16.6,PERCENT OF TOTAL BILLED CHARGES
"Z BILIRUBIN,TOTAL",82247,CPT,301,RC,,OUTPATIENT,,,10.04,4.016,AETNA,AETNA COMMERCIAL,9.8392,98,,,OTHER,7.5,9.8,PERCENT OF TOTAL BILLED CHARGES
Z SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,10.36,4.144,AETNA,AETNA COMMERCIAL,10.1528,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,10.6,4.24,AETNA,AETNA COMMERCIAL,10.388,98,,,OTHER,8,10.4,PERCENT OF TOTAL BILLED CHARGES
Z AKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,10.36,4.144,AETNA,AETNA COMMERCIAL,10.1528,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z RIA NONANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,188.05,75.22,AETNA,AETNA COMMERCIAL,184.289,98,,,OTHER,141,184.3,PERCENT OF TOTAL BILLED CHARGES
Z VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,OUTPATIENT,,,188.05,75.22,AETNA,AETNA COMMERCIAL,184.289,98,,,OTHER,141,184.3,PERCENT OF TOTAL BILLED CHARGES
ZLIPOPRO BLD ELECTROPHORETIC,83700,CPT,300,RC,,OUTPATIENT,,,22.52,9.008,AETNA,AETNA COMMERCIAL,22.0696,98,,,OTHER,16.9,22.1,PERCENT OF TOTAL BILLED CHARGES
ZLIPOPROTEIN BLD HR FRACTION,83701,CPT,301,RC,,OUTPATIENT,,,67.72,27.088,AETNA,AETNA COMMERCIAL,66.3656,98,,,OTHER,50.8,66.4,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,AETNA,AETNA COMMERCIAL,28.665,98,,,OTHER,21.9,28.7,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,AETNA,AETNA COMMERCIAL,28.665,98,,,OTHER,21.9,28.7,PERCENT OF TOTAL BILLED CHARGES
TEST FW BOUND TOT TEST,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,AETNA,AETNA COMMERCIAL,100.5088,98,,,OTHER,76.9,100.5,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,160.24,64.096,AETNA,AETNA COMMERCIAL,157.0352,98,,,OTHER,120.2,157,PERCENT OF TOTAL BILLED CHARGES
UR SYNTHETIC THC METABOLITE SC,80307,CPT,301,RC,,OUTPATIENT,,,206.56,82.624,AETNA,AETNA COMMERCIAL,202.4288,98,,,OTHER,154.9,202.4,PERCENT OF TOTAL BILLED CHARGES
GENERAL HEALTH PANEL,80050,CPT,301,RC,,OUTPATIENT,,,324.75,129.9,AETNA,AETNA COMMERCIAL,318.255,98,,,OTHER,243.6,318.3,PERCENT OF TOTAL BILLED CHARGES
BIOTIN VITAMIN,84591,CPT,300,RC,,OUTPATIENT,,,210,84,AETNA,AETNA COMMERCIAL,205.8,98,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
MAYO PSAD SENDOUT,84153,CPT,301,RC,,OUTPATIENT,,,151,60.4,AETNA,AETNA COMMERCIAL,147.98,98,,,OTHER,113.3,148,PERCENT OF TOTAL BILLED CHARGES
MAYO PSAS SENDOUT,G0103,HCPCS,301,RC,,INPATIENT,,,151,60.4,AETNA,AETNA COMMERCIAL,147.98,98,,,OTHER,113.3,148,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM QUANTITATIVE FECES,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,AETNA,AETNA COMMERCIAL,87.465,98,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
5 HYDROXYINDOLEACETIC ACID P,83497,CPT,300,RC,,OUTPATIENT,,,25.8,10.32,AETNA,AETNA COMMERCIAL,25.284,98,,,OTHER,19.4,25.3,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,363.8,145.52,AETNA,AETNA COMMERCIAL,356.524,98,,,OTHER,272.9,356.5,PERCENT OF TOTAL BILLED CHARGES
ZASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,149.71,59.884,AETNA,AETNA COMMERCIAL,146.7158,98,,,OTHER,112.3,146.7,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,OUTPATIENT,,,25,10,AETNA,AETNA COMMERCIAL,24.5,98,,,OTHER,18.8,24.5,PERCENT OF TOTAL BILLED CHARGES
ZPROTEIN E-PHORESIS SERUM,84165,CPT,300,RC,,OUTPATIENT,,,59,23.6,AETNA,AETNA COMMERCIAL,57.82,98,,,OTHER,44.3,57.8,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN B PLASMA,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,AETNA,AETNA COMMERCIAL,93.835,98,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGG,86674,CPT,302,RC,,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGA,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGM,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,AETNA,AETNA COMMERCIAL,47.775,98,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
BETA 2 GLYCOPROTEIN 1 ANTIBODY,86146,CPT,300,RC,,OUTPATIENT,,,65,26,AETNA,AETNA COMMERCIAL,63.7,98,,,OTHER,48.8,63.7,PERCENT OF TOTAL BILLED CHARGES
LOCUST BLACK IGE,86003,CPT,300,RC,,OUTPATIENT,,,88.72,35.488,AETNA,AETNA COMMERCIAL,86.9456,98,,,OTHER,66.5,86.9,PERCENT OF TOTAL BILLED CHARGES
FEATHER PANEL 2 ALLERGENS,86003,CPT,300,RC,,OUTPATIENT,,,52.82,21.128,AETNA,AETNA COMMERCIAL,51.7636,98,,,OTHER,39.6,51.8,PERCENT OF TOTAL BILLED CHARGES
EASTERN SYCAMORE IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,AETNA,AETNA COMMERCIAL,11.76,98,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
STRONGYLOIDES IGG AB,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,AETNA,AETNA COMMERCIAL,144.06,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
JOHNSONS GRASS IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,AETNA,AETNA COMMERCIAL,11.76,98,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
LAMBS QUARTER IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,AETNA,AETNA COMMERCIAL,11.76,98,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
CASHEW IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
MACADAMIA NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
PINE NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
PEANUT IGE COMPONENTS REFLEX,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
BELL PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,AETNA,AETNA COMMERCIAL,65.758,98,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
BLACK PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,AETNA,AETNA COMMERCIAL,65.758,98,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
PEA GREEN IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,AETNA,AETNA COMMERCIAL,65.758,98,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
C DSDNA AB CRITHIDIA IFA IGG,86255,CPT,300,RC,,OUTPATIENT,,,223,89.2,AETNA,AETNA COMMERCIAL,218.54,98,,,OTHER,167.3,218.5,PERCENT OF TOTAL BILLED CHARGES
CANDIDA ALBICANS IGG,86001,CPT,300,RC,,OUTPATIENT,,,65.44,26.176,AETNA,AETNA COMMERCIAL,64.1312,98,,,OTHER,49.1,64.1,PERCENT OF TOTAL BILLED CHARGES
THSD7A AB S CHARGE,86255,CPT,300,RC,,OUTPATIENT,,,380,152,AETNA,AETNA COMMERCIAL,372.4,98,,,OTHER,285,372.4,PERCENT OF TOTAL BILLED CHARGES
TAPIOCA IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,57.41,22.964,AETNA,AETNA COMMERCIAL,56.2618,98,,,OTHER,43.1,56.3,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,AETNA,AETNA COMMERCIAL,32.879,98,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
DIRECT ANTIGLOBULIN IGG,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
DIRECT ANTIGLOBULIN C3,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
JALAPENO CHIPOTLE IGE,86003,CPT,300,RC,,OUTPATIENT,,,96,38.4,AETNA,AETNA COMMERCIAL,94.08,98,,,OTHER,72,94.1,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
BRAZIL NUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,36.16,14.464,AETNA,AETNA COMMERCIAL,35.4368,98,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
Z ANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,AETNA,AETNA COMMERCIAL,35.4466,98,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,AETNA,AETNA COMMERCIAL,35.4466,98,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
PINEAPPLE IGG,86001,CPT,300,RC,,OUTPATIENT,,,62,24.8,AETNA,AETNA COMMERCIAL,60.76,98,,,OTHER,46.5,60.8,PERCENT OF TOTAL BILLED CHARGES
C1Q BINDING ASSAY,86332,CPT,302,RC,,OUTPATIENT,,,48.74,19.496,AETNA,AETNA COMMERCIAL,47.7652,98,,,OTHER,36.6,47.8,PERCENT OF TOTAL BILLED CHARGES
GLIADIN DEAMIDATED AB,86258,CPT,300,RC,,OUTPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.3,61.7,PERCENT OF TOTAL BILLED CHARGES
ANTI TIF 1GAMMA AB,86235,CPT,300,RC,,OUTPATIENT,,,185.73,74.292,AETNA,AETNA COMMERCIAL,182.0154,98,,,OTHER,139.3,182,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,AETNA,AETNA COMMERCIAL,23.4808,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,AETNA,AETNA COMMERCIAL,23.4808,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,AETNA,AETNA COMMERCIAL,23.4808,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,AETNA,AETNA COMMERCIAL,23.4808,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,AETNA,AETNA COMMERCIAL,23.4808,98,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,AETNA,AETNA COMMERCIAL,68.6,98,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
ISLET CELL ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,135,54,AETNA,AETNA COMMERCIAL,132.3,98,,,OTHER,101.3,132.3,PERCENT OF TOTAL BILLED CHARGES
COW EPITHELIUM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL POTATO,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL FRUIT PANEL,86001,CPT,300,RC,,OUTPATIENT,,,305.35,122.14,AETNA,AETNA COMMERCIAL,299.243,98,,,OTHER,229,299.2,PERCENT OF TOTAL BILLED CHARGES
ZFLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,380,152,AETNA,AETNA COMMERCIAL,372.4,98,,,OTHER,285,372.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,AETNA,AETNA COMMERCIAL,15.3272,98,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
TRICHINELLA ANTIBODY,86784,CPT,302,RC,,OUTPATIENT,,,66,26.4,AETNA,AETNA COMMERCIAL,64.68,98,,,OTHER,49.5,64.7,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,AETNA,AETNA COMMERCIAL,65.4444,98,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,AETNA,AETNA COMMERCIAL,65.4444,98,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,AETNA,AETNA COMMERCIAL,65.4444,98,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,AETNA,AETNA COMMERCIAL,65.4444,98,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,110,44,AETNA,AETNA COMMERCIAL,107.8,98,,,OTHER,82.5,107.8,PERCENT OF TOTAL BILLED CHARGES
ZFLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,109,43.6,AETNA,AETNA COMMERCIAL,106.82,98,,,OTHER,81.8,106.8,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.3,97,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,AETNA,AETNA COMMERCIAL,22.54,98,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOFIX E-PHORESIS SERUM,86334,CPT,300,RC,,OUTPATIENT,,,100,40,AETNA,AETNA COMMERCIAL,98,98,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT IGG,86880,CPT,300,RC,,OUTPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.8,44.1,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT C3,86880,CPT,300,RC,,OUTPATIENT,,,45,18,AETNA,AETNA COMMERCIAL,44.1,98,,,OTHER,33.8,44.1,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT POLY,86880,CPT,300,RC,,OUTPATIENT,,,58,23.2,AETNA,AETNA COMMERCIAL,56.84,98,,,OTHER,43.5,56.8,PERCENT OF TOTAL BILLED CHARGES
ALL SQUASH,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL WASP VENOM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL DOG DANDER IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL ROUGH PIGWEED IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,AETNA,AETNA COMMERCIAL,10.2312,98,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
RIA ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,71.75,28.7,AETNA,AETNA COMMERCIAL,70.315,98,,,OTHER,53.81,70.32,PERCENT OF TOTAL BILLED CHARGES
FLUROESCENT ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
ISLET ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,AETNA,AETNA COMMERCIAL,117.11,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN - PF4 ANTIBODY,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,AETNA,AETNA COMMERCIAL,326.83,98,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
R D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,AETNA,AETNA COMMERCIAL,166.11,98,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
Z HERPES VIRUS 6 IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z HERPES VIRUS 6 IGM,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,AETNA,AETNA COMMERCIAL,106.575,98,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z DENGUE FEVER IGG,86790,CPT,300,RC,,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z DENGUE FEVER IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,162,64.8,AETNA,AETNA COMMERCIAL,158.76,98,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN III ACTVTY PLASMA,85300,CPT,300,RC,,OUTPATIENT,,,210.5,84.2,AETNA,AETNA COMMERCIAL,206.29,98,,,OTHER,157.88,206.29,PERCENT OF TOTAL BILLED CHARGES
ADMATS13 ACTIVITY INHIBITOR PF,85397,CPT,300,RC,,OUTPATIENT,,,337.5,135,AETNA,AETNA COMMERCIAL,330.75,98,,,OTHER,253.1,330.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD SMEAR INTERPRETATION,85007,CPT,305,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
RBC OSMOTIC FRAGILITY,85557,CPT,300,RC,,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.8,122.5,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE FIBRIN MONOMER CHARGE,85366,CPT,300,RC,,OUTPATIENT,,,160.92,64.368,AETNA,AETNA COMMERCIAL,157.7016,98,,,OTHER,120.7,157.7,PERCENT OF TOTAL BILLED CHARGES
ENZYME DETECTION PER ENZYME,87185,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
FECAL REDUCING SUBSTANCE,84376,CPT,301,RC,,OUTPATIENT,,,191.75,76.7,AETNA,AETNA COMMERCIAL,187.915,98,,,OTHER,143.81,187.92,PERCENT OF TOTAL BILLED CHARGES
MYCOBACTERIUM TB AMPLIFIED,87556,CPT,306,RC,,OUTPATIENT,,,529.75,211.9,AETNA,AETNA COMMERCIAL,519.155,98,,,OTHER,397.31,519.16,PERCENT OF TOTAL BILLED CHARGES
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,AETNA,AETNA COMMERCIAL,102.9,98,,,OTHER,78.8,102.9,PERCENT OF TOTAL BILLED CHARGES
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,AETNA,AETNA COMMERCIAL,102.9,98,,,OTHER,78.8,102.9,PERCENT OF TOTAL BILLED CHARGES
NOCARDIA SPECIES  MIC,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
INFECTIOUS AGENT ANTIGEN DETEC,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,AETNA,AETNA COMMERCIAL,50.47,98,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
SUSCEPTABILITY STUDIES,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA HOMINIS PCR,87798,CPT,306,RC,,OUTPATIENT,,,195,78,AETNA,AETNA COMMERCIAL,191.1,98,,,OTHER,146.3,191.1,PERCENT OF TOTAL BILLED CHARGES
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,AETNA,AETNA COMMERCIAL,83.3,98,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,AETNA,AETNA COMMERCIAL,83.3,98,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE BODY FLUID  NOT BLOOD,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,AETNA,AETNA COMMERCIAL,72.765,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
CHCV GENTYPE RESOLUTION,87902,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,AETNA,AETNA COMMERCIAL,504.602,98,,,OTHER,386.2,504.6,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA GENITALIUM TMA,87563,CPT,306,RC,,OUTPATIENT,,,136,54.4,AETNA,AETNA COMMERCIAL,133.28,98,,,OTHER,102,133.3,PERCENT OF TOTAL BILLED CHARGES
MICROSTREP PLUS 1,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA GONDII PCR BLD,87798,CPT,306,RC,,OUTPATIENT,,,513.75,205.5,AETNA,AETNA COMMERCIAL,503.475,98,,,OTHER,385.3,503.5,PERCENT OF TOTAL BILLED CHARGES
SHIGELLA CULTURE FECES,87046,CPT,306,RC,,OUTPATIENT,,,149.51,59.804,AETNA,AETNA COMMERCIAL,146.5198,98,,,OTHER,112.1,146.5,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOCOCCUS AG TITER,LFA,CSF",87899,CPT,300,RC,,OUTPATIENT,,,87.66,35.064,AETNA,AETNA COMMERCIAL,85.9068,98,,,OTHER,65.7,85.9,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE (DIFLUCAN) SENS,87999,CPT,306,RC,,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
MONKEYPOX PCR,87593,CPT,306,RC,,OUTPATIENT,,,120,48,AETNA,AETNA COMMERCIAL,117.6,98,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
RICKETTSIA SPECIEIS DNA PCR,87798,CPT,306,RC,,OUTPATIENT,,,406.66,162.664,AETNA,AETNA COMMERCIAL,398.5268,98,,,OTHER,305,398.5,PERCENT OF TOTAL BILLED CHARGES
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,AETNA,AETNA COMMERCIAL,34.3882,98,,,OTHER,26.3,34.4,PERCENT OF TOTAL BILLED CHARGES
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,AETNA,AETNA COMMERCIAL,34.3882,98,,,OTHER,26.3,34.4,PERCENT OF TOTAL BILLED CHARGES
ZLYME DIS DNA AMP PROBE,87476,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,AETNA,AETNA COMMERCIAL,68.7764,98,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
FUNGAL CULTURE ROUTINE,87102,CPT,306,RC,,OUTPATIENT,,,149.16,59.664,AETNA,AETNA COMMERCIAL,146.1768,98,,,OTHER,111.9,146.2,PERCENT OF TOTAL BILLED CHARGES
FUNGITELL CSF,87449,CPT,300,RC,,OUTPATIENT,,,204,81.6,AETNA,AETNA COMMERCIAL,199.92,98,,,OTHER,153,199.9,PERCENT OF TOTAL BILLED CHARGES
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,2316,926.4,AETNA,AETNA COMMERCIAL,2269.68,98,,,OTHER,1737,2269.7,PERCENT OF TOTAL BILLED CHARGES
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,833.56,333.424,AETNA,AETNA COMMERCIAL,816.8888,98,,,OTHER,625.2,816.9,PERCENT OF TOTAL BILLED CHARGES
Z DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,70.18,28.072,AETNA,AETNA COMMERCIAL,68.7764,98,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
Z TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,AETNA,AETNA COMMERCIAL,68.7764,98,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
Z DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,AETNA,AETNA COMMERCIAL,137.592,98,,,OTHER,105.3,137.6,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE FECES W/ISO PRE EXAM,87046,CPT,306,RC,,OUTPATIENT,,,27.25,10.9,AETNA,AETNA COMMERCIAL,26.705,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE FECES W/ISO PRE EXAM,8704691,CPT,306,RC,91,OUTPATIENT,,,27.25,10.9,AETNA,AETNA COMMERCIAL,26.705,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE SPECIMEN CONCENTRATN,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,AETNA,AETNA COMMERCIAL,61.005,98,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
VISBY SEXUAL HEALTH TEST,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,AETNA,AETNA COMMERCIAL,137.592,98,,,OTHER,105.3,137.6,PERCENT OF TOTAL BILLED CHARGES
UA  NON AUTOMATED  NO MICRO,81002,CPT,307,RC,,OUTPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH LIQUID BASED NON GYN,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY NON-GYN,88106,CPT,300,RC,,OUTPATIENT,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
MAYO RESP PANEL PCR,0202U,HCPCS,310,RC,,INPATIENT,,,833.56,333.424,AETNA,AETNA COMMERCIAL,816.8888,98,,,OTHER,625.2,816.9,PERCENT OF TOTAL BILLED CHARGES
JAK2 EX12 NON-V617F MUT DETECT,81403,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,AETNA,AETNA COMMERCIAL,737.695,98,,,OTHER,564.56,737.7,PERCENT OF TOTAL BILLED CHARGES
IN SITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,189,246.96,PERCENT OF TOTAL BILLED CHARGES
GENE POLYMORPHISM,81400,CPT,300,RC,,OUTPATIENT,,,653.4,261.36,AETNA,AETNA COMMERCIAL,640.332,98,,,OTHER,490.1,640.3,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOFLUORESCENT STUDY,88347,CPT,310,RC,,OUTPATIENT,,,315.75,126.3,AETNA,AETNA COMMERCIAL,309.435,98,,,OTHER,236.81,309.44,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOFLUORESCENT STUDY,8834791,CPT,310,RC,91,OUTPATIENT,,,315.75,126.3,AETNA,AETNA COMMERCIAL,309.435,98,,,OTHER,236.81,309.44,PERCENT OF TOTAL BILLED CHARGES
M/PHMTRC ALYS ISHQUANT/SEMIQ,88373,CPT,310,RC,,OUTPATIENT,,,228.69,91.476,AETNA,AETNA COMMERCIAL,224.1162,98,,,OTHER,171.5,224.1,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,310,RC,,OUTPATIENT,,,174,69.6,AETNA,AETNA COMMERCIAL,170.52,98,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
FLT3 GENE,81245,CPT,310,RC,,OUTPATIENT,,,331.02,132.408,AETNA,AETNA COMMERCIAL,324.3996,98,,,OTHER,248.3,324.4,PERCENT OF TOTAL BILLED CHARGES
NPM1 GENE,81310,CPT,310,RC,,OUTPATIENT,,,493.04,197.216,AETNA,AETNA COMMERCIAL,483.1792,98,,,OTHER,369.8,483.2,PERCENT OF TOTAL BILLED CHARGES
LACTOTYPE,81400,CPT,300,RC,,OUTPATIENT,,,531.75,212.7,AETNA,AETNA COMMERCIAL,521.115,98,,,OTHER,398.81,521.12,PERCENT OF TOTAL BILLED CHARGES
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,314,RC,,INPATIENT,,,588.62,235.448,AETNA,AETNA COMMERCIAL,576.8476,98,,,OTHER,441.5,576.8,PERCENT OF TOTAL BILLED CHARGES
TARGETED GENOMIC SEQ ANALYS,81450,CPT,310,RC,,OUTPATIENT,,,1080,432,AETNA,AETNA COMMERCIAL,1058.4,98,,,OTHER,810,1058.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,312,RC,,OUTPATIENT,,,322,128.8,AETNA,AETNA COMMERCIAL,315.56,98,,,OTHER,241.5,315.6,PERCENT OF TOTAL BILLED CHARGES
Z UROVYSION DETECTION BLAD CA,88368,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
Z UROVYSION DETECTION BLAD CA,8836891,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,OUTPATIENT,,,350.8,140.32,AETNA,AETNA COMMERCIAL,343.784,98,,,OTHER,263.1,343.8,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION,19086,CPT,610,RC,,OUTPATIENT,,,2441.25,976.5,AETNA,AETNA COMMERCIAL,2392.425,98,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
RIBOSOME P ANTIBODIES IGG,83516,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,AETNA,AETNA COMMERCIAL,149.205,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
CENTROMERE ANTIBODIES,83516,CPT,300,RC,,OUTPATIENT,,,143,57.2,AETNA,AETNA COMMERCIAL,140.14,98,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,OUTPATIENT,,,2730,1092,AETNA,AETNA COMMERCIAL,2675.4,98,,,OTHER,2047.5,2675.4,PERCENT OF TOTAL BILLED CHARGES
IGH VARI REGIONAL MUTATION,81263,CPT,300,RC,,OUTPATIENT,,,1682.14,672.856,AETNA,AETNA COMMERCIAL,1648.4972,98,,,OTHER,1261.6,1648.5,PERCENT OF TOTAL BILLED CHARGES
CHRONIC LYMPHOCYTIC LEUKEMIA,81351,CPT,,,,OUTPATIENT,,,2141.85,856.74,AETNA,AETNA COMMERCIAL,2099.013,98,,,OTHER,1606.4,2099,PERCENT OF TOTAL BILLED CHARGES
MYELODYSPLASTIC SYNDROME,81219,CPT,300,RC,,OUTPATIENT,,,243.26,97.304,AETNA,AETNA COMMERCIAL,238.3948,98,,,OTHER,182.4,238.4,PERCENT OF TOTAL BILLED CHARGES
MYELODYSPLASTIC SYNDROME,81338,CPT,310,RC,,OUTPATIENT,,,300.66,120.264,AETNA,AETNA COMMERCIAL,294.6468,98,,,OTHER,225.5,294.6,PERCENT OF TOTAL BILLED CHARGES
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,OUTPATIENT,,,327.92,131.168,AETNA,AETNA COMMERCIAL,321.3616,98,,,OTHER,245.9,321.4,PERCENT OF TOTAL BILLED CHARGES
TGSAP SO NEO 5-50DNA/DNA&RNA,81445,CPT,310,RC,,OUTPATIENT,,,1195.82,478.328,AETNA,AETNA COMMERCIAL,1171.9036,98,,,OTHER,896.9,1171.9,PERCENT OF TOTAL BILLED CHARGES
THINPREP SCREEN  W/O PHYS INTR,88142,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
THINPREP PAP RESCREEN,88143,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
FINE NEEDLE BIOPSY INTRP&RPT,88173,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
PAP SMEAR  TECHNICAL FEE,88150,CPT,311,RC,,OUTPATIENT,,,40.75,16.3,AETNA,AETNA COMMERCIAL,39.935,98,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
PAP W/MATURATION INDEX,88165,CPT,311,RC,,OUTPATIENT,,,84.44,33.776,AETNA,AETNA COMMERCIAL,82.7512,98,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY BODY FLUIDS MULT,88162,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH SMEAR,88108,CPT,311,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
EVALUATION OF FINE NEEDLE BX,88172,CPT,311,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
EVALUATION OF TOUCH PREP,88333,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,AETNA,AETNA COMMERCIAL,1281.6538,98,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHLOGY FLUIDS WASH/BRUSH,88104,CPT,310,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
UROVYSION FISH,88120,CPT,311,RC,,OUTPATIENT,,,414.75,165.9,AETNA,AETNA COMMERCIAL,406.455,98,,,OTHER,311.06,406.46,PERCENT OF TOTAL BILLED CHARGES
FISH TESTING,88271,CPT,300,RC,,OUTPATIENT,,,320,128,AETNA,AETNA COMMERCIAL,313.6,98,,,OTHER,240,313.6,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETIC TESTING,88274,CPT,311,RC,,OUTPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
PATH REVIEW,85060,CPT,305,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH TBS  C/V  MANUAL,88164,CPT,311,RC,,OUTPATIENT,,,43.75,17.5,AETNA,AETNA COMMERCIAL,42.875,98,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,AETNA,AETNA COMMERCIAL,333.69,98,,,OTHER,255.38,333.69,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,AETNA,AETNA COMMERCIAL,57.575,98,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
Z CYTO MOLECULAR REPORT,G0452,HCPCS,310,RC,,INPATIENT,,,86.5,34.6,AETNA,AETNA COMMERCIAL,84.77,98,,,OTHER,64.88,84.77,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,AETNA,AETNA COMMERCIAL,57.575,98,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
CONSULTATION COMPREHENSIVE,88325,CPT,310,RC,,OUTPATIENT,,,567,226.8,AETNA,AETNA COMMERCIAL,555.66,98,,,OTHER,425.25,555.66,PERCENT OF TOTAL BILLED CHARGES
PATHOLOGY CONSULATION,88323,CPT,310,RC,,OUTPATIENT,,,279,111.6,AETNA,AETNA COMMERCIAL,273.42,98,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,73.25,29.3,AETNA,AETNA COMMERCIAL,71.785,98,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BCR/ABL RNA QUANT MONITOR CML,81206,CPT,310,RC,,OUTPATIENT,,,600.25,240.1,AETNA,AETNA COMMERCIAL,588.245,98,,,OTHER,450.19,588.25,PERCENT OF TOTAL BILLED CHARGES
OR CONS FRZ SEC ADDL TECHNICAL,88332,CPT,312,RC,,OUTPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAINS GROUP II,88313,CPT,300,RC,,OUTPATIENT,,,145,58,AETNA,AETNA COMMERCIAL,142.1,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
PATHOLOGY CONSULT DURING SURG,88329,CPT,310,RC,,OUTPATIENT,,,199.5,79.8,AETNA,AETNA COMMERCIAL,195.51,98,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,88185,CPT,310,RC,,OUTPATIENT,,,271.75,108.7,AETNA,AETNA COMMERCIAL,266.315,98,,,OTHER,203.81,266.32,PERCENT OF TOTAL BILLED CHARGES
CLINICAL PATHOLOGY CONSULT,80500,CPT,,,,OUTPATIENT,,,113.25,45.3,AETNA,AETNA COMMERCIAL,110.985,98,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY CELL SURFACE,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY CYTOPLASMIC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
MORPHOMETRIC ANALYUSIS TMR IMM,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
MICRO GEN ANA OF TISSUE ADD'L,88369,CPT,310,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.6,223,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE FOR NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,AETNA,AETNA COMMERCIAL,527.73,98,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS 20-25 CELL,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,AETNA,AETNA COMMERCIAL,914.83,98,,,OTHER,700.13,914.83,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY SMEARS INTREPRET,88108,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
CONSULT AND REPORT SLIDES,88321,CPT,312,RC,,OUTPATIENT,,,567,226.8,AETNA,AETNA COMMERCIAL,555.66,98,,,OTHER,425.25,555.66,PERCENT OF TOTAL BILLED CHARGES
CHROMO ANALY ADD'L KARYOTYPES,88280,CPT,310,RC,,OUTPATIENT,,,77,30.8,AETNA,AETNA COMMERCIAL,75.46,98,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
SKIN OR OTH SOLID TISSUE BPSY,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,AETNA,AETNA COMMERCIAL,652.435,98,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
DECALCIFICATION-TECHNICAL,88311,CPT,312,RC,,OUTPATIENT,,,33.75,13.5,AETNA,AETNA COMMERCIAL,33.075,98,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY INITIAL,88342,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY MULTIPLEX,G0462,HCPCS,312,RC,,BOTH,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
OR CONSULT W/FROZ SECTION SING,88331,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,159.38,208.25,PERCENT OF TOTAL BILLED CHARGES
SPEC GROUP STAIN I TECHNICAL,88312,CPT,312,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE ADD'L STUDY,87253,CPT,300,RC,,OUTPATIENT,,,442,176.8,AETNA,AETNA COMMERCIAL,433.16,98,,,OTHER,331.5,433.16,PERCENT OF TOTAL BILLED CHARGES
SURGICAL MACRO MICRO I,88302,CPT,312,RC,,OUTPATIENT,,,188.75,75.5,AETNA,AETNA COMMERCIAL,184.975,98,,,OTHER,141.56,184.98,PERCENT OF TOTAL BILLED CHARGES
SURGICAL MACRO I,88300,CPT,312,RC,,OUTPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
TISSUE 1 COMPLEX TECHNICAL,88304,CPT,312,RC,,OUTPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
TISSUE 2 COMPLEX  TECHNICAL,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,AETNA,AETNA COMMERCIAL,143.08,98,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
TISSUE 3 COMPLEX--TECHNICAL,88307,CPT,312,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
TISSUE 4 COMPLEX--TECHNICAL,88309,CPT,312,RC,,OUTPATIENT,,,1307.81,523.124,AETNA,AETNA COMMERCIAL,1281.6538,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRO 16+MRUS,88189,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRP 2-8 MRUS,88187,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
MICRODISSECTION - MANUAL,88381,CPT,312,RC,,OUTPATIENT,,,180.5,72.2,AETNA,AETNA COMMERCIAL,176.89,98,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
EPIDERMAL GROWTH FACTOR RCPTR,81235,CPT,312,RC,,OUTPATIENT,,,905.25,362.1,AETNA,AETNA COMMERCIAL,887.145,98,,,OTHER,678.94,887.15,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY ADD'L,88341,CPT,312,RC,,OUTPATIENT,,,227.5,91,AETNA,AETNA COMMERCIAL,222.95,98,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS 15-20 CELL,88262,CPT,310,RC,,OUTPATIENT,,,351.25,140.5,AETNA,AETNA COMMERCIAL,344.225,98,,,OTHER,263.44,344.23,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRP 9-15 MRKS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
R FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY EA ADD'L MRKER,88185,CPT,310,RC,,OUTPATIENT,,,432.75,173.1,AETNA,AETNA COMMERCIAL,424.095,98,,,OTHER,324.56,424.1,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,AETNA,AETNA COMMERCIAL,143.815,98,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY ADD ON,88185,CPT,310,RC,,OUTPATIENT,,,52.25,20.9,AETNA,AETNA COMMERCIAL,51.205,98,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
MORPHOMETRIC ANALYSIS MANUAL,88368,CPT,310,RC,,OUTPATIENT,,,622.75,249.1,AETNA,AETNA COMMERCIAL,610.295,98,,,OTHER,467.06,610.3,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
SITZ MARKER CAPSULE,A9698,HCPCS,636,RC,,INPATIENT,,,40,16,AETNA,AETNA COMMERCIAL,39.2,98,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN SERIES 3 VIEWS  ACUTE,74022,CPT,320,RC,,OUTPATIENT,,,494.75,197.9,AETNA,AETNA COMMERCIAL,484.855,98,,,OTHER,371.06,484.86,PERCENT OF TOTAL BILLED CHARGES
SITZ MARKER KUB SUBSEQUENT,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
ABCESS O GRAM,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,AETNA,AETNA COMMERCIAL,943.2304,98,,,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATH INSERTION SIMPLE,51702,CPT,320,RC,,OUTPATIENT,,,244.25,97.7,AETNA,AETNA COMMERCIAL,239.365,98,,,OTHER,183.19,239.37,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATH INSERTION COMPLCTD,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,AETNA,AETNA COMMERCIAL,441.49,98,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE COMPLD CHANGE,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,AETNA,AETNA COMMERCIAL,2515.415,98,,,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHNG IMAGE GD,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,AETNA,AETNA COMMERCIAL,1009.645,98,,,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
LOWER EXTREMITY INFANT,73592,CPT,320,RC,,OUTPATIENT,,,229,91.6,AETNA,AETNA COMMERCIAL,224.42,98,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY INFANT,73092,CPT,320,RC,,OUTPATIENT,,,229,91.6,AETNA,AETNA COMMERCIAL,224.42,98,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY INFANT BIL,7309250,CPT,320,RC,50,OUTPATIENT,,,350,140,AETNA,AETNA COMMERCIAL,343,98,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
BE SCREENING,G0120,HCPCS,320,RC,,INPATIENT,,,910.75,364.3,AETNA,AETNA COMMERCIAL,892.535,98,,,OTHER,683.06,892.54,PERCENT OF TOTAL BILLED CHARGES
VENOUS CATHETER REMOVAL,36589,CPT,760,RC,,OUTPATIENT,,,1885.5,754.2,AETNA,AETNA COMMERCIAL,1847.79,98,,,OTHER,1414.13,1847.79,PERCENT OF TOTAL BILLED CHARGES
FEEDING TUBE REPLACEMENT,43999,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,675,882,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE REPLACEMENT,75984,CPT,320,RC,,OUTPATIENT,,,1100,440,AETNA,AETNA COMMERCIAL,1078,98,,,OTHER,2333.81,3049.52,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE REPLACEMENT,50435,CPT,361,RC,,OUTPATIENT,,,3000,1200,AETNA,AETNA COMMERCIAL,2940,98,,,OTHER,2064.56,2697.7,PERCENT OF TOTAL BILLED CHARGES
GASTROGRAFIN ABDOMEN 1 VIEW,74000,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA LT,20605LT,CPT,361,RC,LT,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA,20605RT,CPT,320,RC,RT,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
SELLA TURCICA EXAM,70240,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA BI,2060550,CPT,320,RC,50,OUTPATIENT,,,1124.25,449.7,AETNA,AETNA COMMERCIAL,1101.765,98,,,OTHER,843.19,1101.77,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 2 VIEWS,74019,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,AETNA,AETNA COMMERCIAL,423.115,98,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
CENTRAL VENOUS ACCESS EVAL,36598,CPT,320,RC,,OUTPATIENT,,,568,227.2,AETNA,AETNA COMMERCIAL,556.64,98,,,OTHER,426,556.64,PERCENT OF TOTAL BILLED CHARGES
BILIARY CATH CHANGE,47525,CPT,320,RC,,OUTPATIENT,,,6430.08,2572.032,AETNA,AETNA COMMERCIAL,6301.4784,98,,,OTHER,1387.13,1812.51,PERCENT OF TOTAL BILLED CHARGES
CHEST TUBE PLACEMENT,32557,CPT,320,RC,,OUTPATIENT,,,1708,683.2,AETNA,AETNA COMMERCIAL,1673.84,98,,,OTHER,1281,1673.84,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR KNEE XRAY,27370,CPT,320,RC,,OUTPATIENT,,,275.75,110.3,AETNA,AETNA COMMERCIAL,270.235,98,,,OTHER,206.81,270.24,PERCENT OF TOTAL BILLED CHARGES
ACROMIOCLAVICULAR JOINTS,73050,CPT,320,RC,,OUTPATIENT,,,348.5,139.4,AETNA,AETNA COMMERCIAL,341.53,98,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
NEEDLE LOCAL BY XRAY BILATERAL,7700250,CPT,,,50,OUTPATIENT,,,550,220,AETNA,AETNA COMMERCIAL,539,98,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JNT/BURSA W/O US BIL,2061050,CPT,320,RC,50,OUTPATIENT,,,1300,520,AETNA,AETNA COMMERCIAL,1274,98,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
FEEDING TUBE PLACEMENT,43752,CPT,320,RC,,OUTPATIENT,,,538.59,215.436,AETNA,AETNA COMMERCIAL,527.8182,98,,,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE ARTHROGRAM RT,73615RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE ARTHROGRAM LT,73615LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE 3 VIEWS RT,73610RT,CPT,320,RC,RT,OUTPATIENT,,,320.25,128.1,AETNA,AETNA COMMERCIAL,313.845,98,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
ANKLE 3 VIEWS LT,73610LT,CPT,320,RC,LT,OUTPATIENT,,,320.25,128.1,AETNA,AETNA COMMERCIAL,313.845,98,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
ANKLE 2 VIEWS RT,73600RT,CPT,320,RC,RT,OUTPATIENT,,,218,87.2,AETNA,AETNA COMMERCIAL,213.64,98,,,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
ANKLE 2 VIEWS LT,73600LT,CPT,320,RC,LT,OUTPATIENT,,,218,87.2,AETNA,AETNA COMMERCIAL,213.64,98,,,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
ANKLE INJECTION RT,27648RT,CPT,320,RC,RT,OUTPATIENT,,,343.75,137.5,AETNA,AETNA COMMERCIAL,336.875,98,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
ANKLE INJECTION LT,27648LT,CPT,320,RC,LT,OUTPATIENT,,,343.75,137.5,AETNA,AETNA COMMERCIAL,336.875,98,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
ANKLE BILATERAL,7361050,CPT,320,RC,50,OUTPATIENT,,,640,256,AETNA,AETNA COMMERCIAL,627.2,98,,,OTHER,480,627.2,PERCENT OF TOTAL BILLED CHARGES
FLUOROSCOPIC GUIDANCE INJ PROC,77003,CPT,320,RC,,OUTPATIENT,,,296.5,118.6,AETNA,AETNA COMMERCIAL,290.57,98,,,OTHER,222.38,290.57,PERCENT OF TOTAL BILLED CHARGES
INTRO GASTROINTESTINAL TUBE,44500,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,525,686,PERCENT OF TOTAL BILLED CHARGES
FLURO GUIDED SI JOINT INJECTIO,27096,CPT,350,RC,,OUTPATIENT,,,2455.25,982.1,AETNA,AETNA COMMERCIAL,2406.145,98,,,OTHER,1841.4,2406.1,PERCENT OF TOTAL BILLED CHARGES
KNEE INJECT RT,27369RT,CPT,361,RC,RT,OUTPATIENT,,,357,142.8,AETNA,AETNA COMMERCIAL,349.86,98,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
KNEE INJECT LT,27369LT,CPT,361,RC,LT,OUTPATIENT,,,357,142.8,AETNA,AETNA COMMERCIAL,349.86,98,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE CHANGE,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,490.5,640.92,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE CHANGE,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,AETNA,AETNA COMMERCIAL,1009.645,98,,,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE CATH DEVICE,C1729,HCPCS,272,RC,,INPATIENT,,,395.5,158.2,AETNA,AETNA COMMERCIAL,387.59,98,,,OTHER,296.63,387.59,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1961.5,784.6,AETNA,AETNA COMMERCIAL,1922.27,98,,,OTHER,1471.13,1922.27,PERCENT OF TOTAL BILLED CHARGES
BABYGRAM,71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,AETNA,AETNA COMMERCIAL,317.275,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
BABYGRAM,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,AETNA,AETNA COMMERCIAL,356.23,98,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
XRAY FILTER GUIDANCE,37191,CPT,361,RC,,OUTPATIENT,,,3145.75,1258.3,AETNA,AETNA COMMERCIAL,3082.835,98,,,OTHER,2359.31,3082.84,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED NEEDLE PLACEMENT,77002,CPT,320,RC,,OUTPATIENT,,,709,283.6,AETNA,AETNA COMMERCIAL,694.82,98,,,OTHER,531.8,694.8,PERCENT OF TOTAL BILLED CHARGES
BARIUM ENEMA W/AIR CONTRAST,74280,CPT,320,RC,,OUTPATIENT,,,910.75,364.3,AETNA,AETNA COMMERCIAL,892.535,98,,,OTHER,683.06,892.54,PERCENT OF TOTAL BILLED CHARGES
BARIUM ENEMA SINGLE CONTRAST,74270,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,AETNA,AETNA COMMERCIAL,740.145,98,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
BONE AGE STUDIES,77072,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,AETNA,AETNA COMMERCIAL,244.265,98,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
DEXA BONE DENSITY/IVA,77082,CPT,320,RC,,OUTPATIENT,,,246.75,98.7,AETNA,AETNA COMMERCIAL,241.815,98,,,OTHER,185.06,241.82,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY COMPLETE,77075,CPT,320,RC,,OUTPATIENT,,,1182,472.8,AETNA,AETNA COMMERCIAL,1158.36,98,,,OTHER,886.5,1158.36,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY LIMITED,77074,CPT,320,RC,,OUTPATIENT,,,679.25,271.7,AETNA,AETNA COMMERCIAL,665.665,98,,,OTHER,509.44,665.67,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY INFANT,77076,CPT,320,RC,,OUTPATIENT,,,598,239.2,AETNA,AETNA COMMERCIAL,586.04,98,,,OTHER,448.5,586.04,PERCENT OF TOTAL BILLED CHARGES
DEXA W/O WRIST,77080,CPT,320,RC,,OUTPATIENT,,,428,171.2,AETNA,AETNA COMMERCIAL,419.44,98,,,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM PTOP,47531,CPT,320,RC,,OUTPATIENT,,,6345.05,2538.02,AETNA,AETNA COMMERCIAL,6218.149,98,,,OTHER,478.31,625,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM ADD SET,74301,CPT,320,RC,,OUTPATIENT,,,150.75,60.3,AETNA,AETNA COMMERCIAL,147.735,98,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
FNA BX W/CT GDN EA ADDL,10010,CPT,320,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM OPERATIVE,74300,CPT,320,RC,,OUTPATIENT,,,279,111.6,AETNA,AETNA COMMERCIAL,273.42,98,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE RT,73000RT,CPT,320,RC,RT,OUTPATIENT,,,260.5,104.2,AETNA,AETNA COMMERCIAL,255.29,98,,,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE LT,73000LT,CPT,320,RC,LT,OUTPATIENT,,,260.5,104.2,AETNA,AETNA COMMERCIAL,255.29,98,,,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 4 OR 5 VIEWS,72050,CPT,320,RC,,OUTPATIENT,,,560.25,224.1,AETNA,AETNA COMMERCIAL,549.045,98,,,OTHER,420.19,549.05,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 3 VIEWS,72040,CPT,320,RC,,OUTPATIENT,,,364,145.6,AETNA,AETNA COMMERCIAL,356.72,98,,,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 6 OR MORE VIEWS,72052,CPT,320,RC,,OUTPATIENT,,,618,247.2,AETNA,AETNA COMMERCIAL,605.64,98,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
FLUROSCOPY,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,AETNA,AETNA COMMERCIAL,659.295,98,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
CHEST 2 VIEWS,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,AETNA,AETNA COMMERCIAL,326.83,98,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
CHEST 1 VIEW,71045,CPT,320,RC,,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
INJ NEEDLE PLACEMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,AETNA,AETNA COMMERCIAL,618.38,98,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
NEEDLE LOCALIZATION BY XRAY,77002,CPT,320,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CHEST 4 VIEWS,71048,CPT,320,RC,,OUTPATIENT,,,384.5,153.8,AETNA,AETNA COMMERCIAL,376.81,98,,,OTHER,288.38,376.81,PERCENT OF TOTAL BILLED CHARGES
CHEST 3 VIEWS,71047,CPT,320,RC,,OUTPATIENT,,,371.75,148.7,AETNA,AETNA COMMERCIAL,364.315,98,,,OTHER,278.81,364.32,PERCENT OF TOTAL BILLED CHARGES
CHEST (MINE),71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,AETNA,AETNA COMMERCIAL,317.275,98,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
CHEST (MINE) 2 VIEWS PRE-EMP,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,AETNA,AETNA COMMERCIAL,326.83,98,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
CYSTOGRAPHY 3 VIEWS,74430,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,408,533.12,PERCENT OF TOTAL BILLED CHARGES
INJ PROC CYSTOGRAPHY,51600,CPT,320,RC,,OUTPATIENT,,,436.5,174.6,AETNA,AETNA COMMERCIAL,427.77,98,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
DEXA/ARM W/WRIST RT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,AETNA,AETNA COMMERCIAL,204.82,98,,,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
DEXA/ARM W/WRIST LT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,AETNA,AETNA COMMERCIAL,204.82,98,,,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
DEXA HIP (R),76075RT,CPT,320,RC,RT,OUTPATIENT,,,62.75,25.1,AETNA,AETNA COMMERCIAL,61.495,98,,,OTHER,47.06,61.5,PERCENT OF TOTAL BILLED CHARGES
ELBOW 3 VIEWS RT,73080RT,CPT,320,RC,RT,OUTPATIENT,,,317,126.8,AETNA,AETNA COMMERCIAL,310.66,98,,,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
ELBOW 3 VIEWS LT,73080LT,CPT,320,RC,LT,OUTPATIENT,,,317,126.8,AETNA,AETNA COMMERCIAL,310.66,98,,,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
ELBOW 2 VIEWS RT,73070RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,AETNA,AETNA COMMERCIAL,209.475,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
ELBOW 2 VIEWS LT,73070LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,AETNA,AETNA COMMERCIAL,209.475,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
ELBOW ARTHROGRAM RT,73085RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,AETNA,AETNA COMMERCIAL,785.225,98,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
ELBOW ARTHROGRAM LT,73085LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,AETNA,AETNA COMMERCIAL,785.225,98,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGRAM,74220,CPT,320,RC,,OUTPATIENT,,,496.25,198.5,AETNA,AETNA COMMERCIAL,486.325,98,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
FACE BONE 3 VIEWS,70150,CPT,320,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS RT,73552RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS LT,73552LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS BILATERAL,73552,CPT,320,RC,,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL,7355250,CPT,320,RC,50,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
FINGER THUMB LT,73140FA,CPT,320,RC,FA,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 2ND DIGIT LT,73140F1,CPT,320,RC,F1,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 3RD DIGIT LT,73140F2,CPT,320,RC,F2,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 4TH DIGIT LT,73140F3,CPT,320,RC,F3,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 5TH DIGIT LT,73140F4,CPT,320,RC,F4,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER THUMB RT,73140F5,CPT,320,RC,F5,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 2ND DIGIT RT,73140F6,CPT,320,RC,F6,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 3RD DIGIT RT,73140F7,CPT,320,RC,F7,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 4TH DIGIT RT,73140F8,CPT,320,RC,F8,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 5TH DIGIT RT,73140F9,CPT,320,RC,F9,OUTPATIENT,,,233.75,93.5,AETNA,AETNA COMMERCIAL,229.075,98,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FISTULA SINUS W/CONTRAST,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,AETNA,AETNA COMMERCIAL,943.2304,98,,,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
OR HIP LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,639.5,255.8,AETNA,AETNA COMMERCIAL,626.71,98,,,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
FLUORO LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,AETNA,AETNA COMMERCIAL,659.295,98,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
FLUORO MORE THAN 1HR EXTENSIVE,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,AETNA,AETNA COMMERCIAL,659.295,98,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
PICC PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,3124,1249.6,AETNA,AETNA COMMERCIAL,3061.52,98,,,OTHER,2343,3061.52,PERCENT OF TOTAL BILLED CHARGES
MIDLINE INSERTION,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,AETNA,AETNA COMMERCIAL,478.24,98,,,OTHER,366,478.2,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED NEEDLE PLCMNT,77002,CPT,320,RC,,OUTPATIENT,,,295,118,AETNA,AETNA COMMERCIAL,289.1,98,,,OTHER,221.25,289.1,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,662.75,265.1,AETNA,AETNA COMMERCIAL,649.495,98,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,550,220,AETNA,AETNA COMMERCIAL,539,98,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE SPINAL FLUID,62328,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR BLADDER XRAY,51610,CPT,320,RC,,OUTPATIENT,,,856.5,342.6,AETNA,AETNA COMMERCIAL,839.37,98,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
URETHROCYSTOGRAM,74450,CPT,320,RC,,OUTPATIENT,,,537,214.8,AETNA,AETNA COMMERCIAL,526.26,98,,,OTHER,402.75,526.26,PERCENT OF TOTAL BILLED CHARGES
C-ARM LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,AETNA,AETNA COMMERCIAL,857.01,98,,,OTHER,655.88,857.01,PERCENT OF TOTAL BILLED CHARGES
C-ARM CENTRAL VENOUS ACCESS,77001,CPT,320,RC,,OUTPATIENT,,,350,140,AETNA,AETNA COMMERCIAL,343,98,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
C-ARM PAIN CLINIC,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,AETNA,AETNA COMMERCIAL,857.01,98,,,OTHER,655.9,857,PERCENT OF TOTAL BILLED CHARGES
FOREARM AP/LAT RT,73090RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,AETNA,AETNA COMMERCIAL,306.25,98,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
FOREARM AP/LAT LT,73090LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,AETNA,AETNA COMMERCIAL,306.25,98,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
FOREARM BILATERAL,7309050,CPT,320,RC,50,OUTPATIENT,,,624.75,249.9,AETNA,AETNA COMMERCIAL,612.255,98,,,OTHER,468.56,612.26,PERCENT OF TOTAL BILLED CHARGES
FOOT 2 VIEWS RT,73620RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,AETNA,AETNA COMMERCIAL,209.475,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
FOOT 2 VIEWS LT,73620LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,AETNA,AETNA COMMERCIAL,209.475,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
FOOT 3 VIEWS RT,73630RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
FOOT 3 VIEWS LT,73630LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
FEET TWO VIEWS BILATERAL,73620,CPT,,,,OUTPATIENT,,,427.5,171,AETNA,AETNA COMMERCIAL,418.95,98,,,OTHER,320.6,419,PERCENT OF TOTAL BILLED CHARGES
HAND 3 VIEWS RT,73130RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HAND 3 VIEWS LT,73130LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEOUS RT,73650RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEOUS LT,73650LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEUS BILATERAL,7365050,CPT,320,RC,50,OUTPATIENT,,,525,210,AETNA,AETNA COMMERCIAL,514.5,98,,,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
HIP INJECTION,73525,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR HIP XRAY,27093,CPT,320,RC,,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
HIP BILATERAL WITH PELVIS,73522,CPT,320,RC,,OUTPATIENT,,,550,220,AETNA,AETNA COMMERCIAL,539,98,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
SHOULDER BILATERAL,7303050,CPT,320,RC,50,OUTPATIENT,,,696.25,278.5,AETNA,AETNA COMMERCIAL,682.325,98,,,OTHER,522.19,682.33,PERCENT OF TOTAL BILLED CHARGES
WRIST BILATERAL,7311050,CPT,320,RC,50,OUTPATIENT,,,490.5,196.2,AETNA,AETNA COMMERCIAL,480.69,98,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
KNEE BILATERAL,7356250,CPT,320,RC,50,OUTPATIENT,,,749.75,299.9,AETNA,AETNA COMMERCIAL,734.755,98,,,OTHER,562.31,734.76,PERCENT OF TOTAL BILLED CHARGES
HAND BILATERAL,7313050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,AETNA,AETNA COMMERCIAL,661.255,98,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
FOOT BILATERAL,7363050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,AETNA,AETNA COMMERCIAL,661.255,98,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
ELBOWS BILATERAL,7308050,CPT,320,RC,50,OUTPATIENT,,,633.5,253.4,AETNA,AETNA COMMERCIAL,620.83,98,,,OTHER,475.13,620.83,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS RT,73120RT,CPT,320,RC,RT,OUTPATIENT,,,217.19,86.876,AETNA,AETNA COMMERCIAL,212.8462,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS LT,73120LT,CPT,320,RC,LT,OUTPATIENT,,,217.19,86.876,AETNA,AETNA COMMERCIAL,212.8462,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS BILATERAL,73120,CPT,,,,OUTPATIENT,,,434.38,173.752,AETNA,AETNA COMMERCIAL,425.6924,98,,,OTHER,325.8,425.7,PERCENT OF TOTAL BILLED CHARGES
HIP 2 VIEW RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,AETNA,AETNA COMMERCIAL,306.25,98,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
HIP 2 VIEW LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,AETNA,AETNA COMMERCIAL,306.25,98,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
HIP/PELVIS CHILD 2 VIEWS,73502,CPT,320,RC,,OUTPATIENT,,,273.75,109.5,AETNA,AETNA COMMERCIAL,268.275,98,,,OTHER,205.31,268.28,PERCENT OF TOTAL BILLED CHARGES
HIP 1 VIEW RIGHT,73501RT,CPT,320,RC,RT,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
HIP 1 VIEW LEFT,73501LT,CPT,320,RC,LT,OUTPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
HIP ARTHROGRAM RT,73525RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
HIP ARTHROGRAM LT,73525LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,662.75,265.1,AETNA,AETNA COMMERCIAL,649.495,98,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
STEROID/CONTRAST INJECTION,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,AETNA,AETNA COMMERCIAL,649.495,98,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
STEROID/CONTRAST INJ LG JOINT,20610,CPT,320,RC,,OUTPATIENT,,,631,252.4,AETNA,AETNA COMMERCIAL,618.38,98,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT,2061050,CPT,320,RC,50,OUTPATIENT,,,1324.75,529.9,AETNA,AETNA COMMERCIAL,1298.255,98,,,OTHER,993.56,1298.26,PERCENT OF TOTAL BILLED CHARGES
HUMERUS AP/LAT RT,73060RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HUMERUS AP/LAT LT,73060LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,AETNA,AETNA COMMERCIAL,330.995,98,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HUMERUS BILATERAL,7306050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,AETNA,AETNA COMMERCIAL,661.255,98,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
HYSTEO INJECTION,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,AETNA,AETNA COMMERCIAL,509.355,98,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSALPINGOGRAM,74740,CPT,320,RC,,OUTPATIENT,,,458.69,183.476,AETNA,AETNA COMMERCIAL,449.5162,98,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
IVP LIMITED,7440052,CPT,,,52,OUTPATIENT,,,752.25,300.9,AETNA,AETNA COMMERCIAL,737.205,98,,,OTHER,564.19,737.21,PERCENT OF TOTAL BILLED CHARGES
FLUOROSCOPIC PROCEDURE,76496,CPT,320,RC,,OUTPATIENT,,,347.5,139,AETNA,AETNA COMMERCIAL,340.55,98,,,OTHER,260.63,340.55,PERCENT OF TOTAL BILLED CHARGES
KNEE 3 VIEWS RT,73562RT,CPT,320,RC,RT,OUTPATIENT,,,375,150,AETNA,AETNA COMMERCIAL,367.5,98,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
KNEE 3 VIEWS LT,73562LT,CPT,320,RC,LT,OUTPATIENT,,,375,150,AETNA,AETNA COMMERCIAL,367.5,98,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
KNEE 2 VIEWS RT,73560RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
KNEE 2 VIEWS LT,73560LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
KNEE ARTHROGRAPHY RT,73580RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
KNEE ARTHROGRAPHY LT,73580LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
KNEE 4 VIEWS RT,73564RT,CPT,320,RC,RT,OUTPATIENT,,,440.75,176.3,AETNA,AETNA COMMERCIAL,431.935,98,,,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
KNEE 4 VIEWS LT,73564LT,CPT,320,RC,LT,OUTPATIENT,,,440.75,176.3,AETNA,AETNA COMMERCIAL,431.935,98,,,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB RT,73590RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB LT,73590LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TIB FIB BILATERAL,7359050,CPT,320,RC,50,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB BILATERAL,73590,CPT,320,RC,,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
LUMBAR AP & LAT 2 OR 3 VIEWS,72100,CPT,320,RC,,OUTPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
LUMBAR 4 VIEWS,72110,CPT,320,RC,,OUTPATIENT,,,595,238,AETNA,AETNA COMMERCIAL,583.1,98,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
LUMBAR FLEX/EXT 5 VIEWS,72114,CPT,320,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
MANDIBLE 4 VIEWS,70110,CPT,320,RC,,OUTPATIENT,,,420.75,168.3,AETNA,AETNA COMMERCIAL,412.335,98,,,OTHER,315.56,412.34,PERCENT OF TOTAL BILLED CHARGES
MYELOGRAM/FLUOROSCOPY,72270,CPT,320,RC,,OUTPATIENT,,,2314,925.6,AETNA,AETNA COMMERCIAL,2267.72,98,,,OTHER,1735.5,2267.72,PERCENT OF TOTAL BILLED CHARGES
MYELOGRAM/FLUOROSCOPY,62284,CPT,350,RC,,OUTPATIENT,,,1052.5,421,AETNA,AETNA COMMERCIAL,1031.45,98,,,OTHER,789.38,1031.45,PERCENT OF TOTAL BILLED CHARGES
NECK SOFT TISSUE,70360,CPT,320,RC,,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOGRAM,50431,CPT,320,RC,,OUTPATIENT,,,1542.5,617,AETNA,AETNA COMMERCIAL,1511.65,98,,,OTHER,1156.88,1511.65,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOGRAM,74425,CPT,320,RC,,OUTPATIENT,,,814.25,325.7,AETNA,AETNA COMMERCIAL,797.965,98,,,OTHER,610.69,797.97,PERCENT OF TOTAL BILLED CHARGES
NASAL BONES,70160,CPT,320,RC,,OUTPATIENT,,,292,116.8,AETNA,AETNA COMMERCIAL,286.16,98,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
ORTHO ROENT,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,AETNA,AETNA COMMERCIAL,346.92,98,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
OR HIP RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,639.5,255.8,AETNA,AETNA COMMERCIAL,626.71,98,,,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
OBSTRUCTION REMOVAL FROM TUBE,49460,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
PELVIS 3 VIEWS,72190,CPT,320,RC,,OUTPATIENT,,,409.5,163.8,AETNA,AETNA COMMERCIAL,401.31,98,,,OTHER,307.13,401.31,PERCENT OF TOTAL BILLED CHARGES
PELVIS AP,72170,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,AETNA,AETNA COMMERCIAL,244.265,98,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
RIBS-UNILAT/PA CHEST 3 VWS LT,71101LT,CPT,320,RC,LT,OUTPATIENT,,,431.75,172.7,AETNA,AETNA COMMERCIAL,423.115,98,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
RIBS UNILATERAL 2 VIEWS,71100,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,AETNA,AETNA COMMERCIAL,423.115,98,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
RIBS UNILATERAL W/ 1 VIEW CHES,71101,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
RIBS BILATERAL,71110,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,AETNA,AETNA COMMERCIAL,522.83,98,,,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
RIBS BILATERAL W/ 1 VIEW CHEST,71111,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
RIBS-BILAT/PA CHEST 4 VIEWS,71111,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,AETNA,AETNA COMMERCIAL,522.83,98,,,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
RETROGRADE PYLEOGRAM,3202150,CDM,320,RC,,INPATIENT,,,595,238,AETNA,AETNA COMMERCIAL,583.1,98,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
SACRUM & COCCYX 2 VIEWS,72220,CPT,320,RC,,OUTPATIENT,,,362,144.8,AETNA,AETNA COMMERCIAL,354.76,98,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SACROILIAC REGION 3 VIEWS,72202,CPT,320,RC,,OUTPATIENT,,,458.5,183.4,AETNA,AETNA COMMERCIAL,449.33,98,,,OTHER,343.88,449.33,PERCENT OF TOTAL BILLED CHARGES
SMALL BOWEL SERIES,74250,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,AETNA,AETNA COMMERCIAL,740.145,98,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
SCAPULA RT,73010RT,CPT,320,RC,RT,OUTPATIENT,,,258.75,103.5,AETNA,AETNA COMMERCIAL,253.575,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
SCAPULA LT,73010LT,CPT,320,RC,LT,OUTPATIENT,,,258.75,103.5,AETNA,AETNA COMMERCIAL,253.575,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
STERNOCLAVICULAR JT 3 VIEWS,71130,CPT,320,RC,,OUTPATIENT,,,357,142.8,AETNA,AETNA COMMERCIAL,349.86,98,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
SCOLIOSIS AP,72082,CPT,320,RC,,OUTPATIENT,,,320.25,128.1,AETNA,AETNA COMMERCIAL,313.845,98,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 1 VIEW RT,73020RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 1 VIEW LT,73020LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
SHOULDER ARTHROGRAM RT,73040RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,AETNA,AETNA COMMERCIAL,785.225,98,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
SHOULDER ARTHROGRAM LT,73040LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,AETNA,AETNA COMMERCIAL,785.225,98,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 2 OR MORE VIEWS RT,73030RT,CPT,320,RC,RT,OUTPATIENT,,,348.5,139.4,AETNA,AETNA COMMERCIAL,341.53,98,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 2 OR MORE VIEWS LT,73030LT,CPT,320,RC,LT,OUTPATIENT,,,348.5,139.4,AETNA,AETNA COMMERCIAL,341.53,98,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
SHOULDER INJECT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,520.55,208.22,AETNA,AETNA COMMERCIAL,510.139,98,,,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
SHOULDER INJECT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,520.55,208.22,AETNA,AETNA COMMERCIAL,510.139,98,,,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR MRI ARTHRO RT,27093RT,CPT,320,RC,RT,OUTPATIENT,,,685,274,AETNA,AETNA COMMERCIAL,671.3,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR MR ARTHRO LT,27093LT,CPT,320,RC,LT,OUTPATIENT,,,685,274,AETNA,AETNA COMMERCIAL,671.3,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHROCENTISIS ASSIST ME,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
SHLDER INJ FOR MR/CT ARTHRO L,23350,CPT,,,,OUTPATIENT,,,598,239.2,AETNA,AETNA COMMERCIAL,586.04,98,,,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
SHLDER INJ FOR MR/CT ARTHRO R,23350,CPT,,,,OUTPATIENT,,,598,239.2,AETNA,AETNA COMMERCIAL,586.04,98,,,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
WRIST INJ FOR MR/CT ARTHRO LT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,AETNA,AETNA COMMERCIAL,571.34,98,,,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
WRIST INJ FOR MR/CR ARTHRO RT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,AETNA,AETNA COMMERCIAL,571.34,98,,,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
SHOULDER BILATERAL 1 VIEW,7302050,CPT,320,RC,50,OUTPATIENT,,,491,196.4,AETNA,AETNA COMMERCIAL,481.18,98,,,OTHER,368.25,481.18,PERCENT OF TOTAL BILLED CHARGES
SIALAGRAM,70390,CPT,320,RC,,OUTPATIENT,,,563.5,225.4,AETNA,AETNA COMMERCIAL,552.23,98,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
SINUS 1 VIEW,70210,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
SINUS 4 VIEWS,70220,CPT,320,RC,,OUTPATIENT,,,425,170,AETNA,AETNA COMMERCIAL,416.5,98,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
SKULL COMPLETE,70260,CPT,320,RC,,OUTPATIENT,,,542.25,216.9,AETNA,AETNA COMMERCIAL,531.405,98,,,OTHER,406.69,531.41,PERCENT OF TOTAL BILLED CHARGES
SKULL 3 VIEWS,70250,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,AETNA,AETNA COMMERCIAL,423.115,98,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
STERNUM 2 VIEWS,71120,CPT,320,RC,,OUTPATIENT,,,350.25,140.1,AETNA,AETNA COMMERCIAL,343.245,98,,,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
SPINE SINGLE VIEW,72020,CPT,320,RC,,OUTPATIENT,,,196,78.4,AETNA,AETNA COMMERCIAL,192.08,98,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
SPINE ENTIRE 1 VIEW,72081,CPT,,,,OUTPATIENT,,,196,78.4,AETNA,AETNA COMMERCIAL,192.08,98,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
TEMPEROMANDIBULAR JT,70328,CPT,320,RC,,OUTPATIENT,,,581.75,232.7,AETNA,AETNA COMMERCIAL,570.115,98,,,OTHER,436.31,570.12,PERCENT OF TOTAL BILLED CHARGES
TOE GREAT LT,73660TA,CPT,320,RC,TA,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 2ND DIGIT LT,73660T1,CPT,320,RC,T1,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 3RD DIGIT LT,73660T2,CPT,320,RC,T2,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 4TH DIGIT LT,73660T3,CPT,320,RC,T3,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 5TH DIGIT LT,73660T4,CPT,320,RC,T4,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE GREAT RT,73660T5,CPT,320,RC,T5,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 2ND DIGIT RT,73660T6,CPT,320,RC,T6,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 3RD DIGIT RT,73660T7,CPT,320,RC,T7,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 4TH DIGIT RT,73660T8,CPT,320,RC,T8,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 5TH DIGIT RT,73660T9,CPT,320,RC,T9,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
T-TUBE INJECTION,47505,CPT,320,RC,,OUTPATIENT,,,308,123.2,AETNA,AETNA COMMERCIAL,301.84,98,,,OTHER,231,301.84,PERCENT OF TOTAL BILLED CHARGES
THORACIC SPINE,72072,CPT,320,RC,,OUTPATIENT,,,375,150,AETNA,AETNA COMMERCIAL,367.5,98,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
THORACIC SPINE 2VIEWS,72070,CPT,320,RC,,OUTPATIENT,,,305.75,122.3,AETNA,AETNA COMMERCIAL,299.635,98,,,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
THORACOLUMBAR 2 VIEWS,72080,CPT,320,RC,,OUTPATIENT,,,375,150,AETNA,AETNA COMMERCIAL,367.5,98,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
UPPER GI SERIES,74240,CPT,320,RC,,OUTPATIENT,,,694.75,277.9,AETNA,AETNA COMMERCIAL,680.855,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
UGI/SMALL BOWEL-NO AIR,74240,CPT,320,RC,,OUTPATIENT,,,743.25,297.3,AETNA,AETNA COMMERCIAL,728.385,98,,,OTHER,557.44,728.39,PERCENT OF TOTAL BILLED CHARGES
X-RAY SM INT F-THRU STD,74248,CPT,320,RC,,OUTPATIENT,,,200,80,AETNA,AETNA COMMERCIAL,196,98,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
UPPER GI W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,760.75,304.3,AETNA,AETNA COMMERCIAL,745.535,98,,,OTHER,570.56,745.54,PERCENT OF TOTAL BILLED CHARGES
UPPER GI/SMALL BOWEL W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,785.75,314.3,AETNA,AETNA COMMERCIAL,770.035,98,,,OTHER,589.31,770.04,PERCENT OF TOTAL BILLED CHARGES
TUBE PLACEMENT FLUORO/FILM,74340,CPT,320,RC,,OUTPATIENT,,,440,176,AETNA,AETNA COMMERCIAL,431.2,98,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
URETHROCYSTOGRAPH,74450,CPT,320,RC,,OUTPATIENT,,,474.25,189.7,AETNA,AETNA COMMERCIAL,464.765,98,,,OTHER,355.69,464.77,PERCENT OF TOTAL BILLED CHARGES
URETHRA/BLADDER,74455,CPT,320,RC,,OUTPATIENT,,,1399,559.6,AETNA,AETNA COMMERCIAL,1371.02,98,,,OTHER,1049.25,1371.02,PERCENT OF TOTAL BILLED CHARGES
VENOGRAM UNILATERAL RT,75820RT,CPT,320,RC,RT,OUTPATIENT,,,2802.66,1121.064,AETNA,AETNA COMMERCIAL,2746.6068,98,,,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
VENOGRAM UNILATERAL LT,75820LT,CPT,320,RC,LT,OUTPATIENT,,,2802.66,1121.064,AETNA,AETNA COMMERCIAL,2746.6068,98,,,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
WRIST RT,73110RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
WRIST LT,73110LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,AETNA,AETNA COMMERCIAL,240.59,98,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
WRISTS BILAT 4 VIEWS ONLY,73100,CPT,,,,OUTPATIENT,,,491,196.4,AETNA,AETNA COMMERCIAL,481.18,98,,,OTHER,368.3,481.2,PERCENT OF TOTAL BILLED CHARGES
WRIST 2 VIEWS RT,73100RT,CPT,320,RC,RT,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
WRIST 2 VIEWS LT,73100LT,CPT,320,RC,LT,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
WRIST ARTHRO RT,73115RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
WRIST ARTHRO LT,73115LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,AETNA,AETNA COMMERCIAL,719.0456,98,,,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
"LUMBAR AP,FLEX/EXT",72120,CPT,320,RC,,OUTPATIENT,,,215.38,86.152,AETNA,AETNA COMMERCIAL,211.0724,98,,,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
FOREIGN BODY EVALUATION  CHILD,76010,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,AETNA,AETNA COMMERCIAL,261.905,98,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
X-RAY XM SWLNG FUNCJ C+,74230,CPT,320,RC,,OUTPATIENT,,,363.42,145.368,AETNA,AETNA COMMERCIAL,356.1516,98,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE CHANGE FLUORO,50435,CPT,361,RC,,OUTPATIENT,,,3738.02,1495.208,AETNA,AETNA COMMERCIAL,3663.2596,98,,,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
ANKLE BILATERAL 4 VIEWS,73600,CPT,,,,OUTPATIENT,,,350.16,140.064,AETNA,AETNA COMMERCIAL,343.1568,98,,,OTHER,262.6,343.2,PERCENT OF TOTAL BILLED CHARGES
US PICC LINE PLACEMENT,36569,CPT,361,RC,,OUTPATIENT,,,2033,813.2,AETNA,AETNA COMMERCIAL,1992.34,98,,,OTHER,1524.75,1992.34,PERCENT OF TOTAL BILLED CHARGES
CHEST DECUBITUS,71046,CPT,320,RC,,OUTPATIENT,,,243.5,97.4,AETNA,AETNA COMMERCIAL,238.63,98,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
ORBITS FOR MRI,70030,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,AETNA,AETNA COMMERCIAL,261.905,98,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
ORBITS,70190,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,AETNA,AETNA COMMERCIAL,261.905,98,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
FLURO,36573,CPT,320,RC,,OUTPATIENT,,,660.75,264.3,AETNA,AETNA COMMERCIAL,647.535,98,,,OTHER,495.56,647.54,PERCENT OF TOTAL BILLED CHARGES
DEXA HIPS/PELVIS/SPINE,77080XU,CPT,320,RC,XU,OUTPATIENT,,,428,171.2,AETNA,AETNA COMMERCIAL,419.44,98,,,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
DEXA RADIUS/WRIST/HEEL,77081,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL I,3210001,CDM,320,RC,,INPATIENT,,,856.5,342.6,AETNA,AETNA COMMERCIAL,839.37,98,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL II,3210002,CDM,320,RC,,INPATIENT,,,1497.75,599.1,AETNA,AETNA COMMERCIAL,1467.795,98,,,OTHER,1123.31,1467.8,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL III,3210003,CDM,361,RC,,INPATIENT,,,2139.5,855.8,AETNA,AETNA COMMERCIAL,2096.71,98,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL IV,3210004,CDM,320,RC,,INPATIENT,,,2781,1112.4,AETNA,AETNA COMMERCIAL,2725.38,98,,,OTHER,2085.75,2725.38,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL V,3210005,CDM,320,RC,,INPATIENT,,,3422,1368.8,AETNA,AETNA COMMERCIAL,3353.56,98,,,OTHER,2566.5,3353.56,PERCENT OF TOTAL BILLED CHARGES
BONE BIOPSY TROCAR/NEEDLE,20220,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,AETNA,AETNA COMMERCIAL,2096.71,98,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
BONE BIOPSY TROCAR/NEEDLE DEEP,20225,CPT,321,RC,,OUTPATIENT,,,2139.5,855.8,AETNA,AETNA COMMERCIAL,2096.71,98,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
XRAY SHOULDER INJECTION,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,AETNA,AETNA COMMERCIAL,522.095,98,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
XRAY SHOULDER INJECTION RT,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,AETNA,AETNA COMMERCIAL,522.095,98,,,OTHER,399.6,522.1,PERCENT OF TOTAL BILLED CHARGES
XRAY WRIST INJECTION,25246,CPT,320,RC,,OUTPATIENT,,,532.75,213.1,AETNA,AETNA COMMERCIAL,522.095,98,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED FACET JOINT INJ,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,AETNA,AETNA COMMERCIAL,1664.334,98,,,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
REFILL MAINTAIN PUMP,96521,CPT,760,RC,,OUTPATIENT,,,604.75,241.9,AETNA,AETNA COMMERCIAL,592.655,98,,,OTHER,453.56,592.66,PERCENT OF TOTAL BILLED CHARGES
INTRAVESICAL CHEMO ADMIN,51720,CPT,331,RC,,OUTPATIENT,,,1252.97,501.188,AETNA,AETNA COMMERCIAL,1227.9106,98,,,OTHER,939.73,1227.91,PERCENT OF TOTAL BILLED CHARGES
CHEMO IV PUSH ADD'L DRUG,96411,CPT,331,RC,,OUTPATIENT,,,491.75,196.7,AETNA,AETNA COMMERCIAL,481.915,98,,,OTHER,368.81,481.92,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP SNGL/INT LVL I,96409,CPT,331,RC,,OUTPATIENT,,,602,240.8,AETNA,AETNA COMMERCIAL,589.96,98,,,OTHER,451.5,589.96,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP SNGL/INT LVL II,96409,CPT,331,RC,,OUTPATIENT,,,534,213.6,AETNA,AETNA COMMERCIAL,523.32,98,,,OTHER,400.5,523.32,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP PICC LVL III,96409,CPT,331,RC,,OUTPATIENT,,,468.25,187.3,AETNA,AETNA COMMERCIAL,458.885,98,,,OTHER,351.19,458.89,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP PICC LVL IV,96409,CPT,331,RC,,OUTPATIENT,,,520.25,208.1,AETNA,AETNA COMMERCIAL,509.845,98,,,OTHER,390.19,509.85,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION CHEMO EA ADD'L HR,96415,CPT,335,RC,,OUTPATIENT,,,148.75,59.5,AETNA,AETNA COMMERCIAL,145.775,98,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
EA ADD'L/SEQ INFUSED CHEMO<1HR,96417,CPT,335,RC,,OUTPATIENT,,,159.25,63.7,AETNA,AETNA COMMERCIAL,156.065,98,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL I,96413,CPT,335,RC,,OUTPATIENT,,,793.25,317.3,AETNA,AETNA COMMERCIAL,777.385,98,,,OTHER,594.94,777.39,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL II,96413,CPT,335,RC,,OUTPATIENT,,,694,277.6,AETNA,AETNA COMMERCIAL,680.12,98,,,OTHER,520.5,680.12,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL III,96413,CPT,335,RC,,OUTPATIENT,,,740.75,296.3,AETNA,AETNA COMMERCIAL,725.935,98,,,OTHER,555.56,725.94,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL IV,96413,CPT,335,RC,,OUTPATIENT,,,662,264.8,AETNA,AETNA COMMERCIAL,648.76,98,,,OTHER,496.5,648.76,PERCENT OF TOTAL BILLED CHARGES
CYSTOGRAM,78740,CPT,340,RC,,OUTPATIENT,,,1170.75,468.3,AETNA,AETNA COMMERCIAL,1147.335,98,,,OTHER,878.06,1147.34,PERCENT OF TOTAL BILLED CHARGES
THYROID CARCINOMA MET IMAGING,78018,CPT,340,RC,,OUTPATIENT,,,1658,663.2,AETNA,AETNA COMMERCIAL,1624.84,98,,,OTHER,1243.5,1624.84,PERCENT OF TOTAL BILLED CHARGES
CEREBROSPINAL FLUID FLOW IMAGE,78630,CPT,340,RC,,OUTPATIENT,,,3353,1341.2,AETNA,AETNA COMMERCIAL,3285.94,98,,,OTHER,2514.75,3285.94,PERCENT OF TOTAL BILLED CHARGES
CAPTOPRIL RENAL,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,AETNA,AETNA COMMERCIAL,1638.315,98,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
BONE IMAGING LIMITED (BONL),78300,CPT,341,RC,,OUTPATIENT,,,1688.25,675.3,AETNA,AETNA COMMERCIAL,1654.485,98,,,OTHER,1266.19,1654.49,PERCENT OF TOTAL BILLED CHARGES
BONE WHOLE BODY (BONW),78306,CPT,341,RC,,OUTPATIENT,,,1814.25,725.7,AETNA,AETNA COMMERCIAL,1777.965,98,,,OTHER,1360.69,1777.97,PERCENT OF TOTAL BILLED CHARGES
BONE IMAGING 3 PHASE (BON3),78315,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,AETNA,AETNA COMMERCIAL,1638.315,98,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
TAGGED RBC GI BLEED (TRBC),78278,CPT,341,RC,,OUTPATIENT,,,2035,814,AETNA,AETNA COMMERCIAL,1994.3,98,,,OTHER,1526.25,1994.3,PERCENT OF TOTAL BILLED CHARGES
HIDA W/O,78226,CPT,341,RC,,OUTPATIENT,,,952.25,380.9,AETNA,AETNA COMMERCIAL,933.205,98,,,OTHER,714.19,933.21,PERCENT OF TOTAL BILLED CHARGES
VQ SCAN VENT/PERFUSION,78598,CPT,341,RC,,OUTPATIENT,,,1837,734.8,AETNA,AETNA COMMERCIAL,1800.26,98,,,OTHER,1377.75,1800.26,PERCENT OF TOTAL BILLED CHARGES
HIDA W/CCK,78227,CPT,341,RC,,OUTPATIENT,,,1721.75,688.7,AETNA,AETNA COMMERCIAL,1687.315,98,,,OTHER,1291.31,1687.32,PERCENT OF TOTAL BILLED CHARGES
LUNG PERFUSION,78580,CPT,341,RC,,OUTPATIENT,,,1403.5,561.4,AETNA,AETNA COMMERCIAL,1375.43,98,,,OTHER,1052.63,1375.43,PERCENT OF TOTAL BILLED CHARGES
LUNG VENTILATION,78582,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,AETNA,AETNA COMMERCIAL,1638.315,98,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
MECKLES IMAGING (MECK),78290,CPT,341,RC,,OUTPATIENT,,,1462,584.8,AETNA,AETNA COMMERCIAL,1432.76,98,,,OTHER,1096.5,1432.76,PERCENT OF TOTAL BILLED CHARGES
RENAL FLOW/FUNCTION,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,AETNA,AETNA COMMERCIAL,1638.315,98,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
THYROID IMAGING ONLY (THYI),78013,CPT,341,RC,,OUTPATIENT,,,751.66,300.664,AETNA,AETNA COMMERCIAL,736.6268,98,,,OTHER,491.81,642.64,PERCENT OF TOTAL BILLED CHARGES
THYROID UPTAKE W/MULT DETE,78012,CPT,341,RC,,OUTPATIENT,,,1586,634.4,AETNA,AETNA COMMERCIAL,1554.28,98,,,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
BONE SPECT (BNSP),78320,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,AETNA,AETNA COMMERCIAL,1358.035,98,,,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
GASTRO EMPTYING STUDY (GASE),78264,CPT,341,RC,,OUTPATIENT,,,1586,634.4,AETNA,AETNA COMMERCIAL,1554.28,98,,,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
LIVER/SPLEEN IMAGING W/FLOW,78216,CPT,341,RC,,OUTPATIENT,,,1237.5,495,AETNA,AETNA COMMERCIAL,1212.75,98,,,OTHER,928.13,1212.75,PERCENT OF TOTAL BILLED CHARGES
LIVER (SPECT) (LIVS),78205,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,AETNA,AETNA COMMERCIAL,1358.035,98,,,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
LYMPH GLAND INJECTION,78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,AETNA,AETNA COMMERCIAL,1738.03,98,,,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERFUSION,78452,CPT,341,RC,,OUTPATIENT,,,3980.75,1592.3,AETNA,AETNA COMMERCIAL,3901.135,98,,,OTHER,2985.56,3901.14,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERF WALL MOTION,78453,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,AETNA,AETNA COMMERCIAL,2550.891,98,,,OTHER,931.69,1217.41,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERF EJECTION FRACT,78496,CPT,341,RC,,OUTPATIENT,,,811.25,324.5,AETNA,AETNA COMMERCIAL,795.025,98,,,OTHER,608.44,795.03,PERCENT OF TOTAL BILLED CHARGES
MUGA SCAN,78472,CPT,341,RC,,OUTPATIENT,,,2449,979.6,AETNA,AETNA COMMERCIAL,2400.02,98,,,OTHER,1836.75,2400.02,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID IMAGING,78070,CPT,341,RC,,OUTPATIENT,,,1799,719.6,AETNA,AETNA COMMERCIAL,1763.02,98,,,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
SPECT,78807,CPT,340,RC,,OUTPATIENT,,,2279.5,911.8,AETNA,AETNA COMMERCIAL,2233.91,98,,,OTHER,1709.63,2233.91,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID IMAGING WITH SPECT,78071,CPT,341,RC,,OUTPATIENT,,,1984.5,793.8,AETNA,AETNA COMMERCIAL,1944.81,98,,,OTHER,1488.38,1944.81,PERCENT OF TOTAL BILLED CHARGES
TUMOR LOCAL WHOLE BODY,78804,CPT,341,RC,,OUTPATIENT,,,2752,1100.8,AETNA,AETNA COMMERCIAL,2696.96,98,,,OTHER,2064,2696.96,PERCENT OF TOTAL BILLED CHARGES
TUMOR LOCAL (LTD) (TLLT),78800,CPT,341,RC,,OUTPATIENT,,,1799,719.6,AETNA,AETNA COMMERCIAL,1763.02,98,,,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC (LTD) (TWBL),78805,CPT,341,RC,,OUTPATIENT,,,3635,1454,AETNA,AETNA COMMERCIAL,3562.3,98,,,OTHER,2726.25,3562.3,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC WHOLE BODY (TWBW),78806,CPT,341,RC,,OUTPATIENT,,,3823,1529.2,AETNA,AETNA COMMERCIAL,3746.54,98,,,OTHER,2867.25,3746.54,PERCENT OF TOTAL BILLED CHARGES
LIVER IMAGING SPECT W/FLOW,78206,CPT,340,RC,,OUTPATIENT,,,1589.75,635.9,AETNA,AETNA COMMERCIAL,1557.955,98,,,OTHER,1192.31,1557.96,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC SPECT (TWBS),78807,CPT,340,RC,,OUTPATIENT,,,4529,1811.6,AETNA,AETNA COMMERCIAL,4438.42,98,,,OTHER,3396.75,4438.42,PERCENT OF TOTAL BILLED CHARGES
PET SCAN LIMITED INITIAL,78814PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
LOCAL TUMOR ONCOSCENT IN 111,78802,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,AETNA,AETNA COMMERCIAL,2550.891,98,,,OTHER,1386.75,1812.02,PERCENT OF TOTAL BILLED CHARGES
PET SCAN SKULL TO THIGH INITAL,78815PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
BRAIN IMAGINE WITH FLOW,78606,CPT,341,RC,,OUTPATIENT,,,1544.75,617.9,AETNA,AETNA COMMERCIAL,1513.855,98,,,OTHER,1158.56,1513.86,PERCENT OF TOTAL BILLED CHARGES
PET SCAN WHOLE BODY INITIAL,78816PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN LIMITED SUBSEQUENT,78814PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN WHOLE BODY SUBSEQUENT,78816PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN PROSTATE,78815,CPT,404,RC,,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.8,PERCENT OF TOTAL BILLED CHARGES
PET SCAN SKULL-THIGH SUBSEQUET,78815PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,AETNA,AETNA COMMERCIAL,8194.76,98,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
LYMPHOSCINTIGRAPHY (LYSC),78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,AETNA,AETNA COMMERCIAL,1738.03,98,,,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
ABDOMINAL SCINTIGRAPHY,78999,CPT,341,RC,,OUTPATIENT,,,1575,630,AETNA,AETNA COMMERCIAL,1543.5,98,,,OTHER,1181.25,1543.5,PERCENT OF TOTAL BILLED CHARGES
TC99M PERTECHNETATE,A9512,HCPCS,343,RC,,INPATIENT,,,142.5,57,AETNA,AETNA COMMERCIAL,139.65,98,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M DISOFENIN,A9510,HCPCS,343,RC,,INPATIENT,,,169.75,67.9,AETNA,AETNA COMMERCIAL,166.355,98,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
TC99M MAA,A9540,HCPCS,343,RC,,INPATIENT,,,142.5,57,AETNA,AETNA COMMERCIAL,139.65,98,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M BICISATE,A9557,HCPCS,343,RC,,INPATIENT,,,142.5,57,AETNA,AETNA COMMERCIAL,139.65,98,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M MERTIATIDE,A9562,HCPCS,343,RC,,INPATIENT,,,720.5,288.2,AETNA,AETNA COMMERCIAL,706.09,98,,,OTHER,540.38,706.09,PERCENT OF TOTAL BILLED CHARGES
IODINE I-123 SOD IODIDE,A9584,HCPCS,343,RC,,INPATIENT,,,234,93.6,AETNA,AETNA COMMERCIAL,229.32,98,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,142.5,57,AETNA,AETNA COMMERCIAL,139.65,98,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M SULFUR COLLOID,A9541,HCPCS,343,RC,,INPATIENT,,,259.25,103.7,AETNA,AETNA COMMERCIAL,254.065,98,,,OTHER,194.44,254.07,PERCENT OF TOTAL BILLED CHARGES
TC99M SESTAMIBI (ONE DOSE),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,AETNA,AETNA COMMERCIAL,599.27,98,,,OTHER,458.63,599.27,PERCENT OF TOTAL BILLED CHARGES
TC99M SESTAMIBI (2 DOSES),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,AETNA,AETNA COMMERCIAL,599.27,98,,,OTHER,458.63,599.27,PERCENT OF TOTAL BILLED CHARGES
GA67 GALLIUM,A9556,HCPCS,343,RC,,INPATIENT,,,275,110,AETNA,AETNA COMMERCIAL,269.5,98,,,OTHER,206.25,269.5,PERCENT OF TOTAL BILLED CHARGES
IN111 OXYQUINOLINE,A9547,HCPCS,343,RC,,INPATIENT,,,2250.5,900.2,AETNA,AETNA COMMERCIAL,2205.49,98,,,OTHER,1687.88,2205.49,PERCENT OF TOTAL BILLED CHARGES
IN111 PENTERTEOTIDE,A9572,HCPCS,343,RC,,INPATIENT,,,4420.25,1768.1,AETNA,AETNA COMMERCIAL,4331.845,98,,,OTHER,3315.19,4331.85,PERCENT OF TOTAL BILLED CHARGES
CT AORTA,74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,AETNA,AETNA COMMERCIAL,1976.17,98,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT CALCIUM SCORING,75571,CPT,,,,OUTPATIENT,,,172,68.8,AETNA,AETNA COMMERCIAL,168.56,98,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS ANGIO W/RUNOFF,75635,CPT,350,RC,,OUTPATIENT,,,3501.5,1400.6,AETNA,AETNA COMMERCIAL,3431.47,98,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS ANGIO W/RUNOFF,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,AETNA,AETNA COMMERCIAL,3431.47,98,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS W/CONT (ABPE),74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,AETNA,AETNA COMMERCIAL,3657.115,98,,,OTHER,2798.81,3657.12,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/WO CONT (ABDB),74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,AETNA,AETNA COMMERCIAL,2242.975,98,,,OTHER,1716.56,2242.98,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/WO CONTRAST,74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,AETNA,AETNA COMMERCIAL,2242.975,98,,,OTHER,1716.56,2242.98,PERCENT OF TOTAL BILLED CHARGES
CT BONE LENGTH SCANOGRAM,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,AETNA,AETNA COMMERCIAL,346.92,98,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
CT CHOLECYSTOSTOMY W DRAIN,47533,CPT,350,RC,,OUTPATIENT,,,6430.08,2572.032,AETNA,AETNA COMMERCIAL,6301.4784,98,,,OTHER,3633.94,4748.35,PERCENT OF TOTAL BILLED CHARGES
LOWDOSE LUNG SCREENING,G0297,HCPCS,350,RC,,BOTH,,,1563.5,625.4,AETNA,AETNA COMMERCIAL,1532.23,98,,,OTHER,1172.63,1532.23,PERCENT OF TOTAL BILLED CHARGES
CT FIDUCIAL MARKER PLACEMENT,32553,CPT,760,RC,,OUTPATIENT,,,2515.73,1006.292,AETNA,AETNA COMMERCIAL,2465.4154,98,,,OTHER,1541.25,2013.9,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO BILATERAL,7320650,CPT,350,RC,50,OUTPATIENT,,,3097.5,1239,AETNA,AETNA COMMERCIAL,3035.55,98,,,OTHER,2323.13,3035.55,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/CONT (ABDW),74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,AETNA,AETNA COMMERCIAL,1956.815,98,,,OTHER,1497.56,1956.82,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/CONTRAST,74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,AETNA,AETNA COMMERCIAL,1956.815,98,,,OTHER,1497.56,1956.82,PERCENT OF TOTAL BILLED CHARGES
CT ADRENAL CORE BX,60699,CPT,,,,OUTPATIENT,,,1513,605.2,AETNA,AETNA COMMERCIAL,1482.74,98,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
CT ADRENAL CORE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,2275,910,AETNA,AETNA COMMERCIAL,2229.5,98,,,OTHER,1706.25,2229.5,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496QQ,CPT,350,RC,QQ,OUTPATIENT,,,2275,910,AETNA,AETNA COMMERCIAL,2229.5,98,,,OTHER,1706.25,2229.5,PERCENT OF TOTAL BILLED CHARGES
CT ABD AND PELVIS W CONTRAST,74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,AETNA,AETNA COMMERCIAL,3657.115,98,,,OTHER,2798.81,3657.12,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/WO CONTRAST,74178QQ,CPT,350,RC,QQ,OUTPATIENT,,,4262.75,1705.1,AETNA,AETNA COMMERCIAL,4177.495,98,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/O CONTRAST,74176QQ,CPT,350,RC,QQ,OUTPATIENT,,,3079.5,1231.8,AETNA,AETNA COMMERCIAL,3017.91,98,,,OTHER,2309.63,3017.91,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/WO CONTRAST,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,AETNA,AETNA COMMERCIAL,4177.495,98,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/O CONTRAST (ABWO),74150,CPT,350,RC,,OUTPATIENT,,,1705.25,682.1,AETNA,AETNA COMMERCIAL,1671.145,98,,,OTHER,1278.94,1671.15,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PEL W/O,74176,CPT,350,RC,,OUTPATIENT,,,3079.5,1231.8,AETNA,AETNA COMMERCIAL,3017.91,98,,,OTHER,2309.63,3017.91,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PEL W/WO HEMATURIA(APWW,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,AETNA,AETNA COMMERCIAL,4177.495,98,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABSCESS DRAINAGE W/CATH,49406,CPT,361,RC,,OUTPATIENT,,,4165.75,1666.3,AETNA,AETNA COMMERCIAL,4082.435,98,,,OTHER,3124.31,4082.44,PERCENT OF TOTAL BILLED CHARGES
CT ABSCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,AETNA,AETNA COMMERCIAL,729.12,98,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE PLACEMENT,50432,CPT,361,RC,,OUTPATIENT,,,2752.75,1101.1,AETNA,AETNA COMMERCIAL,2697.695,98,,,OTHER,2064.56,2697.7,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ LEVEL 1,64493,CPT,350,RC,,OUTPATIENT,,,1777.25,710.9,AETNA,AETNA COMMERCIAL,1741.705,98,,,OTHER,1332.94,1741.71,PERCENT OF TOTAL BILLED CHARGES
CT CHEST TUBE PLCMT FOR ABCESS,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
CT CHEST TUBE PLCMT FOR PNEUMO,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
CT NECK/CHEST BIOPSY,21550,CPT,350,RC,,OUTPATIENT,,,1862.25,744.9,AETNA,AETNA COMMERCIAL,1825.005,98,,,OTHER,1396.69,1825.01,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/O CONT,70480,CPT,350,RC,,OUTPATIENT,,,1659.5,663.8,AETNA,AETNA COMMERCIAL,1626.31,98,,,OTHER,1244.63,1626.31,PERCENT OF TOTAL BILLED CHARGES
LUMBAR INJECTION CT MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,825,330,AETNA,AETNA COMMERCIAL,808.5,98,,,OTHER,618.75,808.5,PERCENT OF TOTAL BILLED CHARGES
LUMBAR INJECTION FOR MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,2329,931.6,AETNA,AETNA COMMERCIAL,2282.42,98,,,OTHER,1746.75,2282.42,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE CT MYELOGRAM,72265,CPT,320,RC,,OUTPATIENT,,,2314,925.6,AETNA,AETNA COMMERCIAL,2267.72,98,,,OTHER,1735.5,2267.72,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAIN W/CATH ST,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,AETNA,AETNA COMMERCIAL,729.12,98,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
LUMBAR SPINE W/WO CONTRAST,72133,CPT,350,RC,,OUTPATIENT,,,2495,998,AETNA,AETNA COMMERCIAL,2445.1,98,,,OTHER,1871.25,2445.1,PERCENT OF TOTAL BILLED CHARGES
LUMBAR SPINE W/CONTRAST,72132,CPT,350,RC,,OUTPATIENT,,,2145.25,858.1,AETNA,AETNA COMMERCIAL,2102.345,98,,,OTHER,1608.94,2102.35,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/CONT (IACW),70481,CPT,350,RC,,OUTPATIENT,,,2050.75,820.3,AETNA,AETNA COMMERCIAL,2009.735,98,,,OTHER,1538.06,2009.74,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/CONTRAST,70481QQ,CPT,350,RC,QQ,OUTPATIENT,,,2050.75,820.3,AETNA,AETNA COMMERCIAL,2009.735,98,,,OTHER,1538.06,2009.74,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE CHANGE,50435,CPT,361,RC,,OUTPATIENT,,,1839.5,735.8,AETNA,AETNA COMMERCIAL,1802.71,98,,,OTHER,1379.63,1802.71,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/WO CNT(IAWW,70482,CPT,350,RC,,OUTPATIENT,,,2516,1006.4,AETNA,AETNA COMMERCIAL,2465.68,98,,,OTHER,1887,2465.68,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/WO CONTRAST,70482QQ,CPT,350,RC,QQ,OUTPATIENT,,,2516,1006.4,AETNA,AETNA COMMERCIAL,2465.68,98,,,OTHER,1887,2465.68,PERCENT OF TOTAL BILLED CHARGES
CT THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,AETNA,AETNA COMMERCIAL,1925.7,98,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CORE BX (RNBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,AETNA,AETNA COMMERCIAL,1666.49,98,,,OTHER,1275.38,1666.49,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
ASPIRATION OF BLADDER,51102,CPT,350,RC,,OUTPATIENT,,,2759,1103.6,AETNA,AETNA COMMERCIAL,2703.82,98,,,OTHER,2069.25,2703.82,PERCENT OF TOTAL BILLED CHARGES
CT FNA W/IMAGE GUIDANCE,10009,CPT,350,RC,,OUTPATIENT,,,3220.25,1288.1,AETNA,AETNA COMMERCIAL,3155.845,98,,,OTHER,2415.19,3155.85,PERCENT OF TOTAL BILLED CHARGES
CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
CT ASPIRATION GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE LT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,AETNA,AETNA COMMERCIAL,862.1452,98,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE RT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,AETNA,AETNA COMMERCIAL,862.1452,98,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE BI,73706,CPT,,,,OUTPATIENT,,,1319.61,527.844,AETNA,AETNA COMMERCIAL,1293.2178,98,,,OTHER,989.7,1293.2,PERCENT OF TOTAL BILLED CHARGES
CT FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,AETNA,AETNA COMMERCIAL,1316.63,98,,,OTHER,1007.63,1316.63,PERCENT OF TOTAL BILLED CHARGES
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,AETNA,AETNA COMMERCIAL,2406.145,98,,,OTHER,1841.44,2406.15,PERCENT OF TOTAL BILLED CHARGES
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,AETNA,AETNA COMMERCIAL,2406.145,98,,,OTHER,1841.44,2406.15,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE FOR INJECTION,77012,CPT,350,RC,,OUTPATIENT,,,1062,424.8,AETNA,AETNA COMMERCIAL,1040.76,98,,,OTHER,796.5,1040.76,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,AETNA,AETNA COMMERCIAL,1869.84,98,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO PARATHYROID W/WO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,AETNA,AETNA COMMERCIAL,1869.84,98,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/CONTRAST,72126,CPT,350,RC,,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW BIOPSY,38221,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,AETNA,AETNA COMMERCIAL,2096.71,98,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW BX & ASP SAME SITE,38222,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,AETNA,AETNA COMMERCIAL,2096.71,98,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O CNT(CSWO,72125,CPT,350,RC,,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O CONTRAST,72125QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O & W/DYE,72127,CPT,352,RC,,OUTPATIENT,,,3099,1239.6,AETNA,AETNA COMMERCIAL,3037.02,98,,,OTHER,2324.3,3037,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1868,747.2,AETNA,AETNA COMMERCIAL,1830.64,98,,,OTHER,1401,1830.64,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE NEEDLE PLMNT,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT NEEDLE CYST ASPIRATION,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT NEEDLE BIOPSY (NDBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/WO CONTRAST (HDWW),70470,CPT,350,RC,,OUTPATIENT,,,2113.75,845.5,AETNA,AETNA COMMERCIAL,2071.475,98,,,OTHER,1585.31,2071.48,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/WO CONTRAST,70470QQ,CPT,350,RC,QQ,OUTPATIENT,,,2113.75,845.5,AETNA,AETNA COMMERCIAL,2071.475,98,,,OTHER,1585.31,2071.48,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/CONTRAST (HDWC),70460,CPT,350,RC,,OUTPATIENT,,,1877.5,751,AETNA,AETNA COMMERCIAL,1839.95,98,,,OTHER,1408.13,1839.95,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/CONTRAST,70460QQ,CPT,350,RC,QQ,OUTPATIENT,,,1877.5,751,AETNA,AETNA COMMERCIAL,1839.95,98,,,OTHER,1408.13,1839.95,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,945,378,AETNA,AETNA COMMERCIAL,926.1,98,,,OTHER,708.75,926.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,1470,588,AETNA,AETNA COMMERCIAL,1440.6,98,,,OTHER,1102.5,1440.6,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/O CONTRAST (HDWO),70450,CPT,350,RC,,OUTPATIENT,,,1525,610,AETNA,AETNA COMMERCIAL,1494.5,98,,,OTHER,1143.75,1494.5,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO RIGHT,73206RT,CPT,350,RC,RT,OUTPATIENT,,,2069.75,827.9,AETNA,AETNA COMMERCIAL,2028.355,98,,,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO LEFT,73206LT,CPT,350,RC,LT,OUTPATIENT,,,2069.75,827.9,AETNA,AETNA COMMERCIAL,2028.355,98,,,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE CHANGE BIL,5043550,CPT,350,RC,50,OUTPATIENT,,,3200,1280,AETNA,AETNA COMMERCIAL,3136,98,,,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT RT,73701,CPT,350,RC,,OUTPATIENT,,,2437.25,974.9,AETNA,AETNA COMMERCIAL,2388.505,98,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT RT,73701QQ,CPT,350,RC,QQ,OUTPATIENT,,,2437.25,974.9,AETNA,AETNA COMMERCIAL,2388.505,98,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,AETNA,AETNA COMMERCIAL,2388.505,98,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,AETNA,AETNA COMMERCIAL,2388.505,98,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT BI,7370050,CPT,350,RC,50,OUTPATIENT,,,3125.75,1250.3,AETNA,AETNA COMMERCIAL,3063.235,98,,,OTHER,2344.31,3063.24,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT RT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,AETNA,AETNA COMMERCIAL,1555.995,98,,,OTHER,1475.81,1928.4,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT RT,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,AETNA,AETNA COMMERCIAL,1555.995,98,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT LT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,AETNA,AETNA COMMERCIAL,1555.995,98,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT RT,73201,CPT,350,RC,,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT RT,73201QQ,CPT,350,RC,QQ,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT LT,73201LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT LT,73201LTQQ,CPT,350,RC,LTQQ,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT LIVER NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS CORE BX,48102,CPT,361,RC,,OUTPATIENT,,,2769,1107.6,AETNA,AETNA COMMERCIAL,2713.62,98,,,OTHER,2076.75,2713.62,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3179.75,1271.9,AETNA,AETNA COMMERCIAL,3116.155,98,,,OTHER,2384.81,3116.16,PERCENT OF TOTAL BILLED CHARGES
CT LUNG FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3360,1344,AETNA,AETNA COMMERCIAL,3292.8,98,,,OTHER,2520,3292.8,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR HIP LT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,AETNA,AETNA COMMERCIAL,671.3,98,,,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR HIP CT RIGHT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,AETNA,AETNA COMMERCIAL,671.3,98,,,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
CT LUMBAR SPINE W/O CONT (LSWO,72131,CPT,350,RC,,OUTPATIENT,,,1769.25,707.7,AETNA,AETNA COMMERCIAL,1733.865,98,,,OTHER,1326.94,1733.87,PERCENT OF TOTAL BILLED CHARGES
CT LUMBAR SPINE W/O CONTRAST,72131QQ,CPT,350,RC,QQ,OUTPATIENT,,,1831.5,732.6,AETNA,AETNA COMMERCIAL,1794.87,98,,,OTHER,1373.63,1794.87,PERCENT OF TOTAL BILLED CHARGES
CT MYELOGRAM,72131,CPT,350,RC,,OUTPATIENT,,,2626.5,1050.6,AETNA,AETNA COMMERCIAL,2573.97,98,,,OTHER,1969.88,2573.97,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER DISLOCATION RT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,AETNA,AETNA COMMERCIAL,1144.64,98,,,OTHER,876,1144.64,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER DISLOCATION LT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,AETNA,AETNA COMMERCIAL,1144.64,98,,,OTHER,876,1144.64,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/O CONT,70486,CPT,350,RC,,OUTPATIENT,,,1200,480,AETNA,AETNA COMMERCIAL,1176,98,,,OTHER,900,1176,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/O CONTRAST,70486QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
MAXILLOFACIAL W/WO,70488,CPT,350,RC,,OUTPATIENT,,,1300,520,AETNA,AETNA COMMERCIAL,1274,98,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/CONT(MFWC),70487,CPT,350,RC,,OUTPATIENT,,,1250,500,AETNA,AETNA COMMERCIAL,1225,98,,,OTHER,937.5,1225,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/CONTRAST,70487QQ,CPT,350,RC,QQ,OUTPATIENT,,,2224.5,889.8,AETNA,AETNA COMMERCIAL,2180.01,98,,,OTHER,1668.38,2180.01,PERCENT OF TOTAL BILLED CHARGES
CT SINUS (SINU),70486,CPT,350,RC,,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT SINUS  W/O LIMITED,76380QQ,CPT,350,RC,QQ,OUTPATIENT,,,776.5,310.6,AETNA,AETNA COMMERCIAL,760.97,98,,,OTHER,582.38,760.97,PERCENT OF TOTAL BILLED CHARGES
CT SINUS LIMITED,76380,CPT,350,RC,,OUTPATIENT,,,776.5,310.6,AETNA,AETNA COMMERCIAL,760.97,98,,,OTHER,582.38,760.97,PERCENT OF TOTAL BILLED CHARGES
CT LUNG/MEDIASTINUM CORE BX,3500390,CDM,,,,INPATIENT,,,1198.25,479.3,AETNA,AETNA COMMERCIAL,1174.285,98,,,OTHER,898.69,1174.29,PERCENT OF TOTAL BILLED CHARGES
CT LUNG/MEDIASTINUM NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT CORE LUNG/MEDIA NEEDLE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,AETNA,AETNA COMMERCIAL,1500.38,98,,,OTHER,1148.25,1500.38,PERCENT OF TOTAL BILLED CHARGES
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,AETNA,AETNA COMMERCIAL,1468.04,98,,,OTHER,1123.5,1468.04,PERCENT OF TOTAL BILLED CHARGES
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,AETNA,AETNA COMMERCIAL,1468.04,98,,,OTHER,1123.5,1468.04,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NCK W/WO (NEWW),70492,CPT,350,RC,,OUTPATIENT,,,1908,763.2,AETNA,AETNA COMMERCIAL,1869.84,98,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NCK W/WO (NEWW),70492QQ,CPT,350,RC,QQ,OUTPATIENT,,,2228.5,891.4,AETNA,AETNA COMMERCIAL,2183.93,98,,,OTHER,1671.38,2183.93,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/CONT,70491,CPT,350,RC,,OUTPATIENT,,,1684.25,673.7,AETNA,AETNA COMMERCIAL,1650.565,98,,,OTHER,1263.19,1650.57,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/CONTRAST,70491QQ,CPT,350,RC,QQ,OUTPATIENT,,,1684.25,673.7,AETNA,AETNA COMMERCIAL,1650.565,98,,,OTHER,1263.19,1650.57,PERCENT OF TOTAL BILLED CHARGES
IMAGE CATH FLUID COLXN VISC CT,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,AETNA,AETNA COMMERCIAL,2786.7672,98,,,OTHER,2132.7,2786.8,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/O (NEWO),70490,CPT,350,RC,,OUTPATIENT,,,1100.5,440.2,AETNA,AETNA COMMERCIAL,1078.49,98,,,OTHER,825.38,1078.49,PERCENT OF TOTAL BILLED CHARGES
CT ANGIOGRAPH PELV W/O&W/DYE,72191,CPT,352,RC,,OUTPATIENT,,,879.74,351.896,AETNA,AETNA COMMERCIAL,862.1452,98,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/WO LT,73202LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY W/WO RT,73202RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/WO CONTRAST (PELB),72194,CPT,350,RC,,OUTPATIENT,,,2135.75,854.3,AETNA,AETNA COMMERCIAL,2093.035,98,,,OTHER,1601.81,2093.04,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/WO CONTRAST,72194QQ,CPT,350,RC,QQ,OUTPATIENT,,,2135.75,854.3,AETNA,AETNA COMMERCIAL,2093.035,98,,,OTHER,1601.81,2093.04,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/CONTRAST (PELW),72193,CPT,350,RC,,OUTPATIENT,,,1871,748.4,AETNA,AETNA COMMERCIAL,1833.58,98,,,OTHER,1403.25,1833.58,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/CONTRAST,72193QQ,CPT,350,RC,QQ,OUTPATIENT,,,1871,748.4,AETNA,AETNA COMMERCIAL,1833.58,98,,,OTHER,1403.25,1833.58,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/O CONTRAST,72192,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,AETNA,AETNA COMMERCIAL,1499.645,98,,,OTHER,1147.69,1499.65,PERCENT OF TOTAL BILLED CHARGES
ABSCESSOGRAM,76080,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,AETNA,AETNA COMMERCIAL,1499.645,98,,,OTHER,1147.69,1499.65,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS/HIP FRACTURE,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,AETNA,AETNA COMMERCIAL,1555.995,98,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
ASSESS CYST CONTRACT INJ,49424,CPT,350,RC,,OUTPATIENT,,,500,200,AETNA,AETNA COMMERCIAL,490,98,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,AETNA,AETNA COMMERCIAL,1880.13,98,,,OTHER,1438.88,1880.13,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,AETNA,AETNA COMMERCIAL,1880.13,98,,,OTHER,1438.88,1880.13,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/O CONTRAST (THWO),71250,CPT,350,RC,,OUTPATIENT,,,1563.5,625.4,AETNA,AETNA COMMERCIAL,1532.23,98,,,OTHER,1172.63,1532.23,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2697,1078.8,AETNA,AETNA COMMERCIAL,2643.06,98,,,OTHER,2022.75,2643.06,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2458.75,983.5,AETNA,AETNA COMMERCIAL,2409.575,98,,,OTHER,1844.06,2409.58,PERCENT OF TOTAL BILLED CHARGES
CT MPR/3D RECONSTRUCTION (MPRS,76377,CPT,350,RC,,OUTPATIENT,,,534,213.6,AETNA,AETNA COMMERCIAL,523.32,98,,,OTHER,400.5,523.32,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE BILATERAL,7300050,CPT,320,RC,50,OUTPATIENT,,,520.75,208.3,AETNA,AETNA COMMERCIAL,510.335,98,,,OTHER,390.56,510.34,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/CONT (TSWC,72129,CPT,350,RC,,OUTPATIENT,,,2478.5,991.4,AETNA,AETNA COMMERCIAL,2428.93,98,,,OTHER,1858.88,2428.93,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/CONTRAST,72129QQ,CPT,350,RC,QQ,OUTPATIENT,,,2478.5,991.4,AETNA,AETNA COMMERCIAL,2428.93,98,,,OTHER,1858.88,2428.93,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/O (TSWO),72128,CPT,350,RC,,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/O CONTRAST,72128QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,AETNA,AETNA COMMERCIAL,2080.54,98,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CHEST SPINE W/O & W/DYE,72130,CPT,352,RC,,OUTPATIENT,,,2951.14,1180.456,AETNA,AETNA COMMERCIAL,2892.1172,98,,,OTHER,2213.4,2892.1,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CYST/PELVIS ASPIRATE,50390,CPT,361,RC,,OUTPATIENT,,,3053,1221.2,AETNA,AETNA COMMERCIAL,2991.94,98,,,OTHER,2289.75,2991.94,PERCENT OF TOTAL BILLED CHARGES
CT MUSCLE NEEDLE BX (MSBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT JOINT INJECTION 2 SITE,64494,CPT,350,RC,,OUTPATIENT,,,772.5,309,AETNA,AETNA COMMERCIAL,757.05,98,,,OTHER,579.38,757.05,PERCENT OF TOTAL BILLED CHARGES
CT THORACENTESIS (BNSP),32555,CPT,361,RC,,OUTPATIENT,,,1965,786,AETNA,AETNA COMMERCIAL,1925.7,98,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT THYROID BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT THYROID CORE BX,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,631.88,825.65,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O CONT RT,73200RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O RT,73200RTQQ,CPT,350,RC,RTQQ,OUTPATIENT,,,1934.25,773.7,AETNA,AETNA COMMERCIAL,1895.565,98,,,OTHER,1450.69,1895.57,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O LT,73200LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,AETNA,AETNA COMMERCIAL,1346.52,98,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY BIL,7320050,CPT,350,RC,50,OUTPATIENT,,,2400,960,AETNA,AETNA COMMERCIAL,2352,98,,,OTHER,1800,2352,PERCENT OF TOTAL BILLED CHARGES
CT COLONOSCOPY SCREENING,74263,CPT,350,RC,,OUTPATIENT,,,1719.75,687.9,AETNA,AETNA COMMERCIAL,1685.355,98,,,OTHER,1289.81,1685.36,PERCENT OF TOTAL BILLED CHARGES
CT INJ 1 LEV PARAVRT F JNT L/S,6449350,CPT,350,RC,50,OUTPATIENT,,,2665,1066,AETNA,AETNA COMMERCIAL,2611.7,98,,,OTHER,1998.75,2611.7,PERCENT OF TOTAL BILLED CHARGES
CT INJ 2 LEV PARAVRT F JNT L/S,6449450,CPT,350,RC,50,OUTPATIENT,,,639,255.6,AETNA,AETNA COMMERCIAL,626.22,98,,,OTHER,479.25,626.22,PERCENT OF TOTAL BILLED CHARGES
CT INJ 3 LEV PARAVRT F JNT L/S,6449550,CPT,350,RC,50,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
GUIDED GASTROSTOMY TUBE PLC,49450,CPT,350,RC,,OUTPATIENT,,,2507.5,1003,AETNA,AETNA COMMERCIAL,2457.35,98,,,OTHER,1880.63,2457.35,PERCENT OF TOTAL BILLED CHARGES
CT GUIDED GASTROSTOMY TUBE PLC,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT MUSCLE NEEDLE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,AETNA,AETNA COMMERCIAL,1223.04,98,,,OTHER,936,1223.04,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 1 LEVEL,64493,CPT,350,RC,,OUTPATIENT,,,1777,710.8,AETNA,AETNA COMMERCIAL,1741.46,98,,,OTHER,1332.75,1741.46,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 2 LEVELS,64494,CPT,350,RC,,OUTPATIENT,,,426,170.4,AETNA,AETNA COMMERCIAL,417.48,98,,,OTHER,319.5,417.48,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 3 LEVELS,64495,CPT,350,RC,,OUTPATIENT,,,399.75,159.9,AETNA,AETNA COMMERCIAL,391.755,98,,,OTHER,299.81,391.76,PERCENT OF TOTAL BILLED CHARGES
INJ TENDON SHEATH LIGAMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,AETNA,AETNA COMMERCIAL,618.38,98,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
CT SCAN FOR NEEDLE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL INJECTION,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,894,1168.16,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN/PELVIS ANGIO,74174,CPT,350,RC,,OUTPATIENT,,,2016,806.4,AETNA,AETNA COMMERCIAL,1975.68,98,,,OTHER,1512,1975.68,PERCENT OF TOTAL BILLED CHARGES
CT BONE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT EXTREMITY ANGIO,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,AETNA,AETNA COMMERCIAL,3431.47,98,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER ARTHROGRAM RIGHT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,AETNA,AETNA COMMERCIAL,2223.865,98,,,OTHER,1701.9,2223.9,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER ARTHROGRAM LEFT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,AETNA,AETNA COMMERCIAL,2223.865,98,,,OTHER,1701.9,2223.9,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO (CAAN),70498QQ,CPT,350,RC,QQ,OUTPATIENT,,,1908,763.2,AETNA,AETNA COMMERCIAL,1869.84,98,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
"CT CHEST ANGIO(PE,AORTA)(CTAC)",71275,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,AETNA,AETNA COMMERCIAL,1976.17,98,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT CHEST ANGIO,71275QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,AETNA,AETNA COMMERCIAL,1976.17,98,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT ABD ANGIO (CTAA),74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,AETNA,AETNA COMMERCIAL,1976.17,98,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT ABD ANGIO (CTAA),74175QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,AETNA,AETNA COMMERCIAL,1976.17,98,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS CORE BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,AETNA,AETNA COMMERCIAL,2325.54,98,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT GUIDED PARACENTESIS,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,1210.2,1581.4,PERCENT OF TOTAL BILLED CHARGES
LITHOTRIPSY (ESWL),3600010,CDM,,,,INPATIENT,,,17451.5,6980.6,AETNA,AETNA COMMERCIAL,17102.47,98,,,OTHER,13088.63,17102.47,PERCENT OF TOTAL BILLED CHARGES
LITHOTRIPSY (LASER),3600012,CDM,,,,INPATIENT,,,7544.75,3017.9,AETNA,AETNA COMMERCIAL,7393.855,98,,,OTHER,5658.56,7393.86,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL1,3600102,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL2,3600202,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INJ FOR SACROILIAC JT ANESTH,G0260,HCPCS,350,RC,,INPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
IVC FILTER PLACEMENT,37191,CPT,361,RC,,OUTPATIENT,,,6206.5,2482.6,AETNA,AETNA COMMERCIAL,6082.37,98,,,OTHER,4654.88,6082.37,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL3,3600302,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL4,3600402,CDM,,,,INPATIENT,,,4778,1911.2,AETNA,AETNA COMMERCIAL,4682.44,98,,,OTHER,3583.5,4682.44,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 1 EA ADD'L 15 MIN,3600500,CDM,,,,INPATIENT,,,277.75,111.1,AETNA,AETNA COMMERCIAL,272.195,98,,,OTHER,208.31,272.2,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 2 EA ADD'L 15 MIN,3600502,CDM,,,,INPATIENT,,,306.25,122.5,AETNA,AETNA COMMERCIAL,300.125,98,,,OTHER,229.69,300.13,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 3 EA ADD'L 15 MIN,3600504,CDM,,,,INPATIENT,,,334.25,133.7,AETNA,AETNA COMMERCIAL,327.565,98,,,OTHER,250.69,327.57,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 4 EA ADD'L 15 MIN,3600506,CDM,,,,INPATIENT,,,365,146,AETNA,AETNA COMMERCIAL,357.7,98,,,OTHER,273.75,357.7,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION LEVEL 1,3600510,CDM,,,,INPATIENT,,,343.75,137.5,AETNA,AETNA COMMERCIAL,336.875,98,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION LEVEL 2,3600512,CDM,,,,INPATIENT,,,514.25,205.7,AETNA,AETNA COMMERCIAL,503.965,98,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
GI TUBE PLACEMENT,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,987.56,1290.42,PERCENT OF TOTAL BILLED CHARGES
ADENOIDECTOMY               II,3601002,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ADENOIDECTOMY/MYRING        II,3601003,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE STUMP REVIS        II,3601004,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE TOES/FINGER       I,3601005,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE STUMP DEBRIDE      II,3601006,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ART/SHAVE/LIG/REPAIR       III,3601009,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ARTHROSCOPY                III,3601011,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ARTHROSCOPY/SHAVING        III,3601013,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
BX ABD/RETROPERITONEAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,AETNA,AETNA COMMERCIAL,1482.74,98,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
BIOPSY OF PAROTID           II,3601016,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
BUNIONECTOMY UNI/SIM        II,3601017,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
BURSA OLECRANON REM II,3601018,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL RELEASE       II,3601025,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL DEQUERVAINS   II,3601026,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CATARACT EXTRACTION         II,3601027,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CERVICAL CONE W/ D&C         I,3601028,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION ADULT II,3601029,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION PED II,3601030,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT W/ CAST          I,3601031,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
CONTIGEN INJECTION         III,3601033,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/BLADDER BIOPSY       III,3601035,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/BLADDER EXTRAC        II,3601036,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYSTO/RETROGRADE PYE        II,3601037,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYSTO/URETER/LITHO         III,3601038,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/URETERAL EXTRA        II,3601039,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYTOSCOPY                   II,3601040,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
D&C                          I,3601041,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT WOUND           II,3601042,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
DUPUYTRENS CONTRACT         II,3601043,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ECCE W/ IOL                 II,3601044,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPIC SINUS            II,3601045,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXC BREAST MASS UNIL         I,3601046,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXCISION LIPOMA             II,3601047,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXCISION MISC/MINOR          I,3601048,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXCISION TOENAIL             I,3601049,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXOSTOSIS EXCISION          II,3601050,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXP. JNT SOFT TISSUE        II,3601051,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
FRENULECTOMY                 I,3601054,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
GANGLIONECTOMY              II,3601055,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HAMMER TOES EX BILA II,3601056,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HAMMER TOES EX UNI II,3601057,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HARDWARE REMOVAL MAJOR      II,3601058,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HARDWARE REMOVAL MINOR       I,3601059,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
HEMORRHOIDECTOMY            II,3601060,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HYDROCELECTOMY               I,3601061,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
INCIS HERNIA REPAIR         II,3601062,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INGUINAL HERNIA UNIL         I,3601063,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
INGUINAL HERNIA BIL         II,3601064,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INSERT/REMOVE HICKMAN CATH  II,3601065,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
LAPAROSCOPY                 II,3601066,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
LAP CHOLECYSTECTOMY  III,3601067,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
LIG/HAND/FOOT REPAIR        II,3601068,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MEATOTOMY                    I,3601069,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
MICROLARYNGOSCOPY           II,3601070,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MINI LAP TUBAL/PPTL         II,3601071,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 1,3601072,CDM,,,,INPATIENT,,,1400,560,AETNA,AETNA COMMERCIAL,1372,98,,,OTHER,1050,1372,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 2,3601073,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 3,3601074,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 4,3601075,CDM,,,,INPATIENT,,,4778,1911.2,AETNA,AETNA COMMERCIAL,4682.44,98,,,OTHER,3583.5,4682.44,PERCENT OF TOTAL BILLED CHARGES
MYRINGOTOMY W/WO TUBES       I,3601076,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
NODE BIOPSY                 II,3601077,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MORTONS NEUROMA II,3601078,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F FINGERS/TOES        II,3601079,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F RADIUS/ULNA         II,3601080,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F ARM                 II,3601081,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
OPEN REDUCT NASAL FX        II,3601082,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ORCHIECTOMY                 II,3601083,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ORCHIOPEXY                  II,3601084,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F ANKLE               II,3601085,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
PARS PLANA VITRECTOMY      III,3601087,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
PILONIDAL CYSTECTOMY        II,3601089,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
POLYPECTOMY NASAL           II,3601090,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
PTOSIS REPAIR               II,3601092,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SECONDARY LENS IMPLANT      II,3601094,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SEPTO W/TURBINECTOMY        II,3601095,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SEPTOPLASTY                 II,3601096,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SILASTIC IMPT HD & FT       II,3601097,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL SIMPLE         I,3601098,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
TENDON REPAIR SIMPLE I,3601099,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
SKIN GRAFTING MINOR         II,3602002,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SPERMATOCELECTOMY           II,3602003,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
STRABISMUS                  II,3602004,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
T & A TUBES                 II,3602007,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TND/TRAN FINER/O R I F      II,3602008,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TONSIL/ADENOIDECTOMY        II,3602009,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TONSILLECTOMY               II,3602010,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRABECULECTOMY              II,3602011,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRIGGER FINGER RELEASE      II,3602012,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRIPPLE ENDOSCOPY           II,3602013,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TURP                        II,3602014,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TYMPANOPLASTY              III,3602015,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ULNAR NERVE TRANSFER        II,3602016,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL HERNIA             I,3602017,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
URETHRAL DILATATION          I,3602018,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
VARICOSE VEIN STRIP         II,3602019,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
VASOVASOSTOMY               II,3602020,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
Z-PLASTY HD OR FT            I,3602021,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
OP SURGERY 15 MIN,3602022,CDM,,,,INPATIENT,,,271,108.4,AETNA,AETNA COMMERCIAL,265.58,98,,,OTHER,203.25,265.58,PERCENT OF TOTAL BILLED CHARGES
APPENDECTOMY                II,3602023,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL ENDOSCOPIC   III,3602024,CDM,,,,INPATIENT,,,3588,1435.2,AETNA,AETNA COMMERCIAL,3516.24,98,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSCOPY                II,3602025,CDM,,,,INPATIENT,,,2689.25,1075.7,AETNA,AETNA COMMERCIAL,2635.465,98,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INSERT/REMOVE GROSHONG CATH  I,3602026,CDM,,,,INPATIENT,,,1402.25,560.9,AETNA,AETNA COMMERCIAL,1374.205,98,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE INJ FOR NM,3602030,CDM,361,RC,,INPATIENT,,,1369.75,547.9,AETNA,AETNA COMMERCIAL,1342.355,98,,,OTHER,1027.31,1342.36,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE (SPINAL TAP),3602032,CDM,,,,INPATIENT,,,303.25,121.3,AETNA,AETNA COMMERCIAL,297.185,98,,,OTHER,227.44,297.19,PERCENT OF TOTAL BILLED CHARGES
TURP GREEN LIGHT,52648,CPT,360,RC,,INPATIENT,,,11506.75,4602.7,AETNA,AETNA COMMERCIAL,11276.615,98,,,OTHER,8630.06,11276.62,PERCENT OF TOTAL BILLED CHARGES
TURP W/LASER,52648,CPT,360,RC,,INPATIENT,,,8082.75,3233.1,AETNA,AETNA COMMERCIAL,7921.095,98,,,OTHER,6062.06,7921.1,PERCENT OF TOTAL BILLED CHARGES
PX SMALL INTESTINE,44799,CPT,360,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,977.06,1276.7,PERCENT OF TOTAL BILLED CHARGES
GASTRO TUBE REPLACEMENT,49450,CPT,350,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,570,744.8,PERCENT OF TOTAL BILLED CHARGES
ERCP,43260,CPT,361,RC,,INPATIENT,,,6622,2648.8,AETNA,AETNA COMMERCIAL,6489.56,98,,,OTHER,4966.5,6489.56,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,INPATIENT,,,2927.25,1170.9,AETNA,AETNA COMMERCIAL,2868.705,98,,,OTHER,2195.44,2868.71,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS W/PLASMA SEQUEST,3605010,CDM,,,,INPATIENT,,,3543.25,1417.3,AETNA,AETNA COMMERCIAL,3472.385,98,,,OTHER,2657.44,3472.39,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSALPINGOGRAM,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,AETNA,AETNA COMMERCIAL,509.355,98,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,OUTPATIENT,,,543,217.2,AETNA,AETNA COMMERCIAL,532.14,98,,,OTHER,407.25,532.14,PERCENT OF TOTAL BILLED CHARGES
FNA ADDITIONAL LESION,10006,CPT,402,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 1,64493,CPT,350,RC,,OUTPATIENT,,,1763.58,705.432,AETNA,AETNA COMMERCIAL,1728.3084,98,,,OTHER,1322.7,1728.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 2,64494,CPT,350,RC,,OUTPATIENT,,,2730.94,1092.376,AETNA,AETNA COMMERCIAL,2676.3212,98,,,OTHER,2048.2,2676.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 3,64495,CPT,350,RC,,OUTPATIENT,,,2490,996,AETNA,AETNA COMMERCIAL,2440.2,98,,,OTHER,1867.5,2440.2,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION (PACU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,AETNA,AETNA COMMERCIAL,1451.87,98,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
TTL COLONSCOPY BIOPSY/SNARE,3610050,CDM,,,,INPATIENT,,,2691.25,1076.5,AETNA,AETNA COMMERCIAL,2637.425,98,,,OTHER,2018.44,2637.43,PERCENT OF TOTAL BILLED CHARGES
COLONOSCOPY TOTAL,3610070,CDM,,,,INPATIENT,,,1992.75,797.1,AETNA,AETNA COMMERCIAL,1952.895,98,,,OTHER,1494.56,1952.9,PERCENT OF TOTAL BILLED CHARGES
SIGMOIDOSCOPY LOW LEVEL,3610074,CDM,,,,INPATIENT,,,1000,400,AETNA,AETNA COMMERCIAL,980,98,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
BIOPSY W/PROCEDURE,3610076,CDM,,,,INPATIENT,,,698.5,279.4,AETNA,AETNA COMMERCIAL,684.53,98,,,OTHER,523.88,684.53,PERCENT OF TOTAL BILLED CHARGES
EGD,3610080,CDM,,,,INPATIENT,,,2537,1014.8,AETNA,AETNA COMMERCIAL,2486.26,98,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
EGD WITH COLONOSCOPY,3610090,CDM,,,,INPATIENT,,,656.25,262.5,AETNA,AETNA COMMERCIAL,643.125,98,,,OTHER,492.19,643.13,PERCENT OF TOTAL BILLED CHARGES
EGD WITH PEG INCISION,3610100,CDM,,,,INPATIENT,,,2537,1014.8,AETNA,AETNA COMMERCIAL,2486.26,98,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
EGD W/BIOPSY,3610110,CDM,,,,INPATIENT,,,2630.25,1052.1,AETNA,AETNA COMMERCIAL,2577.645,98,,,OTHER,1972.69,2577.65,PERCENT OF TOTAL BILLED CHARGES
EGD W/FOREIGN BODY REMOVAL,3610112,CDM,361,RC,,INPATIENT,,,2537,1014.8,AETNA,AETNA COMMERCIAL,2486.26,98,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
FLUSHING IMPLANTABLE PORT,96523,CPT,260,RC,,OUTPATIENT,,,282.25,112.9,AETNA,AETNA COMMERCIAL,276.605,98,,,OTHER,211.69,276.61,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD PICC LINE LVL I,36592,CPT,761,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,132.94,173.71,PERCENT OF TOTAL BILLED CHARGES
DECLOTTING AGENT OF IMPLT,36593,CPT,761,RC,,OUTPATIENT,,,804,321.6,AETNA,AETNA COMMERCIAL,787.92,98,,,OTHER,603,787.92,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD PICC LINE LVL II,36592,CPT,761,RC,,OUTPATIENT,,,232,92.8,AETNA,AETNA COMMERCIAL,227.36,98,,,OTHER,174,227.36,PERCENT OF TOTAL BILLED CHARGES
BLOOD DRAW FROM IMPLNT PORT,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,AETNA,AETNA COMMERCIAL,281.75,98,,,OTHER,215.63,281.75,PERCENT OF TOTAL BILLED CHARGES
HEMORRDOID BANDING,3610140,CDM,,,,INPATIENT,,,722.25,288.9,AETNA,AETNA COMMERCIAL,707.805,98,,,OTHER,541.69,707.81,PERCENT OF TOTAL BILLED CHARGES
PARACENTESIS,49080,CPT,361,RC,,OUTPATIENT,,,582.5,233,AETNA,AETNA COMMERCIAL,570.85,98,,,OTHER,436.88,570.85,PERCENT OF TOTAL BILLED CHARGES
SIGMOIDOSCOPY,3610170,CDM,361,RC,,INPATIENT,,,1891,756.4,AETNA,AETNA COMMERCIAL,1853.18,98,,,OTHER,1418.25,1853.18,PERCENT OF TOTAL BILLED CHARGES
ANOSCOPY DIAGNOSTIC,3610225,CDM,,,,INPATIENT,,,206.5,82.6,AETNA,AETNA COMMERCIAL,202.37,98,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,AETNA,AETNA COMMERCIAL,510.1488,98,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
INJECT TRIGGER POINTS 3/>,20553,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,AETNA,AETNA COMMERCIAL,510.1488,98,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,528.02,211.208,AETNA,AETNA COMMERCIAL,517.4596,98,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20610,CPT,320,RC,,OUTPATIENT,,,520.56,208.224,AETNA,AETNA COMMERCIAL,510.1488,98,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
DRN/INJ JNT/BURSA W/O US BILA,20610,CPT,320,RC,,OUTPATIENT,,,1041.12,416.448,AETNA,AETNA COMMERCIAL,1020.2976,98,,,OTHER,780.8,1020.3,PERCENT OF TOTAL BILLED CHARGES
DRAIN SPINAL CORD CYST,62268,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,AETNA,AETNA COMMERCIAL,1630.426,98,,,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,320,RC,,OUTPATIENT,,,1283.34,513.336,AETNA,AETNA COMMERCIAL,1257.6732,98,,,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD GR OCPL NRV,64405,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,AETNA,AETNA COMMERCIAL,510.1488,98,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD BRACH PLEXUS,64415,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,AETNA,AETNA COMMERCIAL,1606.514,98,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD AXILLARY NRV,64417,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,AETNA,AETNA COMMERCIAL,1606.514,98,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,OUTPATIENT,,,1283.34,513.336,AETNA,AETNA COMMERCIAL,1257.6732,98,,,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
PVB THORACIC SINGLE INJ SITE,64461,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 LT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T LT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,AETNA,AETNA COMMERCIAL,2596.02,98,,,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S 1,64483,CPT,361,RC,,OUTPATIENT,,,1693.3,677.32,AETNA,AETNA COMMERCIAL,1659.434,98,,,OTHER,1270,1659.4,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S EA,64484,CPT,361,RC,,OUTPATIENT,,,1270.87,508.348,AETNA,AETNA COMMERCIAL,1245.4526,98,,,OTHER,953.2,1245.5,PERCENT OF TOTAL BILLED CHARGES
TAP BLOCK BI INJECTION,64488,CPT,361,RC,,OUTPATIENT,,,7130,2852,AETNA,AETNA COMMERCIAL,6987.4,98,,,OTHER,5347.5,6987.4,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV L,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,AETNA,AETNA COMMERCIAL,1606.514,98,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.34,942.136,AETNA,AETNA COMMERCIAL,2308.2332,98,,,OTHER,1766.5,2308.2,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,350,RC,,OUTPATIENT,,,2287.66,915.064,AETNA,AETNA COMMERCIAL,2241.9068,98,,,OTHER,1715.7,2241.9,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 1 LEV,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,AETNA,AETNA COMMERCIAL,1664.334,98,,,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 2 LEV,64494,CPT,350,RC,,OUTPATIENT,,,826,330.4,AETNA,AETNA COMMERCIAL,809.48,98,,,OTHER,619.5,809.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 3 LEV,64495,CPT,350,RC,,OUTPATIENT,,,1186,474.4,AETNA,AETNA COMMERCIAL,1162.28,98,,,OTHER,889.5,1162.3,PERCENT OF TOTAL BILLED CHARGES
CHEMODENERV MUSC MIGRAINE,64615,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,AETNA,AETNA COMMERCIAL,517.4596,98,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,OUTPATIENT,,,3548.74,1419.496,AETNA,AETNA COMMERCIAL,3477.7652,98,,,OTHER,2661.6,3477.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY C/T FACET JNT,64633,CPT,361,RC,,OUTPATIENT,,,3469.78,1387.912,AETNA,AETNA COMMERCIAL,3400.3844,98,,,OTHER,2602.3,3400.4,PERCENT OF TOTAL BILLED CHARGES
DESTROY C/T FACET JNT ADDL,64634,CPT,361,RC,,OUTPATIENT,,,3512,1404.8,AETNA,AETNA COMMERCIAL,3441.76,98,,,OTHER,2634,3441.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,OUTPATIENT,,,3496.78,1398.712,AETNA,AETNA COMMERCIAL,3426.8444,98,,,OTHER,2622.6,3426.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY L/S FACET JNT ADDL,64636,CPT,361,RC,,OUTPATIENT,,,4010,1604,AETNA,AETNA COMMERCIAL,3929.8,98,,,OTHER,3007.5,3929.8,PERCENT OF TOTAL BILLED CHARGES
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,AETNA,AETNA COMMERCIAL,1630.426,98,,,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
NERVOUS SYSTEM SURGERY UNLISTE,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,AETNA,AETNA COMMERCIAL,517.4596,98,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 RT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T RT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,AETNA,AETNA COMMERCIAL,2596.02,98,,,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV R,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,AETNA,AETNA COMMERCIAL,1606.514,98,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.54,942.216,AETNA,AETNA COMMERCIAL,2308.4292,98,,,OTHER,1766.7,2308.4,PERCENT OF TOTAL BILLED CHARGES
THER/PROPH/DIAG IV INF INIT,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,AETNA,AETNA COMMERCIAL,466.235,98,,,OTHER,356.8,466.2,PERCENT OF TOTAL BILLED CHARGES
THER/PROPH/DIAG IV INF ADDON,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.7,96.3,PERCENT OF TOTAL BILLED CHARGES
INJ FOR SACROILIAC JT ANESTH B,G0260,HCPCS,350,RC,,INPATIENT,,,2529.68,1011.872,AETNA,AETNA COMMERCIAL,2479.0864,98,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA LOCAL ADDT'L 15,3700600,CDM,,,,INPATIENT,,,49.75,19.9,AETNA,AETNA COMMERCIAL,48.755,98,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA LOCAL,3700602,CDM,,,,INPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA REGIONAL ADDT'L 15,3700700,CDM,,,,INPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA REGIONAL SUPPLIES,3700703,CDM,,,,INPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA GENERAL ADDT'L 15,3700800,CDM,,,,INPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA GENERAL,3700803,CDM,,,,INPATIENT,,,941.5,376.6,AETNA,AETNA COMMERCIAL,922.67,98,,,OTHER,706.13,922.67,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL INJECTION ANESTHESIA,3701112,CDM,,,,INPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NRV NRVTG SI JT B,64451,CPT,361,RC,,OUTPATIENT,,,2529.68,1011.872,AETNA,AETNA COMMERCIAL,2479.0864,98,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 BI,64479,CPT,,,,OUTPATIENT,,,2529.68,1011.872,AETNA,AETNA COMMERCIAL,2479.0864,98,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T BIL,64480,CPT,,,,OUTPATIENT,,,5298,2119.2,AETNA,AETNA COMMERCIAL,5192.04,98,,,OTHER,3973.5,5192,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S 1 BI,64483,CPT,361,RC,,OUTPATIENT,,,3278.6,1311.44,AETNA,AETNA COMMERCIAL,3213.028,98,,,OTHER,2459,3213,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV B,64490,CPT,350,RC,,OUTPATIENT,,,2458.95,983.58,AETNA,AETNA COMMERCIAL,2409.771,98,,,OTHER,1844.2,2409.8,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV B,64491,CPT,350,RC,,OUTPATIENT,,,4710.68,1884.272,AETNA,AETNA COMMERCIAL,4616.4664,98,,,OTHER,3533,4616.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 1 LEV B,64493,CPT,350,RC,,OUTPATIENT,,,3396.6,1358.64,AETNA,AETNA COMMERCIAL,3328.668,98,,,OTHER,2547.5,3328.7,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 2 LEV B,64494,CPT,350,RC,,OUTPATIENT,,,1652,660.8,AETNA,AETNA COMMERCIAL,1618.96,98,,,OTHER,1239,1619,PERCENT OF TOTAL BILLED CHARGES
INJECTION TRTMNT OF NERVE BILA,64640,CPT,361,RC,,OUTPATIENT,,,3327.4,1330.96,AETNA,AETNA COMMERCIAL,3260.852,98,,,OTHER,2495.6,3260.9,PERCENT OF TOTAL BILLED CHARGES
RHO(D) IMMUNE GLOBULIN RHIGIV,90386,CPT,636,RC,,OUTPATIENT,,,386,154.4,AETNA,AETNA COMMERCIAL,378.28,98,,,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
RHO(D) IMMUNE GLOBULIN (RHIG),90384,CPT,636,RC,,OUTPATIENT,,,386,154.4,AETNA,AETNA COMMERCIAL,378.28,98,,,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,INPATIENT,,,402.25,160.9,AETNA,AETNA COMMERCIAL,394.205,98,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS BLD OR COMP,36430,CPT,391,RC,,OUTPATIENT,,,1003.75,401.5,AETNA,AETNA COMMERCIAL,983.675,98,,,OTHER,752.81,983.68,PERCENT OF TOTAL BILLED CHARGES
PLATELET PHERESIS LEU IRR,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,AETNA,AETNA COMMERCIAL,1688.295,98,,,OTHER,1292.06,1688.3,PERCENT OF TOTAL BILLED CHARGES
PLATELET EACH - LR,P9032,HCPCS,390,RC,,INPATIENT,,,394.75,157.9,AETNA,AETNA COMMERCIAL,386.855,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
ABO (BLOOD TYPING),86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
ABO BLOOD TYPING,86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY SCREENING (RBC),86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,AETNA,AETNA COMMERCIAL,97.1964,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN TYPING (UNIT),86902,CPT,300,RC,,OUTPATIENT,,,295,118,AETNA,AETNA COMMERCIAL,289.1,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN TYPING (PATIENT),86905,CPT,300,RC,,OUTPATIENT,,,295,118,AETNA,AETNA COMMERCIAL,289.1,98,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,32,12.8,AETNA,AETNA COMMERCIAL,31.36,98,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,AETNA,AETNA COMMERCIAL,92.365,98,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
FETAL SCREEN,85461,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,AETNA,AETNA COMMERCIAL,44.345,98,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY IDENTIFICATION,86870,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,AETNA,AETNA COMMERCIAL,568.9194,98,,,OTHER,269.81,352.56,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY TITER,86886,CPT,390,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
Z PROGEST RECEPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
Z ESTROGEN RECPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
CLOSURE PUNCTURE DEVICE,3900883,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
PRBC LR EA UNIT,P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,AETNA,AETNA COMMERCIAL,534.345,98,,,OTHER,408.94,534.35,PERCENT OF TOTAL BILLED CHARGES
PLATELET APHERESIS LR/UNIT,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,AETNA,AETNA COMMERCIAL,1688.295,98,,,OTHER,1292.06,1688.3,PERCENT OF TOTAL BILLED CHARGES
PLT  EA UNIT,P9019,HCPCS,390,RC,,INPATIENT,,,272,108.8,AETNA,AETNA COMMERCIAL,266.56,98,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
CROSSMATCH LEUKO REDUCED,86920,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
"BLOOD LEUKO REDUCED,IRRADIATED",P9040,HCPCS,390,RC,,INPATIENT,,,929.25,371.7,AETNA,AETNA COMMERCIAL,910.665,98,,,OTHER,696.94,910.67,PERCENT OF TOTAL BILLED CHARGES
IRRADIATION OF BLOOD PROD (EA),86945,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,AETNA,AETNA COMMERCIAL,359.17,98,,,OTHER,274.88,359.17,PERCENT OF TOTAL BILLED CHARGES
PLTPH LR    IRR     APHERESIS,P9037,HCPCS,390,RC,,INPATIENT,,,1875.5,750.2,AETNA,AETNA COMMERCIAL,1837.99,98,,,OTHER,1406.63,1837.99,PERCENT OF TOTAL BILLED CHARGES
SPLITTING OF BLD OR BLD PRODTS,86985,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,AETNA,AETNA COMMERCIAL,291.354,98,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN SCREENING,86906,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
"PRBC TRANSFUSED,LEUKO REDUCED",P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,AETNA,AETNA COMMERCIAL,534.345,98,,,OTHER,408.94,534.35,PERCENT OF TOTAL BILLED CHARGES
PLASMA  FRESH FROZEN SD,P9017,HCPCS,390,RC,,INPATIENT,,,225.5,90.2,AETNA,AETNA COMMERCIAL,220.99,98,,,OTHER,169.13,220.99,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,AETNA,AETNA COMMERCIAL,1281.6538,98,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (0-1HRS),36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,AETNA,AETNA COMMERCIAL,1028.755,98,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (1-2HRS),36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,AETNA,AETNA COMMERCIAL,1126.755,98,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (2-4HRS),36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,AETNA,AETNA COMMERCIAL,1224.755,98,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (4-8HRS),36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,AETNA,AETNA COMMERCIAL,1420.755,98,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM SGL LT,77053LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,AETNA,AETNA COMMERCIAL,738.185,98,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM MULT LT,77054LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,AETNA,AETNA COMMERCIAL,738.185,98,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 3RD RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 4TH RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
STEREO CORE BX RT,19081RT,CPT,401,RC,RT,OUTPATIENT,,,2904.5,1161.8,AETNA,AETNA COMMERCIAL,2846.41,98,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT,77031RT,CPT,320,RC,RT,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC CORE BX GUIDANCE,77031,CPT,320,RC,,OUTPATIENT,,,1744.75,697.9,AETNA,AETNA COMMERCIAL,1709.855,98,,,OTHER,1308.56,1709.86,PERCENT OF TOTAL BILLED CHARGES
STERO 3RD LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
STERO 2ND LESION LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY 2ND LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT,19290RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,AETNA,AETNA COMMERCIAL,1231.86,98,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
STEREO 2ND LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT 2ND,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREO 3RD LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT 3RD,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC LT,19290LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,AETNA,AETNA COMMERCIAL,1231.86,98,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
STEREO 2ND LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC (LT) 2ND,77031LT59,CPT,320,RC,LT59,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREO 3RD LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC (LT) 3RD,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MAMM SPECIMEN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,AETNA,AETNA COMMERCIAL,943.2304,98,,,OTHER,466.31,609.32,PERCENT OF TOTAL BILLED CHARGES
MAMMOGRAPHY GUIDANCE,77032,CPT,320,RC,,OUTPATIENT,,,419,167.6,AETNA,AETNA COMMERCIAL,410.62,98,,,OTHER,314.25,410.62,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,AETNA,AETNA COMMERCIAL,1231.86,98,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 2ND LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 4TH LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STRTCTC,19081,CPT,401,RC,,OUTPATIENT,,,2904.5,1161.8,AETNA,AETNA COMMERCIAL,2846.41,98,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STRTCTC,19082,CPT,401,RC,,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
US MAM UNILATERAL LT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
US MAM UNILATERAL RT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM BILATERAL DIAG,77066,CPT,401,RC,,OUTPATIENT,,,244.58,97.832,AETNA,AETNA COMMERCIAL,239.6884,98,,,OTHER,176.63,230.79,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI SCREEN CAD,7706752,CPT,,,52,OUTPATIENT,,,20.75,8.3,AETNA,AETNA COMMERCIAL,20.335,98,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM BILAT SCREENING,77067,CPT,403,RC,,OUTPATIENT,,,217.5,87,AETNA,AETNA COMMERCIAL,213.15,98,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM SCREENING CAD,77067,CPT,403,RC,,OUTPATIENT,,,20.75,8.3,AETNA,AETNA COMMERCIAL,20.335,98,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM UNILAT RT DIAG,77065RT,CPT,401,RC,RT,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM UNILAT LT DIAG,77065LT,CPT,401,RC,LT,OUTPATIENT,,,193,77.2,AETNA,AETNA COMMERCIAL,189.14,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI RT SCREEN,77067RT52,CPT,403,RC,RT52,OUTPATIENT,,,202.2,80.88,AETNA,AETNA COMMERCIAL,198.156,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI LT SCREEN,77067LT52,CPT,403,RC,LT52,OUTPATIENT,,,202.2,80.88,AETNA,AETNA COMMERCIAL,198.156,98,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2846.75,1138.7,AETNA,AETNA COMMERCIAL,2789.815,98,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2846.75,1138.7,AETNA,AETNA COMMERCIAL,2789.815,98,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO RT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,AETNA,AETNA COMMERCIAL,2767.275,98,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO LT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,AETNA,AETNA COMMERCIAL,2767.275,98,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO RT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,AETNA,AETNA COMMERCIAL,2017.82,98,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO LT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,AETNA,AETNA COMMERCIAL,2017.82,98,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR BREAST XRAY,19030,CPT,401,RC,,OUTPATIENT,,,396.25,158.5,AETNA,AETNA COMMERCIAL,388.325,98,,,OTHER,297.19,388.33,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO BI,1908350,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO BI,1908450,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST BI,1928150,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE,1928250,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,AETNA,AETNA COMMERCIAL,2303.245,98,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST BI,1928350,CPT,401,RC,50,OUTPATIENT,,,2846.75,1138.7,AETNA,AETNA COMMERCIAL,2789.815,98,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO BI,1908150,CPT,401,RC,50,OUTPATIENT,,,5808.75,2323.5,AETNA,AETNA COMMERCIAL,5692.575,98,,,OTHER,4356.56,5692.58,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO BI,1908250,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,AETNA,AETNA COMMERCIAL,2517.62,98,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
DIAG DIGI BREAST TOMO UNI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM SCREENING CAD,77065,CPT,,,,OUTPATIENT,,,20.75,8.3,AETNA,AETNA COMMERCIAL,20.335,98,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMOSYNTHESIS BI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,AETNA,AETNA COMMERCIAL,1231.86,98,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 2ND RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM SGL RT,77053RT,CPT,320,RC,RT,OUTPATIENT,,,753.25,301.3,AETNA,AETNA COMMERCIAL,738.185,98,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM MULT RT,77054RT,CPT,401,RC,RT,OUTPATIENT,,,753.25,301.3,AETNA,AETNA COMMERCIAL,738.185,98,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
STEREO CORE BX LT,19081LT,CPT,401,RC,LT,OUTPATIENT,,,2904.5,1161.8,AETNA,AETNA COMMERCIAL,2846.41,98,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC LT,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,AETNA,AETNA COMMERCIAL,1699.075,98,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BILATERAL 1EA,4020004,CDM,,,,INPATIENT,,,4117.5,1647,AETNA,AETNA COMMERCIAL,4035.15,98,,,OTHER,3088.13,4035.15,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 1ST LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 2ND LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDED 2ND NEEDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 1ST LESION,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT LT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,AETNA,AETNA COMMERCIAL,1576.33,98,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT BI,7694250,CPT,402,RC,50,OUTPATIENT,,,1608.5,643.4,AETNA,AETNA COMMERCIAL,1576.33,98,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 2 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 3 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY LIVER,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,AETNA,AETNA COMMERCIAL,1728.72,98,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 2ND PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US THYROID FNA,10005,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,AETNA,AETNA COMMERCIAL,1810.795,98,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
US OB AFI/PLACENTA/HR/POS/E.G.,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 1 LESION,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 2 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 3 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US OB VERSION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US OB CERVIX LENGTH,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 3RD PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 3RD LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,AETNA,AETNA COMMERCIAL,1330.84,98,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY MUSCLE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US ABCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,AETNA,AETNA COMMERCIAL,729.12,98,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
ABCESS DRAINAGE - ABDOMEN,49406,CPT,361,RC,,OUTPATIENT,,,3982,1592.8,AETNA,AETNA COMMERCIAL,3902.36,98,,,OTHER,2986.5,3902.36,PERCENT OF TOTAL BILLED CHARGES
US BREAST ASPIRATION LT2 SITES,19001LT,CPT,361,RC,LT,OUTPATIENT,,,768,307.2,AETNA,AETNA COMMERCIAL,752.64,98,,,OTHER,576,752.64,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY RENAL,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,AETNA,AETNA COMMERCIAL,1728.72,98,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,AETNA,AETNA COMMERCIAL,1666.49,98,,,OTHER,1275.38,1666.49,PERCENT OF TOTAL BILLED CHARGES
US RENAL FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,AETNA,AETNA COMMERCIAL,1728.72,98,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
LEVEL II,20206,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,AETNA,AETNA COMMERCIAL,1810.795,98,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY PELVIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US LUNG/MEDIASTINUM CORE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,AETNA,AETNA COMMERCIAL,1500.38,98,,,OTHER,1148.25,1500.38,PERCENT OF TOTAL BILLED CHARGES
US LUNG/MEDIASTINUM FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,2680.75,1072.3,AETNA,AETNA COMMERCIAL,2627.135,98,,,OTHER,2010.56,2627.14,PERCENT OF TOTAL BILLED CHARGES
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,426.5,170.6,AETNA,AETNA COMMERCIAL,417.97,98,,,OTHER,319.88,417.97,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED LT,76642LT,CPT,402,RC,LT,OUTPATIENT,,,196.25,78.5,AETNA,AETNA COMMERCIAL,192.325,98,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED RT,76642RT,CPT,402,RC,RT,OUTPATIENT,,,196.25,78.5,AETNA,AETNA COMMERCIAL,192.325,98,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED BILATERAL,7664250,CPT,402,RC,50,OUTPATIENT,,,392,156.8,AETNA,AETNA COMMERCIAL,384.16,98,,,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE LT,76641LT,CPT,402,RC,LT,OUTPATIENT,,,293.5,117.4,AETNA,AETNA COMMERCIAL,287.63,98,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE RT,76641RT,CPT,402,RC,RT,OUTPATIENT,,,293.5,117.4,AETNA,AETNA COMMERCIAL,287.63,98,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE BILATERAL,7664150,CPT,402,RC,50,OUTPATIENT,,,586.5,234.6,AETNA,AETNA COMMERCIAL,574.77,98,,,OTHER,439.88,574.77,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY THYROID,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US THYROID,76536,CPT,402,RC,,OUTPATIENT,,,795,318,AETNA,AETNA COMMERCIAL,779.1,98,,,OTHER,596.25,779.1,PERCENT OF TOTAL BILLED CHARGES
US CORE BIOPSY OF THYROID,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,631.88,825.65,PERCENT OF TOTAL BILLED CHARGES
MID LINE PLACEMENT W/US GUIDAN,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,AETNA,AETNA COMMERCIAL,478.24,98,,,OTHER,366,478.2,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,AETNA,AETNA COMMERCIAL,1925.7,98,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
FNA BX W/US GDN 1ST LES OTHER,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,AETNA,AETNA COMMERCIAL,1728.72,98,,,OTHER,1323,1728.7,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,32421,CPT,361,RC,,OUTPATIENT,,,1049,419.6,AETNA,AETNA COMMERCIAL,1028.02,98,,,OTHER,786.75,1028.02,PERCENT OF TOTAL BILLED CHARGES
US ABDOMINAL COMPLETE,76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,AETNA,AETNA COMMERCIAL,593.39,98,,,OTHER,454.13,593.39,PERCENT OF TOTAL BILLED CHARGES
PARACENTESIS W/IMAGE GUIDANCE,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE FOR AMNIOCENTESIS,76946,CPT,402,RC,,OUTPATIENT,,,1081.25,432.5,AETNA,AETNA COMMERCIAL,1059.625,98,,,OTHER,810.94,1059.63,PERCENT OF TOTAL BILLED CHARGES
US AMNIOCENTESIS,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,AETNA,AETNA COMMERCIAL,1237.2402,98,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION LT 1 SITE,19000LT,CPT,361,RC,LT,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 1 SITE,19000RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT RT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,AETNA,AETNA COMMERCIAL,1576.33,98,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US GUIDED 2ND NEEDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 2 SITES,19001RT,CPT,361,RC,RT,OUTPATIENT,,,768,307.2,AETNA,AETNA COMMERCIAL,752.64,98,,,OTHER,576,752.64,PERCENT OF TOTAL BILLED CHARGES
US BREAST/BILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,AETNA,AETNA COMMERCIAL,605.64,98,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 1 SITE,1900050,CPT,402,RC,50,OUTPATIENT,,,1299.75,519.9,AETNA,AETNA COMMERCIAL,1273.755,98,,,OTHER,974.81,1273.76,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 2 SITES,1900150,CPT,402,RC,50,OUTPATIENT,,,1535.5,614.2,AETNA,AETNA COMMERCIAL,1504.79,98,,,OTHER,1151.63,1504.79,PERCENT OF TOTAL BILLED CHARGES
US BREAST/UNILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,AETNA,AETNA COMMERCIAL,605.64,98,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2173.25,869.3,AETNA,AETNA COMMERCIAL,2129.785,98,,,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2173.25,869.3,AETNA,AETNA COMMERCIAL,2129.785,98,,,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US CHEST BSCAN INC MEDIASTINUM,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,AETNA,AETNA COMMERCIAL,390.53,98,,,OTHER,298.88,390.53,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
US SKIN LESION BIOPSY,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,AETNA,AETNA COMMERCIAL,422.625,98,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR,76881,CPT,402,RC,,OUTPATIENT,,,798.75,319.5,AETNA,AETNA COMMERCIAL,782.775,98,,,OTHER,599.06,782.78,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR LIMITED,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
AXILLA ULTRASOUND,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
FOLLOW UP (NOT FOR OB),76970,CPT,402,RC,,OUTPATIENT,,,264.5,105.8,AETNA,AETNA COMMERCIAL,259.21,98,,,OTHER,198.38,259.21,PERCENT OF TOTAL BILLED CHARGES
US SURGICAL SPECIMAN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,AETNA,AETNA COMMERCIAL,943.2304,98,,,OTHER,466.31,609.32,PERCENT OF TOTAL BILLED CHARGES
VASCULAR STUDY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,AETNA,AETNA COMMERCIAL,449.5064,98,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
US TESTICULAR,76870,CPT,402,RC,,OUTPATIENT,,,732,292.8,AETNA,AETNA COMMERCIAL,717.36,98,,,OTHER,549,717.36,PERCENT OF TOTAL BILLED CHARGES
US HEAD/NECK SOFT TISSUE,76536,CPT,402,RC,,OUTPATIENT,,,795,318,AETNA,AETNA COMMERCIAL,779.1,98,,,OTHER,457.69,598.05,PERCENT OF TOTAL BILLED CHARGES
US SONOHYSTOGRAPHY,76831,CPT,402,RC,,OUTPATIENT,,,1027.25,410.9,AETNA,AETNA COMMERCIAL,1006.705,98,,,OTHER,770.44,1006.71,PERCENT OF TOTAL BILLED CHARGES
US HIPS INFANT,76885,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,AETNA,AETNA COMMERCIAL,372.645,98,,,OTHER,285.19,372.65,PERCENT OF TOTAL BILLED CHARGES
US GUIDED BIOPSY,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US MARKING FOR NEEDLE PLACEMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE NEEDLE PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,545.5,218.2,AETNA,AETNA COMMERCIAL,534.59,98,,,OTHER,409.13,534.59,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 1ST PLCM,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,AETNA,AETNA COMMERCIAL,1576.33,98,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US HEAD NEONATAL,76506,CPT,402,RC,,OUTPATIENT,,,525.5,210.2,AETNA,AETNA COMMERCIAL,514.99,98,,,OTHER,394.13,514.99,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB>14 WKS DETAILED,76805,CPT,402,RC,,OUTPATIENT,,,770.75,308.3,AETNA,AETNA COMMERCIAL,755.335,98,,,OTHER,578.06,755.34,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB 14-20 WKS EA GEST,76810,CPT,402,RC,,OUTPATIENT,,,328.25,131.3,AETNA,AETNA COMMERCIAL,321.685,98,,,OTHER,246.19,321.69,PERCENT OF TOTAL BILLED CHARGES
US OB AFI/PLACENTA/HR/POSITION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL OB,76817,CPT,402,RC,,OUTPATIENT,,,616.25,246.5,AETNA,AETNA COMMERCIAL,603.925,98,,,OTHER,462.19,603.93,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS,76801,CPT,402,RC,,OUTPATIENT,,,682.25,272.9,AETNA,AETNA COMMERCIAL,668.605,98,,,OTHER,511.69,668.61,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS E/GEST,76802,CPT,402,RC,,OUTPATIENT,,,274.75,109.9,AETNA,AETNA COMMERCIAL,269.255,98,,,OTHER,206.06,269.26,PERCENT OF TOTAL BILLED CHARGES
US PELVIC,76856,CPT,402,RC,,OUTPATIENT,,,854,341.6,AETNA,AETNA COMMERCIAL,836.92,98,,,OTHER,640.5,836.92,PERCENT OF TOTAL BILLED CHARGES
PELVIS LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,AETNA,AETNA COMMERCIAL,626.465,98,,,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
US RENAL,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,AETNA,AETNA COMMERCIAL,917.035,98,,,OTHER,701.81,917.04,PERCENT OF TOTAL BILLED CHARGES
US AORTA,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,AETNA,AETNA COMMERCIAL,547.33,98,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
US AAA SCREENING,76706,CPT,402,RC,,OUTPATIENT,,,344.25,137.7,AETNA,AETNA COMMERCIAL,337.365,98,,,OTHER,258.19,337.37,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
US RENAL TRANSPLANT,76776,CPT,402,RC,,OUTPATIENT,,,484.75,193.9,AETNA,AETNA COMMERCIAL,475.055,98,,,OTHER,363.56,475.06,PERCENT OF TOTAL BILLED CHARGES
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,OUTPATIENT,,,489.75,195.9,AETNA,AETNA COMMERCIAL,479.955,98,,,OTHER,367.31,479.96,PERCENT OF TOTAL BILLED CHARGES
OB US LIMITED FETUS(S),76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US RETROPERITONEAL LIMITED,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,AETNA,AETNA COMMERCIAL,547.33,98,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL,76830,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,AETNA,AETNA COMMERCIAL,372.645,98,,,OTHER,285.19,372.65,PERCENT OF TOTAL BILLED CHARGES
US CHEST LIMITED,76604,CPT,402,RC,,OUTPATIENT,,,217.19,86.876,AETNA,AETNA COMMERCIAL,212.8462,98,,,OTHER,141.75,185.22,PERCENT OF TOTAL BILLED CHARGES
US ABDOMINAL  LIMITED,76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,AETNA,AETNA COMMERCIAL,462.07,98,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
US OB LIMITED SIZE,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED TWINS,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED POST PARTUM,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,AETNA,AETNA COMMERCIAL,410.375,98,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB >14 WKS EA/GEST,76810,CPT,402,RC,,OUTPATIENT,,,296.5,118.6,AETNA,AETNA COMMERCIAL,290.57,98,,,OTHER,222.38,290.57,PERCENT OF TOTAL BILLED CHARGES
AXILLA MARKER PLACEMENT,10035,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,929.8,1214.9,PERCENT OF TOTAL BILLED CHARGES
US OB FETAL RE-EVAL SZ  FLUID,76816,CPT,402,RC,,OUTPATIENT,,,402.25,160.9,AETNA,AETNA COMMERCIAL,394.205,98,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
US PARACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US NEEDLE PLACEMENT PER LESION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
RETROPERITONEAL COMPLETE,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,AETNA,AETNA COMMERCIAL,917.035,98,,,OTHER,701.81,917.04,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLCMT ADD'L,19286,CPT,402,RC,,OUTPATIENT,,,231.75,92.7,AETNA,AETNA COMMERCIAL,227.115,98,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BILATERAL 1EA,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,AETNA,AETNA COMMERCIAL,3843.315,98,,,OTHER,2941.31,3843.32,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,AETNA,AETNA COMMERCIAL,2767.275,98,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,AETNA,AETNA COMMERCIAL,2767.275,98,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 2 SITES,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L2 SITES,19084,CPT,402,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2,1908350,CPT,401,RC,50,OUTPATIENT,,,5137.75,2055.1,AETNA,AETNA COMMERCIAL,5034.995,98,,,OTHER,3853.31,5035,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 1ST,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2ND,1908450,CPT,401,RC,50,OUTPATIENT,,,2027.75,811.1,AETNA,AETNA COMMERCIAL,1987.195,98,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST 1ST LESION,19083,CPT,401,RC,,OUTPATIENT,,,1960.75,784.3,AETNA,AETNA COMMERCIAL,1921.535,98,,,OTHER,1470.56,1921.54,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST ADD LESION,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,AETNA,AETNA COMMERCIAL,2017.82,98,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
US LIVER FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,AETNA,AETNA COMMERCIAL,1728.72,98,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US LIVER CORE BX,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,AETNA,AETNA COMMERCIAL,1496.215,98,,,OTHER,1145.06,1496.22,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,AETNA,AETNA COMMERCIAL,2017.82,98,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,AETNA,AETNA COMMERCIAL,2017.82,98,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION RT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,AETNA,AETNA COMMERCIAL,1350.685,98,,,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION LT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,AETNA,AETNA COMMERCIAL,1350.685,98,,,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
CATHETER FOR HYSTEROGRAPHY,58340,CPT,320,RC,,OUTPATIENT,,,447.5,179,AETNA,AETNA COMMERCIAL,438.55,98,,,OTHER,335.63,438.55,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,AETNA,AETNA COMMERCIAL,3843.315,98,,,OTHER,2941.31,3843.32,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION BI,19084,CPT,402,RC,,OUTPATIENT,,,787.5,315,AETNA,AETNA COMMERCIAL,771.75,98,,,OTHER,590.63,771.75,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,4117.5,1647,AETNA,AETNA COMMERCIAL,4035.15,98,,,OTHER,3088.13,4035.15,PERCENT OF TOTAL BILLED CHARGES
US MUSCLE CORE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,AETNA,AETNA COMMERCIAL,1223.04,98,,,OTHER,936,1223.04,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY LYMPH SUPERFICIAL,38505,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,AETNA,AETNA COMMERCIAL,1810.795,98,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
HEMATOMA/SEROMA/FLUID DRAIN,10140,CPT,402,RC,,OUTPATIENT,,,427.5,171,AETNA,AETNA COMMERCIAL,418.95,98,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,AETNA,AETNA COMMERCIAL,1316.63,98,,,OTHER,1007.63,1316.63,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY WITH DOPPLER,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,AETNA,AETNA COMMERCIAL,572.32,98,,,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY DOPPLER COMPLETE,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,AETNA,AETNA COMMERCIAL,449.5064,98,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
DUPLEX PELVIC OUTFLOW,93976QQ,CPT,,,QQ,OUTPATIENT,,,529.5,211.8,AETNA,AETNA COMMERCIAL,518.91,98,,,OTHER,397.13,518.91,PERCENT OF TOTAL BILLED CHARGES
BREAST MARKER PLACEMENT,19281,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,409.13,534.59,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS BILATERAL,3255550,CPT,402,RC,50,OUTPATIENT,,,3200,1280,AETNA,AETNA COMMERCIAL,3136,98,,,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
IMAGE CATH FLUID COLXN VISC US,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,AETNA,AETNA COMMERCIAL,2786.7672,98,,,OTHER,2132.7,2786.8,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL CORD DOPPLER,76820,CPT,402,RC,,OUTPATIENT,,,215.38,86.152,AETNA,AETNA COMMERCIAL,211.0724,98,,,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,AETNA,AETNA COMMERCIAL,1236.025,98,,,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
US PICC LINE ONLY,36573,CPT,320,RC,,OUTPATIENT,,,2578.5,1031.4,AETNA,AETNA COMMERCIAL,2526.93,98,,,OTHER,1933.88,2526.93,PERCENT OF TOTAL BILLED CHARGES
US SPINAL CANAL,76800,CPT,402,RC,,OUTPATIENT,,,526.75,210.7,AETNA,AETNA COMMERCIAL,516.215,98,,,OTHER,395.06,516.22,PERCENT OF TOTAL BILLED CHARGES
US PSEUDOANEURYSM REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,527.09,210.836,AETNA,AETNA COMMERCIAL,516.5482,98,,,OTHER,319.88,417.97,PERCENT OF TOTAL BILLED CHARGES
US SOFT TISSUE MISC,76999,CPT,402,RC,,OUTPATIENT,,,334.5,133.8,AETNA,AETNA COMMERCIAL,327.81,98,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
FOLLICLE STUDY,7685752,CPT,402,RC,52,OUTPATIENT,,,217.19,86.876,AETNA,AETNA COMMERCIAL,212.8462,98,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
DIGITAL BREAST TOMO SCRN BIL,77063,CPT,403,RC,,OUTPATIENT,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI RT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI LT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,AETNA,AETNA COMMERCIAL,85.26,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
AEROSOL DAILY,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT 1ST HR,94644,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT ADD'L HR,94645,CPT,410,RC,,OUTPATIENT,,,176.5,70.6,AETNA,AETNA COMMERCIAL,172.97,98,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON-VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
IPPB SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES  INITIAL,G0238,HCPCS,410,RC,,INPATIENT,,,117,46.8,AETNA,AETNA COMMERCIAL,114.66,98,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CPT PD SUBSEQUENT,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL SUBSEQ,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL INITL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
IPPB INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
SPUTUM INDUCTION,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,AETNA,AETNA COMMERCIAL,78.4,98,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
VENTILATOR SUBSEQUENT DAY,94003,CPT,410,RC,,OUTPATIENT,,,2087.75,835.1,AETNA,AETNA COMMERCIAL,2045.995,98,,,OTHER,1565.81,2046,PERCENT OF TOTAL BILLED CHARGES
VENTILATOR FIRST DAY,94002,CPT,410,RC,,OUTPATIENT,,,2575.5,1030.2,AETNA,AETNA COMMERCIAL,2523.99,98,,,OTHER,1931.63,2523.99,PERCENT OF TOTAL BILLED CHARGES
WEANING PARAMETERS,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,AETNA,AETNA COMMERCIAL,272.587,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CPT PD INITIAL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES,G0238,HCPCS,410,RC,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CPAP INITIAL DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,AETNA,AETNA COMMERCIAL,645.82,98,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
CPAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,AETNA,AETNA COMMERCIAL,645.82,98,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
ABG PUNCTURE,36600,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE ED,97112GP,CPT,420,RC,GP,OUTPATIENT,,,142,56.8,AETNA,AETNA COMMERCIAL,139.16,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY,97140GP,CPT,420,RC,GP,OUTPATIENT,,,144.38,57.752,AETNA,AETNA COMMERCIAL,141.4924,98,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACT,97530GP,CPT,420,RC,GP,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,AETNA,AETNA COMMERCIAL,56.4676,98,,,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,AETNA,AETNA COMMERCIAL,56.4676,98,,,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE >20CM,97598GP,CPT,420,RC,GP,OUTPATIENT,,,155.75,62.3,AETNA,AETNA COMMERCIAL,152.635,98,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MAJOR,97606,CPT,,,,OUTPATIENT,,,751.82,300.728,AETNA,AETNA COMMERCIAL,736.7836,98,,,OTHER,563.9,736.8,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MINOR,97605,CPT,,,,OUTPATIENT,,,363.92,145.568,AETNA,AETNA COMMERCIAL,356.6416,98,,,OTHER,272.9,356.6,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - GROUP,97150GP,CPT,423,RC,GP,OUTPATIENT,,,91.25,36.5,AETNA,AETNA COMMERCIAL,89.425,98,,,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - INDIV/15 MN,97113GP,CPT,420,RC,GP,OUTPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
ELEC STIMULATION ATTENDED/15 M,97032GP,CPT,420,RC,GP,OUTPATIENT,,,133.25,53.3,AETNA,AETNA COMMERCIAL,130.585,98,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
ELEC STIM UNATTENDED/VISIT,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ELECT STIM UNATTENDED,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PREEMPLOYMENT SCREEN BASIC,4210052,CDM,,,,INPATIENT,,,150,60,AETNA,AETNA COMMERCIAL,147,98,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
PREEMPLOYMENT SCREEN/INTER,4210053,CDM,,,,INPATIENT,,,300,120,AETNA,AETNA COMMERCIAL,294,98,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVAL MODERATE COMP,97162GP,CPT,424,RC,GP,OUTPATIENT,,,349,139.6,AETNA,AETNA COMMERCIAL,342.02,98,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVALHIGH COMPLEXITY,97163GP,CPT,424,RC,GP,OUTPATIENT,,,394,157.6,AETNA,AETNA COMMERCIAL,386.12,98,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
PT REASSESSMENT,97164GP,CPT,424,RC,GP,OUTPATIENT,,,142.26,56.904,AETNA,AETNA COMMERCIAL,139.4148,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVAL LOW COMPLEXITY,97161GP,CPT,424,RC,GP,OUTPATIENT,,,303,121.2,AETNA,AETNA COMMERCIAL,296.94,98,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
GAIT TRAINING / 15 MIN,97116GP,CPT,420,RC,GP,OUTPATIENT,,,131.45,52.58,AETNA,AETNA COMMERCIAL,128.821,98,,,OTHER,76.13,99.47,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GP,CPT,420,RC,GP,OUTPATIENT,,,139,55.6,AETNA,AETNA COMMERCIAL,136.22,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GP,CPT,420,RC,GP,OUTPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
MASSAGE THERAPY 15 MINS,97124GP,CPT,420,RC,GP,OUTPATIENT,,,120.75,48.3,AETNA,AETNA COMMERCIAL,118.335,98,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST 15 M,97750GP,CPT,420,RC,GP,OUTPATIENT,,,148,59.2,AETNA,AETNA COMMERCIAL,145.04,98,,,OTHER,111,145.04,PERCENT OF TOTAL BILLED CHARGES
MOIST HEAT THERAPY,97010GP,CPT,420,RC,GP,OUTPATIENT,,,65.5,26.2,AETNA,AETNA COMMERCIAL,64.19,98,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FITTING 15 MINS,97760GP,CPT,420,RC,GP,OUTPATIENT,,,117.75,47.1,AETNA,AETNA COMMERCIAL,115.395,98,,,OTHER,88.31,115.4,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH,97018GP,CPT,420,RC,GP,OUTPATIENT,,,72.5,29,AETNA,AETNA COMMERCIAL,71.05,98,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISE 15 MINS,97110GP,CPT,420,RC,GP,OUTPATIENT,,,146.94,58.776,AETNA,AETNA COMMERCIAL,144.0012,98,,,OTHER,85.13,111.23,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXCLUDE HANDS,95833GP,CPT,420,RC,GP,OUTPATIENT,,,79.5,31.8,AETNA,AETNA COMMERCIAL,77.91,98,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING INCLUDE HANDS,95834GP,CPT,420,RC,GP,OUTPATIENT,,,106,42.4,AETNA,AETNA COMMERCIAL,103.88,98,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
TRACTION - MECHANICAL,97012GP,CPT,420,RC,GP,OUTPATIENT,,,91.25,36.5,AETNA,AETNA COMMERCIAL,89.425,98,,,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GP,CPT,420,RC,GP,OUTPATIENT,,,32,12.8,AETNA,AETNA COMMERCIAL,31.36,98,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GP,CPT,420,RC,GP,OUTPATIENT,,,113.9,45.56,AETNA,AETNA COMMERCIAL,111.622,98,,,OTHER,63.38,82.81,PERCENT OF TOTAL BILLED CHARGES
WHIRLPOOL,97022GP,CPT,420,RC,GP,OUTPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
WOUND CARE NON SELECTIVE,97602GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE <20CM,97597GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,402,RC,,OUTPATIENT,,,233.98,93.592,AETNA,AETNA COMMERCIAL,229.3004,98,,,OTHER,175.5,229.3,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXTREMITY,95831GP,CPT,420,RC,GP,OUTPATIENT,,,54.25,21.7,AETNA,AETNA COMMERCIAL,53.165,98,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING-HAND,95832GP,CPT,420,RC,GP,OUTPATIENT,,,118.25,47.3,AETNA,AETNA COMMERCIAL,115.885,98,,,OTHER,88.69,115.89,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GP,CPT,420,RC,GP,OUTPATIENT,,,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CANALITH REPOSITIONING,95992,CPT,420,RC,,OUTPATIENT,,,148.75,59.5,AETNA,AETNA COMMERCIAL,145.775,98,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY/WORK REINTEGRATION,97537,CPT,420,RC,,OUTPATIENT,,,117,46.8,AETNA,AETNA COMMERCIAL,114.66,98,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING,97761,CPT,420,RC,,OUTPATIENT,,,123.75,49.5,AETNA,AETNA COMMERCIAL,121.275,98,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
C/O FOR ORTHOTIC/PROSTH USE,97763GP,CPT,420,RC,GP,OUTPATIENT,,,123.75,49.5,AETNA,AETNA COMMERCIAL,121.275,98,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES,97530GP,CPT,420,RC,GP,OUTPATIENT,,,113.75,45.5,AETNA,AETNA COMMERCIAL,111.475,98,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY OT,97140GO,CPT,430,RC,GO,OUTPATIENT,,,102.75,41.1,AETNA,AETNA COMMERCIAL,100.695,98,,,OTHER,77.06,100.7,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,AETNA,AETNA COMMERCIAL,48.1964,98,,,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,AETNA,AETNA COMMERCIAL,48.1964,98,,,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
APPLICATION CAST FINGER,29086,CPT,,,,OUTPATIENT,,,281.4,112.56,AETNA,AETNA COMMERCIAL,275.772,98,,,OTHER,211.1,275.8,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GO,CPT,430,RC,GO,OUTPATIENT,,,80.25,32.1,AETNA,AETNA COMMERCIAL,78.645,98,,,OTHER,60.19,78.65,PERCENT OF TOTAL BILLED CHARGES
RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,AETNA,AETNA COMMERCIAL,112.7,98,,,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
ELE STIMULATION ATTENDED 15MIN,97032GO,CPT,430,RC,GO,OUTPATIENT,,,90.5,36.2,AETNA,AETNA COMMERCIAL,88.69,98,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISES/15 MIN,97110GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,AETNA,AETNA COMMERCIAL,105.84,98,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - LOW COMPLEXITY,97165GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,AETNA,AETNA COMMERCIAL,196.8428,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - MODERATE COMPLEXITY,97166GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,AETNA,AETNA COMMERCIAL,196.8428,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - HIGH COMPLEXITY,97167GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,AETNA,AETNA COMMERCIAL,196.8428,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,AETNA,AETNA COMMERCIAL,112.7,98,,,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GO,CPT,430,RC,GO,OUTPATIENT,,,129.25,51.7,AETNA,AETNA COMMERCIAL,126.665,98,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING MANUAL HAND,95832GO,CPT,430,RC,GO,OUTPATIENT,,,112.5,45,AETNA,AETNA COMMERCIAL,110.25,98,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE-EDUC/15 MIN,97112GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,AETNA,AETNA COMMERCIAL,105.84,98,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GO,CPT,430,RC,GO,OUTPATIENT,,,30.25,12.1,AETNA,AETNA COMMERCIAL,29.645,98,,,OTHER,22.69,29.65,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY / 15 MIN,97113GO,CPT,430,RC,GO,OUTPATIENT,,,88.25,35.3,AETNA,AETNA COMMERCIAL,86.485,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PROC GROUP (VISIT),97150GO,CPT,433,RC,GO,OUTPATIENT,,,86.5,34.6,AETNA,AETNA COMMERCIAL,84.77,98,,,OTHER,64.88,84.77,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FIT-TRAINING/15 MIN,97760GO,CPT,430,RC,GO,OUTPATIENT,,,275,110,AETNA,AETNA COMMERCIAL,269.5,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING / 15 MIN,97761GO,CPT,430,RC,GO,OUTPATIENT,,,87.14,34.856,AETNA,AETNA COMMERCIAL,85.3972,98,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES/15 MIN,97530GO,CPT,430,RC,GO,OUTPATIENT,,,108.25,43.3,AETNA,AETNA COMMERCIAL,106.085,98,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,AETNA,AETNA COMMERCIAL,73.99,98,,,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY-WORK REINT TRN/15 MN,97537GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,AETNA,AETNA COMMERCIAL,73.99,98,,,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GO,CPT,430,RC,GO,OUTPATIENT,,,119,47.6,AETNA,AETNA COMMERCIAL,116.62,98,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
ORHOTIC/PROSTHETIC CHECK/15 MN,97763GO,CPT,430,RC,GO,OUTPATIENT,,,250.54,100.216,AETNA,AETNA COMMERCIAL,245.5292,98,,,OTHER,40.31,52.68,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORM-CAP TEST/15MN,97750GO,CPT,430,RC,GO,OUTPATIENT,,,140.75,56.3,AETNA,AETNA COMMERCIAL,137.935,98,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
DEVELOP COGNITIVE SKILLS/15 MN,G0515GO,HCPCS,430,RC,GO,BOTH,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
THER IVNTJ EA ADDL 15 MIN,97130,CPT,,,,OUTPATIENT,,,42,16.8,AETNA,AETNA COMMERCIAL,41.16,98,,,OTHER,31.5,41.2,PERCENT OF TOTAL BILLED CHARGES
EVALUATE SWALLOWING FUNCTION,92610,CPT,430,RC,,OUTPATIENT,,,436.5,174.6,AETNA,AETNA COMMERCIAL,427.77,98,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
LIMB MUSCLE TESTING MANUAL,95831,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,AETNA,AETNA COMMERCIAL,125.195,98,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIM,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,AETNA,AETNA COMMERCIAL,197.715,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH THERAPY,97018,CPT,430,RC,,OUTPATIENT,,,101.25,40.5,AETNA,AETNA COMMERCIAL,99.225,98,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,AETNA,AETNA COMMERCIAL,125.195,98,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
ASSISTIVE TECHNOLOGY ASSESS,97755,CPT,430,RC,,OUTPATIENT,,,121.5,48.6,AETNA,AETNA COMMERCIAL,119.07,98,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
THER IVNTJ 1ST 15 MIN,97129,CPT,,,,OUTPATIENT,,,240,96,AETNA,AETNA COMMERCIAL,235.2,98,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
ST COG FUNC PT ADD 15,97130,CPT,,,,OUTPATIENT,,,220.3,88.12,AETNA,AETNA COMMERCIAL,215.894,98,,,OTHER,165.2,215.9,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE EVAL,92523GN,CPT,444,RC,GN,OUTPATIENT,,,261.33,104.532,AETNA,AETNA COMMERCIAL,256.1034,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE TX,92507GN,CPT,440,RC,GN,OUTPATIENT,,,316,126.4,AETNA,AETNA COMMERCIAL,309.68,98,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
EVAL SWALLOWING FUNCTION,92610GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,AETNA,AETNA COMMERCIAL,299.88,98,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
SP SWALLOWING/ORAL TREATMENT,92526GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,AETNA,AETNA COMMERCIAL,299.88,98,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
ASSESSMENT OF APHASIA PER HR,96105GN,CPT,442,RC,GN,OUTPATIENT,,,291.25,116.5,AETNA,AETNA COMMERCIAL,285.425,98,,,OTHER,218.44,285.43,PERCENT OF TOTAL BILLED CHARGES
COGNITIVE FNCT INTERVENTION,G0515GN,HCPCS,440,RC,GN,BOTH,,,59.25,23.7,AETNA,AETNA COMMERCIAL,58.065,98,,,OTHER,44.44,58.07,PERCENT OF TOTAL BILLED CHARGES
VOICE PROSTHETIC EVA,92597GN,CPT,444,RC,GN,OUTPATIENT,,,167.25,66.9,AETNA,AETNA COMMERCIAL,163.905,98,,,OTHER,125.44,163.91,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE 1 HR,92607GN,CPT,444,RC,GN,OUTPATIENT,,,260.32,104.128,AETNA,AETNA COMMERCIAL,255.1136,98,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE ADDL,92608GN,CPT,444,RC,GN,OUTPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
SPEECH GENERATING DEVICE SERV,92609GN,CPT,440,RC,GN,OUTPATIENT,,,242.25,96.9,AETNA,AETNA COMMERCIAL,237.405,98,,,OTHER,181.69,237.41,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIMITED,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,AETNA,AETNA COMMERCIAL,197.715,98,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST,97750,CPT,440,RC,,OUTPATIENT,,,140.75,56.3,AETNA,AETNA COMMERCIAL,137.935,98,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
TRMT OF SWALLOWING DYSFUNCTION,92526GN,CPT,440,RC,GN,OUTPATIENT,,,175.92,70.368,AETNA,AETNA COMMERCIAL,172.4016,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
SPEECH GROUPS THERAPY,92508GN,CPT,443,RC,GN,OUTPATIENT,,,161.5,64.6,AETNA,AETNA COMMERCIAL,158.27,98,,,OTHER,121.13,158.27,PERCENT OF TOTAL BILLED CHARGES
STD COGNITIVE TEST PER HR,96125GN,CPT,444,RC,GN,OUTPATIENT,,,350.25,140.1,AETNA,AETNA COMMERCIAL,343.245,98,,,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH FLUENCY,92521GN,CPT,444,RC,GN,OUTPATIENT,,,277.46,110.984,AETNA,AETNA COMMERCIAL,271.9108,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH SOUND PROD,92522GN,CPT,444,RC,GN,OUTPATIENT,,,182,72.8,AETNA,AETNA COMMERCIAL,178.36,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH SND W/EVAL LANG,92523GN,CPT,444,RC,GN,OUTPATIENT,,,477.2,190.88,AETNA,AETNA COMMERCIAL,467.656,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
BEHAVIORAL ANALYSIS OF VOICE,92524GN,CPT,444,RC,GN,OUTPATIENT,,,226.82,90.728,AETNA,AETNA COMMERCIAL,222.2836,98,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,,,,OUTPATIENT,,,534,213.6,AETNA,AETNA COMMERCIAL,523.32,98,,,OTHER,400.5,523.3,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPY SWALLOW (FEES) VID,92612,CPT,444,RC,,OUTPATIENT,,,531,212.4,AETNA,AETNA COMMERCIAL,520.38,98,,,OTHER,398.3,520.4,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 4-8 HR,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,AETNA,AETNA COMMERCIAL,1420.755,98,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 1,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,AETNA,AETNA COMMERCIAL,275.625,98,,,OTHER,210.94,275.63,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 2,9928225,CPT,450,RC,25,OUTPATIENT,,,371.25,148.5,AETNA,AETNA COMMERCIAL,363.825,98,,,OTHER,278.44,363.83,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 3,9928325,CPT,450,RC,25,OUTPATIENT,,,461.62,184.648,AETNA,AETNA COMMERCIAL,452.3876,98,,,OTHER,325.88,425.81,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 4,9928425,CPT,450,RC,25,OUTPATIENT,,,820.25,328.1,AETNA,AETNA COMMERCIAL,803.845,98,,,OTHER,615.19,803.85,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 5,9928525,CPT,450,RC,25,OUTPATIENT,,,1448.5,579.4,AETNA,AETNA COMMERCIAL,1419.53,98,,,OTHER,1086.38,1419.53,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE,99291,CPT,450,RC,,OUTPATIENT,,,1571,628.4,AETNA,AETNA COMMERCIAL,1539.58,98,,,OTHER,1178.25,1539.58,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE ADD'L 30 MIN,99292,CPT,450,RC,,OUTPATIENT,,,271.25,108.5,AETNA,AETNA COMMERCIAL,265.825,98,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
NEBULIZER INITIAL TREATMENT,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
TRAUMA TEAM ACTIVATION,G0390,HCPCS,684,RC,,INPATIENT,,,2695.25,1078.1,AETNA,AETNA COMMERCIAL,2641.345,98,,,OTHER,2021.44,2641.35,PERCENT OF TOTAL BILLED CHARGES
IV PUSH MED EA ADD'L,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION 1ST,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION EA ADD'L,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,AETNA,AETNA COMMERCIAL,89.915,98,,,OTHER,68.81,89.92,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION >16 MINS INITIAL,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,AETNA,AETNA COMMERCIAL,466.235,98,,,OTHER,356.81,466.24,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION CONCURRENT,96368,CPT,450,RC,,OUTPATIENT,,,183.5,73.4,AETNA,AETNA COMMERCIAL,179.83,98,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION SEQUENTIAL,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CORONARY THROMBOLYSIS,92977,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,AETNA,AETNA COMMERCIAL,1321.53,98,,,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
URINE DIP,81002,CPT,307,RC,,OUTPATIENT,,,38.25,15.3,AETNA,AETNA COMMERCIAL,37.485,98,,,OTHER,28.69,37.49,PERCENT OF TOTAL BILLED CHARGES
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,AETNA,AETNA COMMERCIAL,609.07,98,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
STRAIGHT CATHETER,51701,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER,51702,CPT,320,RC,,OUTPATIENT,,,343.75,137.5,AETNA,AETNA COMMERCIAL,336.875,98,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER COMP,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,AETNA,AETNA COMMERCIAL,441.49,98,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CHEST TUBE ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
NG-OG TUBE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,AETNA,AETNA COMMERCIAL,516.5482,98,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
G-TUBE CHANGE,43762,CPT,450,RC,,OUTPATIENT,,,720.25,288.1,AETNA,AETNA COMMERCIAL,705.845,98,,,OTHER,540.19,705.85,PERCENT OF TOTAL BILLED CHARGES
DEFIBRILLATION,92950,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,AETNA,AETNA COMMERCIAL,1451.87,98,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
TC PACING,92953,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,AETNA,AETNA COMMERCIAL,1321.53,98,,,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE PLCMT ASSIST>5YRS,36556,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,AETNA,AETNA COMMERCIAL,1994.055,98,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST LG,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,AETNA,AETNA COMMERCIAL,649.495,98,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
THORACOTOMY ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
I O INSERTION,36680,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,AETNA,AETNA COMMERCIAL,527.8182,98,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
SHORT ARM,29125,CPT,450,RC,,OUTPATIENT,,,330.75,132.3,AETNA,AETNA COMMERCIAL,324.135,98,,,OTHER,248.06,324.14,PERCENT OF TOTAL BILLED CHARGES
SHORT LEG,29515,CPT,450,RC,,OUTPATIENT,,,361,144.4,AETNA,AETNA COMMERCIAL,353.78,98,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
LONG LEG,29505,CPT,450,RC,,OUTPATIENT,,,450.5,180.2,AETNA,AETNA COMMERCIAL,441.49,98,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,600.25,240.1,AETNA,AETNA COMMERCIAL,588.245,98,,,OTHER,450.19,588.25,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE COMPL,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,AETNA,AETNA COMMERCIAL,2515.415,98,,,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL/SUBS INTERV 15-30MN,G0396,HCPCS,450,RC,,INPATIENT,,,52.28,20.912,AETNA,AETNA COMMERCIAL,51.2344,98,,,OTHER,39.2,51.2,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL/SUBS INTERV >30 MIN,G0397,HCPCS,450,RC,,INPATIENT,,,266.34,106.536,AETNA,AETNA COMMERCIAL,261.0132,98,,,OTHER,199.8,261,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 1-2 HR,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,AETNA,AETNA COMMERCIAL,1126.755,98,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,63,25.2,AETNA,AETNA COMMERCIAL,61.74,98,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL,96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,AETNA,AETNA COMMERCIAL,439.04,98,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
FNA W/O IMAGE,10021,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,AETNA,AETNA COMMERCIAL,765.87,98,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
REMOVE NAIL PLATE ADD-ON,11732,CPT,450,RC,,OUTPATIENT,,,255,102,AETNA,AETNA COMMERCIAL,249.9,98,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
INTER REPAIR GENITIAL 2.6-7.5,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 20.1-30.0CM,12017,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCTION OF SHDLR ANES,23655,CPT,450,RC,,OUTPATIENT,,,1884.25,753.7,AETNA,AETNA COMMERCIAL,1846.565,98,,,OTHER,1413.19,1846.57,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCT SHLD W/O ANES BI,2365050,CPT,450,RC,50,OUTPATIENT,,,884.75,353.9,AETNA,AETNA COMMERCIAL,867.055,98,,,OTHER,663.56,867.06,PERCENT OF TOTAL BILLED CHARGES
TRT OF ANKLE FRACTURE,45027816,CDM,,,,INPATIENT,,,619.25,247.7,AETNA,AETNA COMMERCIAL,606.865,98,,,OTHER,464.44,606.87,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED POSTERIOR,30905,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DENTAL SURGERY PROCEDURE,41899,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
INC OF THROMBOSED HEMORRD EXT,46083,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF SCROTUM ABCESS,55100,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
I&D OF VULVA/PERINEUM,56405,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,AETNA,AETNA COMMERCIAL,549.8094,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1369.75,547.9,AETNA,AETNA COMMERCIAL,1342.355,98,,,OTHER,1027.31,1342.36,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 2-4 HR,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,AETNA,AETNA COMMERCIAL,1224.755,98,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
REMOVAL IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,AETNA,AETNA COMMERCIAL,277.585,98,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
CATHETERIZATION FOR COLLECTION,P9612,HCPCS,300,RC,,INPATIENT,,,6,2.4,AETNA,AETNA COMMERCIAL,5.88,98,,,OTHER,4.5,5.9,PERCENT OF TOTAL BILLED CHARGES
ACNE SURGERY,10040,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS COMP/MULT,10061,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE PILONIDAL,10080,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE EPIDIDYMIS,54700,CPT,450,RC,,OUTPATIENT,,,975,390,AETNA,AETNA COMMERCIAL,955.5,98,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY SUB-Q SIMPLE,10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INC/REMOVAL FOREIGN BODY;COMPL,10121,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,AETNA,AETNA COMMERCIAL,1033.41,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE HEMOTOMA,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,AETNA,AETNA COMMERCIAL,1236.025,98,,,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
PUNCTURE ASPIRATE ABCESS SMPL,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
DBRDMT SKIN UP TO 10% OF BODY,11000,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT OPEN FX SUBQ ONLY,11010,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,AETNA,AETNA COMMERCIAL,3230.57,98,,,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SKIN SUBQ TISSUE,11011,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,AETNA,AETNA COMMERCIAL,3230.57,98,,,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
DEBRIDMENT SKIN PARTIAL THICK,4511040,CDM,,,,INPATIENT,,,470,188,AETNA,AETNA COMMERCIAL,460.6,98,,,OTHER,352.5,460.6,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SKIN FULL THICK,4511041,CDM,,,,INPATIENT,,,470,188,AETNA,AETNA COMMERCIAL,460.6,98,,,OTHER,352.5,460.6,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SUBQ TISSUE 20 SQ,11042,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,AETNA,AETNA COMMERCIAL,912.87,98,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
DEB BONE 20 SQ CM OR LESS,11044,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,AETNA,AETNA COMMERCIAL,912.87,98,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SKIN LESION,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,AETNA,AETNA COMMERCIAL,422.625,98,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
INCISIONAL BIOPSY SINGLE LESN,11106,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT NAIL 1-5,11720,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
REMOVAL OF SKIN TAGS UP TO 15,11200,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
EXC TR-EXT B9+MART 0.6-ICM,11401,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
FLUID EXC H-F-NK-SP B9+MARG,11422,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,450,RC,,OUTPATIENT,,,605,242,AETNA,AETNA COMMERCIAL,592.9,98,,,OTHER,453.8,592.9,PERCENT OF TOTAL BILLED CHARGES
EXC MALIGN LESION INCL MARGINS,11606,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
TRIMMING OF FINGER/TOE NAIL(S),11719,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
AVULSION OF NAIL PLATE SINGLE,11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
EVACUATION SUBUNGAL HEMOTOMA,11740,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,161.25,210.7,PERCENT OF TOTAL BILLED CHARGES
EXCISION OF NAIL PERM RM,11750,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,AETNA,AETNA COMMERCIAL,1033.41,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF NAIL BED,11760,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF TENDON,4511754,CDM,,,,INPATIENT,,,1910.25,764.1,AETNA,AETNA COMMERCIAL,1872.045,98,,,OTHER,1432.69,1872.05,PERCENT OF TOTAL BILLED CHARGES
WEDGE EXCISION OF SKIN OF NAIL,11765,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,AETNA,AETNA COMMERCIAL,765.87,98,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
REMOVE PILONIDAL CYST SIMPLE,11770,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,AETNA,AETNA COMMERCIAL,765.87,98,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 2.5 CM OR LESS,12001,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 2.6CM TO 7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 7.6-12.5 CM,12004,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 12.6 TO 20 CM,12005,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 20.1 TO 30 CM,12006,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR > 30CM,12007,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE <2.5CM,12011,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE 2.6 - 5.0CM,12013,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE 5.1-7.5CM,12014,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 7.6-12.5CM,12015,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 12.6-20.0,12016,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR OVER 30CM,12018,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,AETNA,AETNA COMMERCIAL,940.065,98,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
TRMT OF SUPERFICIAL WND SIMPLE,12020,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR > 2.5 CM,12031,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.6-7.5CM,12032,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12034,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12035,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 20.1-30.0CM,12036,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0 CM,12037,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,AETNA,AETNA COMMERCIAL,3350.6102,98,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
INTER REPAIR GENITAL 2.5 CM<,12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.6-7.5CM,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12044,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12045,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
REPAIR INTERMED 20.1-30.0CM,12046,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0 CM,12047,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,AETNA,AETNA COMMERCIAL,3350.6102,98,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR < 2.5CM FACE,12051,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.5-5.0CM,12052,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 5.1-7.5CM,12053,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12054,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12055,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,277.88,363.09,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 20.1-30.0CM,12056,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0CM,12057,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,AETNA,AETNA COMMERCIAL,3125.22,98,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13100,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13101,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0CM,13102,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,AETNA,AETNA COMMERCIAL,197.225,98,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13120,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIRED SCALP/EXTREMI,13121,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0 CM,13122,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,AETNA,AETNA COMMERCIAL,197.225,98,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13131,CPT,450,RC,,OUTPATIENT,,,985.75,394.3,AETNA,AETNA COMMERCIAL,966.035,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13132,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0CM,13133,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,AETNA,AETNA COMMERCIAL,197.225,98,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR > 1.0CM,13150,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,AETNA,AETNA COMMERCIAL,3125.22,98,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13151,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13152,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5CM,13153,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,AETNA,AETNA COMMERCIAL,197.225,98,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
REMOVE SUTURES SAME SURGEON,15850,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,AETNA,AETNA COMMERCIAL,1023.855,98,,,OTHER,146.06,190.86,PERCENT OF TOTAL BILLED CHARGES
TRT 1ST DEGREE BURN LOCAL,16000,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRIDE SML BURN W/O ANE,16020,CPT,450,RC,,OUTPATIENT,,,361,144.4,AETNA,AETNA COMMERCIAL,353.78,98,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRISE MED BRN W/O ANE,16025,CPT,450,RC,,OUTPATIENT,,,495.25,198.1,AETNA,AETNA COMMERCIAL,485.345,98,,,OTHER,371.44,485.35,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRIDE LRG BURN W/O ANE,16030,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,472.88,617.89,PERCENT OF TOTAL BILLED CHARGES
CHEMICAL CAUTERIZATION,17250,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
SKIN TISSUE,17999,CPT,450,RC,,INPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
I&D ABSCESS,4520005,CDM,450,RC,,INPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXPLORE WOUND,20103,CPT,450,RC,,INPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY IN MUSCLE,20520,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,AETNA,AETNA COMMERCIAL,1033.41,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
INJ TENDONS/LIGAMENTS;SINGLE,20550,CPT,320,RC,,OUTPATIENT,,,561.25,224.5,AETNA,AETNA COMMERCIAL,550.025,98,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
INJ SGL/MULT TRIGGER PTS 1OR2,20552,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,AETNA,AETNA COMMERCIAL,550.025,98,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
INJ SGL/MULT TRIGGER PTS 3>,20553,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,AETNA,AETNA COMMERCIAL,550.025,98,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST SM,20600,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
ARTHRO SM W/US GUIDANCE,20604,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST MED,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
REMOVAL MJR JOINT OR BURSA,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,AETNA,AETNA COMMERCIAL,649.495,98,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
"ARTHRO,ASSIST LG W/US GUIDANCE",20611,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
ASPIRATE/INJ GAGLION,20612,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FIXATION DEVICE;SUPER,20670,CPT,450,RC,,OUTPATIENT,,,3136.96,1254.784,AETNA,AETNA COMMERCIAL,3074.2208,98,,,OTHER,2352.7,3074.2,PERCENT OF TOTAL BILLED CHARGES
FLUID PRESSURE MUSCLE,20950,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD NASAL BONE FRACTURE,21310,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLOSED TRMT OF NASAL BONE FX,21315,CPT,450,RC,,OUTPATIENT,,,1297.25,518.9,AETNA,AETNA COMMERCIAL,1271.305,98,,,OTHER,972.94,1271.31,PERCENT OF TOTAL BILLED CHARGES
DISLOCATION CLOSED TREATMENT,21480,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RIB FRACTURE UNCOMP,21800,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
HIP DISLOCATION W/MANIPULATION,27257,CPT,450,RC,,OUTPATIENT,,,3282.25,1312.9,AETNA,AETNA COMMERCIAL,3216.605,98,,,OTHER,2461.69,3216.61,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CLAVICULAR FRACTURE,23500,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PRX HUMERAL FX W/O,23600,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DISLOCATION CLOSED SHLD UNI,23650,CPT,450,RC,,OUTPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT SHLDER W/ANES BILA,23655,CPT,450,RC,,OUTPATIENT,,,2890.9,1156.36,AETNA,AETNA COMMERCIAL,2833.082,98,,,OTHER,2168.2,2833.1,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT OF SHOULDER ANES,2365550,CPT,450,RC,50,OUTPATIENT,,,3768.5,1507.4,AETNA,AETNA COMMERCIAL,3693.13,98,,,OTHER,2826.38,3693.13,PERCENT OF TOTAL BILLED CHARGES
CLTX SHLD DISLC W/FX HUMERAL,23665,CPT,450,RC,,OUTPATIENT,,,1500,600,AETNA,AETNA COMMERCIAL,1470,98,,,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT SHLD DIS W/SURG,23675,CPT,450,RC,,OUTPATIENT,,,1500,600,AETNA,AETNA COMMERCIAL,1470,98,,,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FB UPPER ARM/ELBOW SUB,24200,CPT,450,RC,,OUTPATIENT,,,675,270,AETNA,AETNA COMMERCIAL,661.5,98,,,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT HUMERAL FRACTURE,24535,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT HUMERAL FX,24565,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD ELBOW DISLOCATION,24600,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRMT CLOSED ELBOW DISLOCATION,24605,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD HD W/MANIPUL,24640,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD HD W/O MANIPULATION,24650,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT RAD HD OR NK FX W/MA,24655,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
EXCISE TENDON FOREARM/WRIST,25109,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,AETNA,AETNA COMMERCIAL,1033.41,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REPAIR TENDON FLEXOR FA/WRIST,25260,CPT,450,RC,,OUTPATIENT,,,1910.25,764.1,AETNA,AETNA COMMERCIAL,1872.045,98,,,OTHER,1432.69,1872.05,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD SHAFT FRCT W/O MA,25500,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD SHAFT FRCT W/MAN,25505,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT FRACTURE OF RADIUS,25520,CPT,450,RC,,OUTPATIENT,,,2814.98,1125.992,AETNA,AETNA COMMERCIAL,2758.6804,98,,,OTHER,2111.2,2758.7,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD ULNAR SH W/O MANIP,25530,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RADIAL&ULNAR FX,4525560,CDM,,,,INPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT RAD/ULN SHAFT,25565,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD COLLES FX W/O MANIP,25600,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT DISTAL RADIAL FRACTU,25605,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF FINGER ABS/SIMPLE,26010,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF FINGER ABSCESS,26011,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,AETNA,AETNA COMMERCIAL,758.03,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
DISTAL PHALANX OF FINGER,26236,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
REPAIR FINGER/HAND TENDON,26350,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,AETNA,AETNA COMMERCIAL,1815.205,98,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
"REPAIR EXT TENDON, FINGER",26418,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,AETNA,AETNA COMMERCIAL,1815.205,98,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MCAPRAL FX W/O MAN,26600,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
FRACTURE W/MANIPULATION,26605,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DISL THUMB W/MANIP,26641,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CMC FX THUMB W/MANIP,26645,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CMC DISL EX THUMB W/M,26670,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MCP DISL W/MANIP,26700,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PHALANGEAL FX W/O MAN,26720,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PHALANGEAL FX W/MANIP,26725,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER FRACTURE,26742,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DIST PHAL FX W/O MANI,26750,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DIST PHAL FX W/MANIP,26755,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER FRACTURE EACH,26765,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,AETNA,AETNA COMMERCIAL,5609.0104,98,,,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
TREATMENT JOINT DISLOCATION,26770,CPT,450,RC,,OUTPATIENT,,,442.5,177,AETNA,AETNA COMMERCIAL,433.65,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER DISLOCATION,26775,CPT,450,RC,,OUTPATIENT,,,580,232,AETNA,AETNA COMMERCIAL,568.4,98,,,OTHER,435,568.4,PERCENT OF TOTAL BILLED CHARGES
AMPUTATION OF FINGER/THUMB,26951,CPT,450,RC,,OUTPATIENT,,,3417.75,1367.1,AETNA,AETNA COMMERCIAL,3349.395,98,,,OTHER,2563.31,3349.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRT FEMO FX W/MANIP,27503,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD HIP DSLOC W/O ANESTH,27250,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT HIP,27252,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,AETNA,AETNA COMMERCIAL,1815.205,98,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
POST HIP ARTHROPLASTY DISLOCAT,27265,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT POST HIP ARTHRO,27266,CPT,450,RC,,OUTPATIENT,,,887.75,355.1,AETNA,AETNA COMMERCIAL,869.995,98,,,OTHER,665.81,870,PERCENT OF TOTAL BILLED CHARGES
CLTX THIGH FX W/MNPJ,27268,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN THIGH/KNEE LESION,27301,CPT,450,RC,,OUTPATIENT,,,4791.96,1916.784,AETNA,AETNA COMMERCIAL,4696.1208,98,,,OTHER,3594,4696.1,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY KNEE/THIGH,27372,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,AETNA,AETNA COMMERCIAL,2709.945,98,,,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
SUTURE INFRAPATELLAR TENDON PR,27380,CPT,450,RC,,OUTPATIENT,,,892.5,357,AETNA,AETNA COMMERCIAL,874.65,98,,,OTHER,669.38,874.65,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD OF THIGH FRACTURE,27502,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.3,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD KNEE DISL W/O ANESTHE,27550,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT KNEECAP,27560,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLOSED TRMT OF PATELLAR DISC,27562,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD TIBIAL FX W/O MANIP,27750,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREATMENT OF TIBIA FRACTURE,27752,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MEDIAL MAL FX W/O MAN,27760,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT MED MALLCOLOURS FX,27762,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,AETNA,AETNA COMMERCIAL,2719.6764,98,,,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,AETNA,AETNA COMMERCIAL,2719.6764,98,,,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT DISTAL FIBULAR FX WO,27786,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX DISTAL FIBULA W/MA,27788,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT BIMALLEOLAR ANKLE FX,27810,CPT,450,RC,,OUTPATIENT,,,634,253.6,AETNA,AETNA COMMERCIAL,621.32,98,,,OTHER,475.5,621.32,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT TRIMALLCOLAR ANK FX,27818,CPT,450,RC,,OUTPATIENT,,,708.75,283.5,AETNA,AETNA COMMERCIAL,694.575,98,,,OTHER,531.56,694.58,PERCENT OF TOTAL BILLED CHARGES
TREAT LOWER LEG FRACTURE,27825,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,AETNA,AETNA COMMERCIAL,569.87,98,,,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
CLOSED TX ANKLE DISLOCATION,27840,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,AETNA,AETNA COMMERCIAL,569.87,98,,,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,AETNA,AETNA COMMERCIAL,2709.945,98,,,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT COMPLICA,28193,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,AETNA,AETNA COMMERCIAL,1683.885,98,,,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF FOOT TENDON EXTENSOR,28208,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,AETNA,AETNA COMMERCIAL,5609.0104,98,,,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX GREAT TOE W/O MANI,28490,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX GREAT TOE W/MANIP,28495,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX OTH PHALANX W/O MA,28510,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX OTH PHALANX W/MANI,28515,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT TARSAL BONE DISLOC,28545,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD TARSOMETAT DISL W/O A,28600,CPT,450,RC,,OUTPATIENT,,,575,230,AETNA,AETNA COMMERCIAL,563.5,98,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD META JOINT DISL W/O A,28630,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD INTPHAL JT DISL W/O A,28660,CPT,450,RC,,OUTPATIENT,,,430,172,AETNA,AETNA COMMERCIAL,421.4,98,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLTX INTERPHALANGEAL JT,28665,CPT,450,RC,,OUTPATIENT,,,675,270,AETNA,AETNA COMMERCIAL,661.5,98,,,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
LONG ARM CAST,29065,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,AETNA,AETNA COMMERCIAL,471.0762,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION SHORT ARM CAST,29075,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,AETNA,AETNA COMMERCIAL,471.0762,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION HAND/FOREARM CAST,29085,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LONG ARM SPLINT,29105,CPT,450,RC,,OUTPATIENT,,,361,144.4,AETNA,AETNA COMMERCIAL,353.78,98,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
APPLY FOREARM SPLINT,29126,CPT,450,RC,,OUTPATIENT,,,331,132.4,AETNA,AETNA COMMERCIAL,324.38,98,,,OTHER,248.3,324.4,PERCENT OF TOTAL BILLED CHARGES
FINGER SPLINT: STATIC,29130,CPT,450,RC,,OUTPATIENT,,,287.75,115.1,AETNA,AETNA COMMERCIAL,281.995,98,,,OTHER,215.81,282,PERCENT OF TOTAL BILLED CHARGES
APPLICATION OF FINGER SPLINT,29131,CPT,450,RC,,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
STRAPPING THORAX,29200,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING OF SHOULDER,29240,CPT,450,RC,,OUTPATIENT,,,912,364.8,AETNA,AETNA COMMERCIAL,893.76,98,,,OTHER,684,893.8,PERCENT OF TOTAL BILLED CHARGES
STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING FINGER OR HAND,29280,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LONG LEG CAST,29345,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION SHORT LEG CAST,29405,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,AETNA,AETNA COMMERCIAL,446.635,98,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING OF HIP,29520,CPT,450,RC,,OUTPATIENT,,,297,118.8,AETNA,AETNA COMMERCIAL,291.06,98,,,OTHER,222.8,291.1,PERCENT OF TOTAL BILLED CHARGES
STRAPPING KNEE,29530,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING ANKLE,29540,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING TOES,29550,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING UNNA BOOT,29580,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
REM OR BIVALV ARM/LEG CAST,29705,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
WINDOWING OF CAST,29730,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
REMOVAL NASAL FOREIGN,30300,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL NASAL HEMORRHAGE SIMPL,30901,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED SIMP BI,3090150,CPT,450,RC,50,OUTPATIENT,,,233.98,93.592,AETNA,AETNA COMMERCIAL,229.3004,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL NASAL HEMORRHAGE COMPL,30903,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED COMPLEX,3090350,CPT,450,RC,50,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
NASAL SURGERY,30999,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ENDOTRACHEAL INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,AETNA,AETNA COMMERCIAL,773.955,98,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
LARYNGOSCOPY FLEXIBLE DIAG,31575,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,AETNA,AETNA COMMERCIAL,773.955,98,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
TRACHEOSTOMY TRANSTRACHAEL,31603,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,AETNA,AETNA COMMERCIAL,3218.075,98,,,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
"TRACHEOSTOMY, EME PROCEDURE",31605,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,AETNA,AETNA COMMERCIAL,3218.075,98,,,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,OUTPATIENT,,,385.92,154.368,AETNA,AETNA COMMERCIAL,378.2016,98,,,OTHER,289.4,378.2,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS,32554,CPT,450,RC,,OUTPATIENT,,,1079.54,431.816,AETNA,AETNA COMMERCIAL,1057.9492,98,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
TUBE THORACOSTOMY,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS;W/IMAGING,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,AETNA,AETNA COMMERCIAL,1925.7,98,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
PERICARDIOCENTESIS INITIAL,33010,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,AETNA,AETNA COMMERCIAL,940.065,98,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
INSERT ELECTRD/PM CATH SNGL,33210,CPT,450,RC,,OUTPATIENT,,,16488.76,6595.504,AETNA,AETNA COMMERCIAL,16158.9848,98,,,OTHER,12366.6,16159,PERCENT OF TOTAL BILLED CHARGES
REPAIR BLOOD VESSEL UPPER EXT,35206,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,AETNA,AETNA COMMERCIAL,3111.745,98,,,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
"RPR BLOOD VESSEL, HAND, FINGER",35207,CPT,450,RC,,OUTPATIENT,,,2625,1050,AETNA,AETNA COMMERCIAL,2572.5,98,,,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
REPAIR BLD VESSEL LOWER EXTREM,35226,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,AETNA,AETNA COMMERCIAL,3111.745,98,,,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 0-1 HR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,AETNA,AETNA COMMERCIAL,1028.755,98,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE PLCMT ASSIST<5YRS,36555,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,AETNA,AETNA COMMERCIAL,1994.055,98,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
INSERT NON-TUNNEL CV CATH,36556,CPT,450,RC,,OUTPATIENT,,,5703.74,2281.496,AETNA,AETNA COMMERCIAL,5589.6652,98,,,OTHER,4277.8,5589.7,PERCENT OF TOTAL BILLED CHARGES
INSERT TUNNELED CV CATH,36558,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,AETNA,AETNA COMMERCIAL,1994.055,98,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
INSERT PICC CATH,36569,CPT,361,RC,,OUTPATIENT,,,1672,668.8,AETNA,AETNA COMMERCIAL,1638.56,98,,,OTHER,1254,1638.56,PERCENT OF TOTAL BILLED CHARGES
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,AETNA,AETNA COMMERCIAL,281.75,98,,,OTHER,215.6,281.8,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,224,89.6,AETNA,AETNA COMMERCIAL,219.52,98,,,OTHER,168,219.5,PERCENT OF TOTAL BILLED CHARGES
ARTERIAL CATH; PERCUTANEOUS,36620,CPT,450,RC,,OUTPATIENT,,,550,220,AETNA,AETNA COMMERCIAL,539,98,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
THROMBOLYTIC CEREBRAL IV INFUS,37195,CPT,450,RC,,OUTPATIENT,,,619.37,247.748,AETNA,AETNA COMMERCIAL,606.9826,98,,,OTHER,330.75,432.18,PERCENT OF TOTAL BILLED CHARGES
UNLIST PROCEDURE SUTURE VEIN,37799,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,AETNA,AETNA COMMERCIAL,1683.885,98,,,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
RPR LIP FULL THICKNESS VERMILI,40650,CPT,450,RC,,OUTPATIENT,,,901.62,360.648,AETNA,AETNA COMMERCIAL,883.5876,98,,,OTHER,676.2,883.6,PERCENT OF TOTAL BILLED CHARGES
RPR LIP FULL THKNS>ONE-HALF HE,40654,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.4,653.9,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF MOUTH,40800,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,OUTPATIENT,,,1663.6,665.44,AETNA,AETNA COMMERCIAL,1630.328,98,,,OTHER,1247.7,1630.3,PERCENT OF TOTAL BILLED CHARGES
RPR FLOOR MTH AND/OR TONGUE,41250,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
"TONGUE, FLOOR OF MOUTH UNLISTE",41599,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,AETNA,AETNA COMMERCIAL,653.905,98,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF GUM,41800,CPT,450,RC,,OUTPATIENT,,,589,235.6,AETNA,AETNA COMMERCIAL,577.22,98,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF TONSIL ABSCESS,42700,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY PHARYNX,42809,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,AETNA,AETNA COMMERCIAL,527.8182,98,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,AETNA,AETNA COMMERCIAL,2025.4934,98,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
INCISION OF RECTAL,46040,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,AETNA,AETNA COMMERCIAL,2025.4934,98,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
I&D PERIANAL ABSCESS SUPERFCL,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,AETNA,AETNA COMMERCIAL,1550.2326,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REMOVE EXT HEM GROUPS 2+,46250,CPT,450,RC,,OUTPATIENT,,,5432.66,2173.064,AETNA,AETNA COMMERCIAL,5324.0068,98,,,OTHER,4074.5,5324,PERCENT OF TOTAL BILLED CHARGES
EXC OF THROMBOSED HEMORRD EXTR,46320,CPT,450,RC,,OUTPATIENT,,,2397.5,959,AETNA,AETNA COMMERCIAL,2349.55,98,,,OTHER,1798.13,2349.55,PERCENT OF TOTAL BILLED CHARGES
ANOSCOPY REMOVE FOR BODY,46608,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,AETNA,AETNA COMMERCIAL,1550.2326,98,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
ABD PARACENTESIS W/O IMAGING,49082,CPT,450,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
ABD PARACENTESIS W/IMAG GUIDAN,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,AETNA,AETNA COMMERCIAL,1581.3868,98,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
DRAIN BL W/CATH INSERTION,51102,CPT,350,RC,,OUTPATIENT,,,3738.02,1495.208,AETNA,AETNA COMMERCIAL,3663.2596,98,,,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
US URINE CAPACITY MEASURE,51798,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,AETNA,AETNA COMMERCIAL,609.07,98,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE SCROTUM,54700,CPT,450,RC,,OUTPATIENT,,,975,390,AETNA,AETNA COMMERCIAL,955.5,98,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF GLAND,56420,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INTRO ANY HEMOSTATIC AGENT,57180,CPT,450,RC,,OUTPATIENT,,,577.5,231,AETNA,AETNA COMMERCIAL,565.95,98,,,OTHER,433.13,565.95,PERCENT OF TOTAL BILLED CHARGES
REPAIR VAGINA/PERINEUM,57210,CPT,450,RC,,OUTPATIENT,,,6049.04,2419.616,AETNA,AETNA COMMERCIAL,5928.0592,98,,,OTHER,4536.8,5928.1,PERCENT OF TOTAL BILLED CHARGES
REMOVE INTRAUTERINE DEVICE,58301,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,AETNA,AETNA COMMERCIAL,549.8094,98,,,OTHER,282.38,368.97,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE SPINAL,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
"INJECTION, EPIDURAL PATCH",62273,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ TRIGEMINAL,64400,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ FACIAL,64402,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ OCCIPITAL,64405,CPT,361,RC,,OUTPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
BILATERAL N BLOCK INJ OCCIPITA,6445050,CPT,450,RC,50,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,801.75,1047.62,PERCENT OF TOTAL BILLED CHARGES
INJ ANES/SCIATIC NERVE SINGLE,64445,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,AETNA,AETNA COMMERCIAL,594.37,98,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,AETNA,AETNA COMMERCIAL,594.37,98,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ PERIPHERAL BILAT,64450,CPT,361,RC,,OUTPATIENT,,,1298.5,519.4,AETNA,AETNA COMMERCIAL,1272.53,98,,,OTHER,973.9,1272.5,PERCENT OF TOTAL BILLED CHARGES
NERVE BLOCK UNLISTED,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,AETNA,AETNA COMMERCIAL,517.4596,98,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY EYE EXTERNAL,65205,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,AETNA,AETNA COMMERCIAL,680.855,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FOREIGN BODY CORNEAL,65220,CPT,450,RC,,OUTPATIENT,,,707.75,283.1,AETNA,AETNA COMMERCIAL,693.595,98,,,OTHER,530.81,693.6,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY CORNEAL W/SLI,65222,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,AETNA,AETNA COMMERCIAL,680.855,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
REMOVE FOREIGN BODY FROM EYE,65235,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,AETNA,AETNA COMMERCIAL,680.855,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF EYELID ABCESS,67700,CPT,450,RC,,OUTPATIENT,,,563.64,225.456,AETNA,AETNA COMMERCIAL,552.3672,98,,,OTHER,422.7,552.4,PERCENT OF TOTAL BILLED CHARGES
CANTHOTOMY,67715,CPT,450,RC,,OUTPATIENT,,,2205,882,AETNA,AETNA COMMERCIAL,2160.9,98,,,OTHER,1653.75,2160.9,PERCENT OF TOTAL BILLED CHARGES
REPAIR EYELID WOUND,67935,CPT,450,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
REMOVE FOREIGN BODY EYELID,67938,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,AETNA,AETNA COMMERCIAL,680.855,98,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
DRAIN EXTERNAL EAR LESION,69000,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY EAR,69200,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,AETNA,AETNA COMMERCIAL,277.585,98,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
FOREIGN BODY REMOVAL EAR W/GA,69205,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,AETNA,AETNA COMMERCIAL,277.585,98,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
REMOVE IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,115.84,46.336,AETNA,AETNA COMMERCIAL,113.5232,98,,,OTHER,86.9,113.5,PERCENT OF TOTAL BILLED CHARGES
REM IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,AETNA,AETNA COMMERCIAL,277.585,98,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE ULTRASOUND OF THE EYES,7651250,CPT,450,RC,50,OUTPATIENT,,,943,377.2,AETNA,AETNA COMMERCIAL,924.14,98,,,OTHER,707.25,924.14,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE ULTRASOUND OF THE EYE,76512,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,AETNA,AETNA COMMERCIAL,462.07,98,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,OUTPATIENT,,,795,318,AETNA,AETNA COMMERCIAL,779.1,98,,,OTHER,457.69,598.05,PERCENT OF TOTAL BILLED CHARGES
US CHEST REAL TIME W/IMAGE DOC,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,AETNA,AETNA COMMERCIAL,390.53,98,,,OTHER,298.88,390.53,PERCENT OF TOTAL BILLED CHARGES
US BREAST LIMITED UNILAT,76642,CPT,402,RC,,OUTPATIENT,,,196.25,78.5,AETNA,AETNA COMMERCIAL,192.325,98,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US ABDOMEN, COMPLETE",76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,AETNA,AETNA COMMERCIAL,593.39,98,,,OTHER,454.13,593.39,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE ABDOMEN, LIMITED",76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,AETNA,AETNA COMMERCIAL,462.07,98,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
"US RETROPERITONEAL, LIMITED",76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,AETNA,AETNA COMMERCIAL,547.33,98,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US, PREGNANT UTERUS",76815,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,AETNA,AETNA COMMERCIAL,462.07,98,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
PELVIC LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,AETNA,AETNA COMMERCIAL,626.465,98,,,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US,LIMITED NONVAS EXTR",76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,AETNA,AETNA COMMERCIAL,271.705,98,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE NEEDLE PLCMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,AETNA,AETNA COMMERCIAL,898.415,98,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BURN SUPPLIES,459002,CDM,,,,INPATIENT,,,1710.5,684.2,AETNA,AETNA COMMERCIAL,1676.29,98,,,OTHER,1282.88,1676.29,PERCENT OF TOTAL BILLED CHARGES
INJ INTER ARTERIAL,96373,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
INJ THER/PROPH/DIAG SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,157,62.8,AETNA,AETNA COMMERCIAL,153.86,98,,,OTHER,117.75,153.86,PERCENT OF TOTAL BILLED CHARGES
GASTRIC LAVAGE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,AETNA,AETNA COMMERCIAL,516.5482,98,,,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
OPHTHALMOLOGICAL EXAM AND EVAL,92002,CPT,450,RC,,OUTPATIENT,,,270,108,AETNA,AETNA COMMERCIAL,264.6,98,,,OTHER,202.5,264.6,PERCENT OF TOTAL BILLED CHARGES
DIAGNOSTIC NASOPHARYNGOSCOPY,92511,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,AETNA,AETNA COMMERCIAL,773.955,98,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
CARDIAC ARREST CPR,92950,CPT,450,RC,,OUTPATIENT,,,998,399.2,AETNA,AETNA COMMERCIAL,978.04,98,,,OTHER,748.5,978.04,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION ELECTIVE,92960,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,AETNA,AETNA COMMERCIAL,1451.87,98,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
"TRANSTHORACIC ECHO, LIMITED",93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,AETNA,AETNA COMMERCIAL,471.87,98,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
US LE ART;UNILAT OR LIMITED,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,AETNA,AETNA COMMERCIAL,525.77,98,,,OTHER,402.38,525.77,PERCENT OF TOTAL BILLED CHARGES
US VENOUS LIMITED - BEDSIDE,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,AETNA,AETNA COMMERCIAL,909.93,98,,,OTHER,696.38,909.93,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SAME DRUG,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IRRIG DRUG DELIVERY DEVICE,96523,CPT,260,RC,,OUTPATIENT,,,172,68.8,AETNA,AETNA COMMERCIAL,168.56,98,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE <20CM,97597,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,450,RC,,OUTPATIENT,,,340,136,AETNA,AETNA COMMERCIAL,333.2,98,,,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP 5/>YRS,99152,CPT,761,RC,,OUTPATIENT,,,650,260,AETNA,AETNA COMMERCIAL,637,98,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP EA,99153,CPT,761,RC,,OUTPATIENT,,,340,136,AETNA,AETNA COMMERCIAL,333.2,98,,,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
MOD SED OTH PHYS/QHP 5>YRS,99156,CPT,450,RC,,OUTPATIENT,,,335,134,AETNA,AETNA COMMERCIAL,328.3,98,,,OTHER,251.3,328.3,PERCENT OF TOTAL BILLED CHARGES
MOD SED OTHER PHYS/QHP EA,99157,CPT,450,RC,,OUTPATIENT,,,189.5,75.8,AETNA,AETNA COMMERCIAL,185.71,98,,,OTHER,142.1,185.7,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 1 W/O MODIFIER,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,AETNA,AETNA COMMERCIAL,275.625,98,,,OTHER,210.94,275.63,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 2 W/O MODIFIER,99282,CPT,450,RC,,OUTPATIENT,,,371.25,148.5,AETNA,AETNA COMMERCIAL,363.825,98,,,OTHER,278.44,363.83,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 3 W/O MODIFIER,99283,CPT,450,RC,,OUTPATIENT,,,461.62,184.648,AETNA,AETNA COMMERCIAL,452.3876,98,,,OTHER,325.88,425.81,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 4 W/O MODIFIER,99284,CPT,450,RC,,OUTPATIENT,,,820.25,328.1,AETNA,AETNA COMMERCIAL,803.845,98,,,OTHER,615.19,803.85,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 5 W/O MODIFIER,99285,CPT,450,RC,,OUTPATIENT,,,1448.5,579.4,AETNA,AETNA COMMERCIAL,1419.53,98,,,OTHER,1086.38,1419.53,PERCENT OF TOTAL BILLED CHARGES
BI-PAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,AETNA,AETNA COMMERCIAL,645.82,98,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
ETCO2 FIRST DAY,94770,CPT,460,RC,,OUTPATIENT,,,222.75,89.1,AETNA,AETNA COMMERCIAL,218.295,98,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
BI-PAP FIRST DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,AETNA,AETNA COMMERCIAL,645.82,98,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY ONCE DAILY,94760,CPT,460,RC,,OUTPATIENT,,,96.25,38.5,AETNA,AETNA COMMERCIAL,94.325,98,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY MULTIPLES DAILY,94761,CPT,460,RC,,OUTPATIENT,,,275.5,110.2,AETNA,AETNA COMMERCIAL,269.99,98,,,OTHER,206.63,269.99,PERCENT OF TOTAL BILLED CHARGES
PEAK FLOW MONITORING,4600043,CDM,270,RC,,INPATIENT,,,124.5,49.8,AETNA,AETNA COMMERCIAL,122.01,98,,,OTHER,93.38,122.01,PERCENT OF TOTAL BILLED CHARGES
PFT  SPIROMETRY  PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,AETNA,AETNA COMMERCIAL,317.52,98,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,AETNA,AETNA COMMERCIAL,317.52,98,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
SPIROMETRY PRE/POST BRDIAL,94060,CPT,460,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
PFT SPIROMETRY PRE/POST BRDIA,94060,CPT,460,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSPASM PROVOCATION EVAL,94070,CPT,460,RC,,OUTPATIENT,,,874.25,349.7,AETNA,AETNA COMMERCIAL,856.765,98,,,OTHER,655.69,856.77,PERCENT OF TOTAL BILLED CHARGES
PFT  LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,AETNA,AETNA COMMERCIAL,655.13,98,,,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
PFT  DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,AETNA,AETNA COMMERCIAL,329.77,98,,,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
VITALOR SCREENING,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,AETNA,AETNA COMMERCIAL,272.587,98,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY NOCTURNAL STUDY,94762,CPT,460,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY WITH AMBULATION,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,AETNA,AETNA COMMERCIAL,188.65,98,,,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.5,315.8,AETNA,AETNA COMMERCIAL,773.71,98,,,OTHER,592.13,773.71,PERCENT OF TOTAL BILLED CHARGES
CARDIOPULMONARY RESUSCITATION,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,AETNA,AETNA COMMERCIAL,977.55,98,,,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
CARDIAC EVENT MONITER SETUP,93270,CPT,480,RC,,OUTPATIENT,,,412,164.8,AETNA,AETNA COMMERCIAL,403.76,98,,,OTHER,309,403.76,PERCENT OF TOTAL BILLED CHARGES
VENTILATION RESCUE BREATHING,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,AETNA,AETNA COMMERCIAL,977.55,98,,,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
ECHO 3D/M MODE & COLOR DOPPLER,C8929,HCPCS,480,RC,,INPATIENT,,,2595.5,1038.2,AETNA,AETNA COMMERCIAL,2543.59,98,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
GRADED EXERCISE BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,AETNA,AETNA COMMERCIAL,1138.025,98,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
GRADED EXERCISE TEST,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,AETNA,AETNA COMMERCIAL,1138.025,98,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
GXT STD THREADMILL WALKING,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,AETNA,AETNA COMMERCIAL,1138.025,98,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
PHARM STRESS TEST BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,AETNA,AETNA COMMERCIAL,1138.025,98,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
PULMONARY STRESS TESTING 6 MIN,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,AETNA,AETNA COMMERCIAL,2543.59,98,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
AE PFT SPIROMETRY PRE/POST BRD,94060,CPT,460,RC,,OUTPATIENT,,,600,240,AETNA,AETNA COMMERCIAL,588,98,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE&COLOR DOP W/C,C8929,HCPCS,480,RC,,BOTH,,,2595.5,1038.2,AETNA,AETNA COMMERCIAL,2543.59,98,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
AE MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
AE MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,AETNA,AETNA COMMERCIAL,1764.735,98,,,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE LIMITED,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,AETNA,AETNA COMMERCIAL,471.87,98,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,AETNA,AETNA COMMERCIAL,2543.59,98,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,AETNA,AETNA COMMERCIAL,1764.735,98,,,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE LIMITED STUDY,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,AETNA,AETNA COMMERCIAL,471.87,98,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
STRESS ECHO TECHNICAL,93350,CPT,480,RC,,OUTPATIENT,,,1572.25,628.9,AETNA,AETNA COMMERCIAL,1540.805,98,,,OTHER,1179.19,1540.81,PERCENT OF TOTAL BILLED CHARGES
AE NEB MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
AE NEB SUBSEQUENT MED AEROSOL,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
AE PEAK FLOW MONITORING,4830104,CDM,270,RC,,INPATIENT,,,124.5,49.8,AETNA,AETNA COMMERCIAL,122.01,98,,,OTHER,93.38,122.01,PERCENT OF TOTAL BILLED CHARGES
AE PFT SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,AETNA,AETNA COMMERCIAL,317.52,98,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
AE PFT LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,AETNA,AETNA COMMERCIAL,655.13,98,,,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
AE PFT DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,AETNA,AETNA COMMERCIAL,329.77,98,,,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION EA ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL I,96360,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,AETNA,AETNA COMMERCIAL,578.69,98,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL II,96360,CPT,450,RC,,OUTPATIENT,,,522.5,209,AETNA,AETNA COMMERCIAL,512.05,98,,,OTHER,391.88,512.05,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL III,96360,CPT,450,RC,,OUTPATIENT,,,532.25,212.9,AETNA,AETNA COMMERCIAL,521.605,98,,,OTHER,399.19,521.61,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION SETUP,5100040,CDM,,,,INPATIENT,,,193.75,77.5,AETNA,AETNA COMMERCIAL,189.875,98,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
MINOR WOUND DEBRIDEMENT,5100050,CDM,,,,INPATIENT,,,177.5,71,AETNA,AETNA COMMERCIAL,173.95,98,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
PICC LINE INSERTION,36489,CPT,361,RC,,OUTPATIENT,,,839.5,335.8,AETNA,AETNA COMMERCIAL,822.71,98,,,OTHER,629.63,822.71,PERCENT OF TOTAL BILLED CHARGES
STERILE DRESSING,5100080,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
EVAL & MGMT CLINICAL VISIT,G0463,HCPCS,510,RC,,BOTH,,,232,92.8,AETNA,AETNA COMMERCIAL,227.36,98,,,OTHER,126.94,165.87,PERCENT OF TOTAL BILLED CHARGES
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,INPATIENT,,,15,6,AETNA,AETNA COMMERCIAL,14.7,98,,,OTHER,11.3,14.7,PERCENT OF TOTAL BILLED CHARGES
SCHOOL/CAMP PHY LEVEL 1,P99901,HCPCS,516,RC,,OUTPATIENT,,,35,14,AETNA,AETNA COMMERCIAL,34.3,98,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
DOT PHYSICAL,P99904,HCPCS,516,RC,,OUTPATIENT,,,170,68,AETNA,AETNA COMMERCIAL,166.6,98,,,OTHER,127.5,166.6,PERCENT OF TOTAL BILLED CHARGES
"CLINDAMYCIN PHOSP, 300MG INJ",S0077,HCPCS,,,,OUTPATIENT,,,22,8.8,AETNA,AETNA COMMERCIAL,21.56,98,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG,S0119,HCPCS,,,,OUTPATIENT,,,39,15.6,AETNA,AETNA COMMERCIAL,38.22,98,,,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
SPLINT DIGIT,S8450,HCPCS,516,RC,,OUTPATIENT,,,5,2,AETNA,AETNA COMMERCIAL,4.9,98,,,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 1 MG,Q0162,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
"ALBUTEROL, INHALATION SOLUTION",J7613,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
PR PREDNISONE IMMEDIATE RELEAS,J7512,HCPCS,516,RC,,OUTPATIENT,,,0.05,0.02,AETNA,AETNA COMMERCIAL,0.049,98,,,OTHER,0.04,0.05,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE ORAL,J7506,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 250CC BAG,J7050,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 1000CC BAG,J7030,HCPCS,516,RC,,OUTPATIENT,,,5,2,AETNA,AETNA COMMERCIAL,4.9,98,,,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
TRIAMCINOLONE ACETONIDE INJ,J3301,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,AETNA,AETNA COMMERCIAL,3.92,98,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2930,HCPCS,516,RC,,OUTPATIENT,,,9,3.6,AETNA,AETNA COMMERCIAL,8.82,98,,,OTHER,6.75,8.82,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2920,HCPCS,516,RC,,OUTPATIENT,,,6,2.4,AETNA,AETNA COMMERCIAL,5.88,98,,,OTHER,4.5,5.88,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE HCL INJECTION,J2550,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,AETNA,AETNA COMMERCIAL,3.92,98,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON HCL INJECTION,J2405,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC TROMETHAMINE INJ,J1885,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,AETNA,AETNA COMMERCIAL,1.96,98,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE HCL INJECTIO,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,AETNA,AETNA COMMERCIAL,1.96,98,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE SODIUM PHOS,J1100,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,AETNA,AETNA COMMERCIAL,0.98,98,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
ROCEPHIN INJ,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,AETNA,AETNA COMMERCIAL,1.96,98,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G BENZATHINE INJ,J0561,HCPCS,516,RC,,OUTPATIENT,,,20,8,AETNA,AETNA COMMERCIAL,19.6,98,,,OTHER,15,19.6,PERCENT OF TOTAL BILLED CHARGES
PENG BENZATHINE/PROCAINE INJ,J0558,HCPCS,516,RC,,OUTPATIENT,,,15,6,AETNA,AETNA COMMERCIAL,14.7,98,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
"REMOVE FOREIGN BODY, SIM",10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
PUNCTURE DRAINAGE OF LESION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,251.25,328.3,PERCENT OF TOTAL BILLED CHARGES
"REMOVAL OF NAIL PLATE, SINGLE",11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,189.75,247.94,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND TR 2.5CM/<,12001,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,172.5,225.4,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND TRNK 2.6-7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,210.75,275.38,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND FA 2.5 CM/<,12011,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,211.5,276.36,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUNDS FA 5.1-7.5 CM,12014,CPT,450,RC,,OUTPATIENT,,,365,146,AETNA,AETNA COMMERCIAL,357.7,98,,,OTHER,273.75,357.7,PERCENT OF TOTAL BILLED CHARGES
"LAYER CLOSURE OF WOUNDS, HAND",12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,AETNA,AETNA COMMERCIAL,675.5238,98,,,OTHER,464.25,606.62,PERCENT OF TOTAL BILLED CHARGES
"BURN TREATMENT W/O ANES, SM",16020,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,AETNA,AETNA COMMERCIAL,350.7126,98,,,OTHER,158.25,206.78,PERCENT OF TOTAL BILLED CHARGES
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,AETNA,AETNA COMMERCIAL,1214.8962,98,,,OTHER,503.25,657.58,PERCENT OF TOTAL BILLED CHARGES
APPLY FOREARM SPLINT,29125,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,124.5,162.68,PERCENT OF TOTAL BILLED CHARGES
APPLICATION OF FINGER SPLINT,29130,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LOWER LEG SPLINT,29515,CPT,450,RC,,OUTPATIENT,,,281.39,112.556,AETNA,AETNA COMMERCIAL,275.7622,98,,,OTHER,139.5,182.28,PERCENT OF TOTAL BILLED CHARGES
ROUTINE VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,8,3.2,AETNA,AETNA COMMERCIAL,7.84,98,,,OTHER,6,7.84,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF ANAL ABSCESS,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,AETNA,AETNA COMMERCIAL,1550.2326,98,,,OTHER,393,513.52,PERCENT OF TOTAL BILLED CHARGES
INCISE EXTERNAL HEMORRHOID,46083,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,AETNA,AETNA COMMERCIAL,519.8508,98,,,OTHER,342,446.88,PERCENT OF TOTAL BILLED CHARGES
INJ NERVE BLOCK PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,155.25,202.86,PERCENT OF TOTAL BILLED CHARGES
CLEAR OUTER EAR CANAL,69200,CPT,450,RC,,OUTPATIENT,,,318,127.2,AETNA,AETNA COMMERCIAL,311.64,98,,,OTHER,238.5,311.64,PERCENT OF TOTAL BILLED CHARGES
REMOVE IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,127,50.8,AETNA,AETNA COMMERCIAL,124.46,98,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,300,RC,,OUTPATIENT,,,17.92,7.168,AETNA,AETNA COMMERCIAL,17.5616,98,,,OTHER,13.4,17.6,PERCENT OF TOTAL BILLED CHARGES
URINALYSIS COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,9,3.6,AETNA,AETNA COMMERCIAL,8.82,98,,,OTHER,6.8,8.8,PERCENT OF TOTAL BILLED CHARGES
"URINALYSIS, NON AUTOMATED",81002,CPT,307,RC,,OUTPATIENT,,,9,3.6,AETNA,AETNA COMMERCIAL,8.82,98,,,OTHER,6.75,8.82,PERCENT OF TOTAL BILLED CHARGES
URINE PREGNANCY TEST,81025,CPT,300,RC,,OUTPATIENT,,,22,8.8,AETNA,AETNA COMMERCIAL,21.56,98,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
UR ALBUMIN SEMIQUANTITATIVE,82044,CPT,,,,OUTPATIENT,,,16,6.4,AETNA,AETNA COMMERCIAL,15.68,98,,,OTHER,12,15.7,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,OUTPATIENT,,,11,4.4,AETNA,AETNA COMMERCIAL,10.78,98,,,OTHER,8.3,10.8,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TEST,82950,CPT,301,RC,,OUTPATIENT,,,16,6.4,AETNA,AETNA COMMERCIAL,15.68,98,,,OTHER,12,15.7,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE BLOOD TEST,82962,CPT,300,RC,,OUTPATIENT,,,6.56,2.624,AETNA,AETNA COMMERCIAL,6.4288,98,,,OTHER,4.5,5.88,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,33,13.2,AETNA,AETNA COMMERCIAL,32.34,98,,,OTHER,24.8,32.3,PERCENT OF TOTAL BILLED CHARGES
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,13,5.2,AETNA,AETNA COMMERCIAL,12.74,98,,,OTHER,9.8,12.7,PERCENT OF TOTAL BILLED CHARGES
SMEAR WET MOUNT SALINE/INK,87210,CPT,300,RC,,OUTPATIENT,,,15,6,AETNA,AETNA COMMERCIAL,14.7,98,,,OTHER,11.3,14.7,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA DNA AMP PROBE,87502,CPT,306,RC,,OUTPATIENT,,,117,46.8,AETNA,AETNA COMMERCIAL,114.66,98,,,OTHER,87.8,114.7,PERCENT OF TOTAL BILLED CHARGES
RSV DNA/RNA AMP PROBE,87634,CPT,300,RC,,OUTPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.8,95.1,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,87635,CPT,300,RC,,OUTPATIENT,,,100.2,40.08,AETNA,AETNA COMMERCIAL,98.196,98,,,OTHER,75.2,98.2,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,54,21.6,AETNA,AETNA COMMERCIAL,52.92,98,,,OTHER,40.5,52.9,PERCENT OF TOTAL BILLED CHARGES
DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,98,39.2,AETNA,AETNA COMMERCIAL,96.04,98,,,OTHER,73.5,96,PERCENT OF TOTAL BILLED CHARGES
"INFCT ANTIGEN, INFLUENZA",87804,CPT,300,RC,,OUTPATIENT,,,41,16.4,AETNA,AETNA COMMERCIAL,40.18,98,,,OTHER,30.75,40.18,PERCENT OF TOTAL BILLED CHARGES
"INFCTS ANTIGN, STREPTOCOCCUS A",87880,CPT,300,RC,,OUTPATIENT,,,47,18.8,AETNA,AETNA COMMERCIAL,46.06,98,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
"IMMUN ADMIN 1 VAC, SNGL/COMBO",90471,CPT,761,RC,,OUTPATIENT,,,123.52,49.408,AETNA,AETNA COMMERCIAL,121.0496,98,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
TD VACCINE NO PRSRV 7/> IM,90714,CPT,516,RC,,OUTPATIENT,,,53,21.2,AETNA,AETNA COMMERCIAL,51.94,98,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
TDAP IMMUNIZATION,90715,CPT,516,RC,,OUTPATIENT,,,79,31.6,AETNA,AETNA COMMERCIAL,77.42,98,,,OTHER,59.25,77.42,PERCENT OF TOTAL BILLED CHARGES
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,OUTPATIENT,,,22,8.8,AETNA,AETNA COMMERCIAL,21.56,98,,,OTHER,16.5,21.6,PERCENT OF TOTAL BILLED CHARGES
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION INITIAL;31-60 MINS,96360,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADDT'L HR,96361,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,AETNA,AETNA COMMERCIAL,78.1354,98,,,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
"INJ, THERAPEUTIC OR DIAGNOSTIC",96372,CPT,260,RC,,OUTPATIENT,,,123.52,49.408,AETNA,AETNA COMMERCIAL,121.0496,98,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SINGLE OR INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,AETNA,AETNA COMMERCIAL,397.4978,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA NEW ADDT'L DRUGS,96375,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,AETNA,AETNA COMMERCIAL,78.1354,98,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW",99201,CPT,516,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
OFFICE/OP VISIT NEW,99202,CPT,516,RC,,OUTPATIENT,,,190,76,AETNA,AETNA COMMERCIAL,186.2,98,,,OTHER,142.5,186.2,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99203,CPT,516,RC,,OUTPATIENT,,,277,110.8,AETNA,AETNA COMMERCIAL,271.46,98,,,OTHER,207.75,271.46,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99204,CPT,516,RC,,OUTPATIENT,,,421,168.4,AETNA,AETNA COMMERCIAL,412.58,98,,,OTHER,315.75,412.58,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MIN",99211,CPT,510,RC,,OUTPATIENT,,,51,20.4,AETNA,AETNA COMMERCIAL,49.98,98,,,OTHER,38.25,49.98,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT EST, LOW",99212,CPT,510,RC,,OUTPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST MOD",99213,CPT,510,RC,,OUTPATIENT,,,185,74,AETNA,AETNA COMMERCIAL,181.3,98,,,OTHER,138.75,181.3,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MOD",99214,CPT,510,RC,,OUTPATIENT,,,274,109.6,AETNA,AETNA COMMERCIAL,268.52,98,,,OTHER,205.5,268.52,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, HIGH",99215,CPT,510,RC,,OUTPATIENT,,,371,148.4,AETNA,AETNA COMMERCIAL,363.58,98,,,OTHER,278.25,363.58,PERCENT OF TOTAL BILLED CHARGES
SLEEP STAGING <6 YRS,95782,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,AETNA,AETNA COMMERCIAL,3821.51,98,,,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
"SS, CPAP STAGING <6 YRS",95783,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,AETNA,AETNA COMMERCIAL,4213.02,98,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
MULTI SLEEP LATENCY TEST,95805,CPT,740,RC,,OUTPATIENT,,,4094.5,1637.8,AETNA,AETNA COMMERCIAL,4012.61,98,,,OTHER,3070.88,4012.61,PERCENT OF TOTAL BILLED CHARGES
SLEEP STUDY UNATTENDED,95806,CPT,740,RC,,OUTPATIENT,,,278.15,111.26,AETNA,AETNA COMMERCIAL,272.587,98,,,OTHER,206.25,269.5,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM STAGING,95810,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,AETNA,AETNA COMMERCIAL,3821.51,98,,,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM CPAP-STAGING,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,AETNA,AETNA COMMERCIAL,4213.02,98,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM W/CPAP,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,AETNA,AETNA COMMERCIAL,4213.02,98,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
ELECTROENCEPHALOGRAM,95816,CPT,740,RC,,OUTPATIENT,,,1063,425.2,AETNA,AETNA COMMERCIAL,1041.74,98,,,OTHER,797.25,1041.74,PERCENT OF TOTAL BILLED CHARGES
EEG ALL NIGHT RECORDING,95827,CPT,740,RC,,OUTPATIENT,,,3742.25,1496.9,AETNA,AETNA COMMERCIAL,3667.405,98,,,OTHER,2806.69,3667.41,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,AETNA,AETNA COMMERCIAL,3290.84,98,,,OTHER,2518.5,3290.84,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST LT W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,AETNA,AETNA COMMERCIAL,2829.75,98,,,OTHER,2165.63,2829.75,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST RT  W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,AETNA,AETNA COMMERCIAL,2829.75,98,,,OTHER,2165.63,2829.75,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST BILATERAL W/WO,C8908,HCPCS,610,RC,,BOTH,,,4059.25,1623.7,AETNA,AETNA COMMERCIAL,3978.065,98,,,OTHER,3044.44,3978.07,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST BILAT W/O CONTRAST,77047,CPT,610,RC,,OUTPATIENT,,,3180,1272,AETNA,AETNA COMMERCIAL,3116.4,98,,,OTHER,2385,3116.4,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB W/WO BILATERAL,7371850,CPT,610,RC,50,OUTPATIENT,,,3675,1470,AETNA,AETNA COMMERCIAL,3601.5,98,,,OTHER,2756.25,3601.5,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL W/WO,7372050,CPT,610,RC,50,OUTPATIENT,,,4811.25,1924.5,AETNA,AETNA COMMERCIAL,4715.025,98,,,OTHER,3608.44,4715.03,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL W/O,7371850,CPT,610,RC,50,OUTPATIENT,,,3526,1410.4,AETNA,AETNA COMMERCIAL,3455.48,98,,,OTHER,2644.5,3455.48,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB BILATERAL W/O,7372050,CPT,610,RC,50,OUTPATIENT,,,3400,1360,AETNA,AETNA COMMERCIAL,3332,98,,,OTHER,2550,3332,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/O CONTRAST,71550,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,AETNA,AETNA COMMERCIAL,3290.84,98,,,OTHER,2518.5,3290.84,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/WO CONTRT,72156,CPT,610,RC,,OUTPATIENT,,,3765.75,1506.3,AETNA,AETNA COMMERCIAL,3690.435,98,,,OTHER,2824.31,3690.44,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/CONTRAST,72142,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/O CONTRST,72141,CPT,610,RC,,OUTPATIENT,,,2808.25,1123.3,AETNA,AETNA COMMERCIAL,2752.085,98,,,OTHER,2106.19,2752.09,PERCENT OF TOTAL BILLED CHARGES
MRI FACE NECK ORBIT W CONTRAST,70542,CPT,610,RC,,OUTPATIENT,,,3577.75,1431.1,AETNA,AETNA COMMERCIAL,3506.195,98,,,OTHER,2683.31,3506.2,PERCENT OF TOTAL BILLED CHARGES
MR GUIDANCE FOR NEEDLE PLACE,77021,CPT,610,RC,,OUTPATIENT,,,2378.75,951.5,AETNA,AETNA COMMERCIAL,2331.175,98,,,OTHER,1784.06,2331.18,PERCENT OF TOTAL BILLED CHARGES
MRI FACE/NECK/OR WO CONTRAST,70540,CPT,610,RC,,OUTPATIENT,,,3169.5,1267.8,AETNA,AETNA COMMERCIAL,3106.11,98,,,OTHER,2377.13,3106.11,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2800,1120,AETNA,AETNA COMMERCIAL,2744,98,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,2800,1120,AETNA,AETNA COMMERCIAL,2744,98,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/O CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/O CONT RT,73721RT,CPT,610,RC,RT,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/CONT RT,73722,CPT,610,RC,,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS WO/CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST BILATERAL W/WO,7322350,CPT,610,RC,50,OUTPATIENT,,,5700,2280,AETNA,AETNA COMMERCIAL,5586,98,,,OTHER,4275,5586,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HAND WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
HAND W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6504.75,2601.9,AETNA,AETNA COMMERCIAL,6374.655,98,,,OTHER,4878.56,6374.66,PERCENT OF TOTAL BILLED CHARGES
HAND W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,5402.25,2160.9,AETNA,AETNA COMMERCIAL,5294.205,98,,,OTHER,4051.69,5294.21,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/WO CONTRAST,70553,CPT,610,RC,,OUTPATIENT,,,3674.75,1469.9,AETNA,AETNA COMMERCIAL,3601.255,98,,,OTHER,2756.06,3601.26,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW,77084,CPT,610,RC,,OUTPATIENT,,,2587.5,1035,AETNA,AETNA COMMERCIAL,2535.75,98,,,OTHER,1940.63,2535.75,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,3071.75,1228.7,AETNA,AETNA COMMERCIAL,3010.315,98,,,OTHER,2303.81,3010.32,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/O CONTRAST,70551,CPT,610,RC,,OUTPATIENT,,,2888.5,1155.4,AETNA,AETNA COMMERCIAL,2830.73,98,,,OTHER,2166.38,2830.73,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT BI,7371850,CPT,610,RC,50,OUTPATIENT,,,5046,2018.4,AETNA,AETNA COMMERCIAL,4945.08,98,,,OTHER,3784.5,4945.08,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
FOOT W/WO CONT BI,7372050,CPT,610,RC,50,OUTPATIENT,,,6848.75,2739.5,AETNA,AETNA COMMERCIAL,6711.775,98,,,OTHER,5136.56,6711.78,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HAND WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS WO/CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/CONTRAST,73722QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364.5,945.8,AETNA,AETNA COMMERCIAL,2317.21,98,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/WO CONT LT,73723LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/O CONT LT,73718RTQQ,CPT,610,RC,RTQQ,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/CONT LT,73719LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/O CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/WO CONT LT,73720LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/O CONTRAST,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,AETNA,AETNA COMMERCIAL,2111.41,98,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/CONT LT,C8912LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/O CONT LT,C8913LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/WO CONT LT,C8914LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,AETNA,AETNA COMMERCIAL,2744,98,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,AETNA,AETNA COMMERCIAL,2472.54,98,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,AETNA,AETNA COMMERCIAL,2744,98,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI WHOLE BODY LIM 1-4 AREAS,76498,CPT,610,RC,,OUTPATIENT,,,3496,1398.4,AETNA,AETNA COMMERCIAL,3426.08,98,,,OTHER,2622,3426.1,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/WO CONTRAST,72158,CPT,610,RC,,OUTPATIENT,,,3560.75,1424.3,AETNA,AETNA COMMERCIAL,3489.535,98,,,OTHER,2670.56,3489.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/CONT LT,C8934LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/O CONT LT,C8935LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/WO CONT LT,C8936LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/CONTRAST,72149,CPT,610,RC,,OUTPATIENT,,,3350.75,1340.3,AETNA,AETNA COMMERCIAL,3283.735,98,,,OTHER,2513.06,3283.74,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/O CONTRAST,72148,CPT,610,RC,,OUTPATIENT,,,2931.5,1172.6,AETNA,AETNA COMMERCIAL,2872.87,98,,,OTHER,2198.63,2872.87,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/O CONTRAST,70544,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,AETNA,AETNA COMMERCIAL,2834.405,98,,,OTHER,2169.19,2834.41,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/CONT RT,C8912,HCPCS,610,RC,,BOTH,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MR ANGIO PELVIS W/O & W/DYE,72198,CPT,610,RC,,OUTPATIENT,,,2625,1050,AETNA,AETNA COMMERCIAL,2572.5,98,,,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
MRA ANG LWR EXT W OR W/O DYE,73725,CPT,610,RC,,OUTPATIENT,,,1837.5,735,AETNA,AETNA COMMERCIAL,1800.75,98,,,OTHER,1378.13,1800.75,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABDOMEN W/WO CONTRST,C8902,HCPCS,610,RC,,INPATIENT,,,2312,924.8,AETNA,AETNA COMMERCIAL,2265.76,98,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/O CONTRAST,70547,CPT,610,RC,,OUTPATIENT,,,2223,889.2,AETNA,AETNA COMMERCIAL,2178.54,98,,,OTHER,1667.25,2178.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/CONTRAST,70548,CPT,610,RC,,OUTPATIENT,,,2434.25,973.7,AETNA,AETNA COMMERCIAL,2385.565,98,,,OTHER,1825.69,2385.57,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/WO CONTRAST,70549,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,AETNA,AETNA COMMERCIAL,2834.405,98,,,OTHER,2169.19,2834.41,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,AETNA,AETNA COMMERCIAL,3780.105,98,,,OTHER,2892.94,3780.11,PERCENT OF TOTAL BILLED CHARGES
MRI TMJ W/O CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,AETNA,AETNA COMMERCIAL,3299.415,98,,,OTHER,2525.06,3299.42,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/WO CONTRT,72157,CPT,610,RC,,OUTPATIENT,,,3352.25,1340.9,AETNA,AETNA COMMERCIAL,3285.205,98,,,OTHER,2514.19,3285.21,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/CONTRAST,72147,CPT,610,RC,,OUTPATIENT,,,3108,1243.2,AETNA,AETNA COMMERCIAL,3045.84,98,,,OTHER,2331,3045.84,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/O CONTRST,72146,CPT,610,RC,,OUTPATIENT,,,2931,1172.4,AETNA,AETNA COMMERCIAL,2872.38,98,,,OTHER,2198.25,2872.38,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT RT,73222QQ,CPT,610,RC,QQ,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT LT,73222LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2720.5,1088.2,AETNA,AETNA COMMERCIAL,2666.09,98,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT RT,73221QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT LT,73221LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2364,945.6,AETNA,AETNA COMMERCIAL,2316.72,98,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/CONTRAST,70545,CPT,610,RC,,OUTPATIENT,,,3099,1239.6,AETNA,AETNA COMMERCIAL,3037.02,98,,,OTHER,2324.25,3037.02,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/WO CONTRAST,70546,CPT,610,RC,,OUTPATIENT,,,3173,1269.2,AETNA,AETNA COMMERCIAL,3109.54,98,,,OTHER,2379.75,3109.54,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/CONTRAST,71551,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,AETNA,AETNA COMMERCIAL,3694.845,98,,,OTHER,2827.69,3694.85,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/WO CONTRAST,71552,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,AETNA,AETNA COMMERCIAL,3891.335,98,,,OTHER,2978.06,3891.34,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/WO CONT RT,73723QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,AETNA,AETNA COMMERCIAL,3410.4,98,,,OTHER,2610,3410.4,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,AETNA,AETNA COMMERCIAL,4812.045,98,,,OTHER,3682.69,4812.05,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/O CONT RT,73218QQ,CPT,610,RC,QQ,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/O CONT LT,73218LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/CONT RT,73219QQ,CPT,610,RC,QQ,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/CONT LT,73219LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT RT,73220QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT LT,73220LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT RT,73223QQ,CPT,610,RC,QQ,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT LT,73223LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3382,1352.8,AETNA,AETNA COMMERCIAL,3314.36,98,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/CONTRAST,74182,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,AETNA,AETNA COMMERCIAL,3694.845,98,,,OTHER,2827.69,3694.85,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/WO CONTRAST,74183,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,AETNA,AETNA COMMERCIAL,3891.335,98,,,OTHER,2978.06,3891.34,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19085RT,CPT,610,RC,RT,OUTPATIENT,,,3207.25,1282.9,AETNA,AETNA COMMERCIAL,3143.105,98,,,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19085LT,CPT,610,RC,LT,OUTPATIENT,,,3207.25,1282.9,AETNA,AETNA COMMERCIAL,3143.105,98,,,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION RT,19086RT,CPT,610,RC,RT,OUTPATIENT,,,2441.25,976.5,AETNA,AETNA COMMERCIAL,2392.425,98,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION LT,19086LT,CPT,610,RC,LT,OUTPATIENT,,,2441.25,976.5,AETNA,AETNA COMMERCIAL,2392.425,98,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,1908550,CPT,610,RC,50,OUTPATIENT,,,3589.75,1435.9,AETNA,AETNA COMMERCIAL,3517.955,98,,,OTHER,2692.31,3517.96,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION BI,1908650,CPT,610,RC,50,OUTPATIENT,,,2823.75,1129.5,AETNA,AETNA COMMERCIAL,2767.275,98,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION UNI,19085,CPT,610,RC,,OUTPATIENT,,,4345,1738,AETNA,AETNA COMMERCIAL,4258.1,98,,,OTHER,3258.75,4258.1,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,AETNA,AETNA COMMERCIAL,2697.45,98,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/WO RT,73218,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,AETNA,AETNA COMMERCIAL,3283.49,98,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,AETNA,AETNA COMMERCIAL,3077.2,98,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,AETNA,AETNA COMMERCIAL,4222.33,98,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,AETNA,AETNA COMMERCIAL,6566.735,98,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
KNEE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,AETNA,AETNA COMMERCIAL,4222.33,98,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
KNEE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,AETNA,AETNA COMMERCIAL,6566.735,98,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
HIP W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,AETNA,AETNA COMMERCIAL,4222.33,98,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
HIP W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,AETNA,AETNA COMMERCIAL,6566.735,98,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,4727.5,1891,AETNA,AETNA COMMERCIAL,4632.95,98,,,OTHER,3545.63,4632.95,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6763.25,2705.3,AETNA,AETNA COMMERCIAL,6627.985,98,,,OTHER,5072.44,6627.99,PERCENT OF TOTAL BILLED CHARGES
WRIST BILAT W/O MRI,73221,CPT,610,RC,,OUTPATIENT,,,3408.64,1363.456,AETNA,AETNA COMMERCIAL,3340.4672,98,,,OTHER,2556.5,3340.5,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/CONT RT,C8934,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/WO CONT RT,C8936,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABD W/O CONTRAST,C8901,HCPCS,610,RC,,INPATIENT,,,2312,924.8,AETNA,AETNA COMMERCIAL,2265.76,98,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABD W/CONTRAST,C8900,HCPCS,610,RC,,INPATIENT,,,2312,924.8,AETNA,AETNA COMMERCIAL,2265.76,98,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/CONTRAST,C8909,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,AETNA,AETNA COMMERCIAL,1793.155,98,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/WO CONTRAST,C8911,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,AETNA,AETNA COMMERCIAL,1793.155,98,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/O CONT RT,C8913,HCPCS,610,RC,,BOTH,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI TMJ W/WO CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,AETNA,AETNA COMMERCIAL,3299.415,98,,,OTHER,2525.06,3299.42,PERCENT OF TOTAL BILLED CHARGES
MRI ST NECK W/CONTRAST,70542QQ,CPT,610,RC,QQ,OUTPATIENT,,,3914.5,1565.8,AETNA,AETNA COMMERCIAL,3836.21,98,,,OTHER,2935.88,3836.21,PERCENT OF TOTAL BILLED CHARGES
MRI FACE/NECK/ORBIT W/WO,70543,CPT,610,RC,,OUTPATIENT,,,4389.75,1755.9,AETNA,AETNA COMMERCIAL,4301.955,98,,,OTHER,3292.31,4301.96,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,4124.5,1649.8,AETNA,AETNA COMMERCIAL,4042.01,98,,,OTHER,3093.38,4042.01,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/WO CONTRST,70553,CPT,610,RC,,OUTPATIENT,,,5173,2069.2,AETNA,AETNA COMMERCIAL,5069.54,98,,,OTHER,3879.75,5069.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/O CONTRAST,C8910,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,AETNA,AETNA COMMERCIAL,1793.155,98,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,AETNA,AETNA COMMERCIAL,3410.4,98,,,OTHER,2610,3410.4,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,AETNA,AETNA COMMERCIAL,3780.105,98,,,OTHER,2892.94,3780.11,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,AETNA,AETNA COMMERCIAL,4812.045,98,,,OTHER,3682.69,4812.05,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/O CONT RT,C8935,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,AETNA,AETNA COMMERCIAL,3589.005,98,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/WO CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,3424.5,1369.8,AETNA,AETNA COMMERCIAL,3356.01,98,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/CONT RT,73719QQ,CPT,610,RC,QQ,OUTPATIENT,,,2837.5,1135,AETNA,AETNA COMMERCIAL,2780.75,98,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/WO CONT RT,C8914,HCPCS,610,RC,,INPATIENT,,,1864.75,745.9,AETNA,AETNA COMMERCIAL,1827.455,98,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
LOCM (180 MG IODINE),Q9946,HCPCS,636,RC,,INPATIENT,,,103,41.2,AETNA,AETNA COMMERCIAL,100.94,98,,,OTHER,77.25,100.94,PERCENT OF TOTAL BILLED CHARGES
LOCM (320 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,379.25,151.7,AETNA,AETNA COMMERCIAL,371.665,98,,,OTHER,284.44,371.67,PERCENT OF TOTAL BILLED CHARGES
LOCM (350 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,103,41.2,AETNA,AETNA COMMERCIAL,100.94,98,,,OTHER,77.25,100.94,PERCENT OF TOTAL BILLED CHARGES
TECHNETIUM TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,196.25,78.5,AETNA,AETNA COMMERCIAL,192.325,98,,,OTHER,147.2,192.3,PERCENT OF TOTAL BILLED CHARGES
GLADOLINIUM,A9579,HCPCS,636,RC,,INPATIENT,,,271.25,108.5,AETNA,AETNA COMMERCIAL,265.825,98,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
FDG F-18 INITIAL,A9552PI,HCPCS,343,RC,PI,INPATIENT,,,1320.75,528.3,AETNA,AETNA COMMERCIAL,1294.335,98,,,OTHER,990.56,1294.34,PERCENT OF TOTAL BILLED CHARGES
FDG F-18 SUB,A9552PS,HCPCS,343,RC,PS,INPATIENT,,,1320.75,528.3,AETNA,AETNA COMMERCIAL,1294.335,98,,,OTHER,990.56,1294.34,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM + .5 HR,7100010,CDM,,,,INPATIENT,,,150.75,60.3,AETNA,AETNA COMMERCIAL,147.735,98,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-GENERAL,7100070,CDM,,,,INPATIENT,,,860,344,AETNA,AETNA COMMERCIAL,842.8,98,,,OTHER,645,842.8,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-LOCAL,7100080,CDM,,,,INPATIENT,,,439,175.6,AETNA,AETNA COMMERCIAL,430.22,98,,,OTHER,329.25,430.22,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-REGIONAL,7100090,CDM,,,,INPATIENT,,,553,221.2,AETNA,AETNA COMMERCIAL,541.94,98,,,OTHER,414.75,541.94,PERCENT OF TOTAL BILLED CHARGES
DELIVERY/RECOVERY 1,7200010,CDM,,,,INPATIENT,,,1865,746,AETNA,AETNA COMMERCIAL,1827.7,98,,,OTHER,1398.75,1827.7,PERCENT OF TOTAL BILLED CHARGES
DELIVERY/RECOVERY 2,7200012,CDM,,,,INPATIENT,,,3997.75,1599.1,AETNA,AETNA COMMERCIAL,3917.795,98,,,OTHER,2998.31,3917.8,PERCENT OF TOTAL BILLED CHARGES
PRECIP DELIVERY,7200014,CDM,,,,INPATIENT,,,896.25,358.5,AETNA,AETNA COMMERCIAL,878.325,98,,,OTHER,672.19,878.33,PERCENT OF TOTAL BILLED CHARGES
CS PREOP,7200016,CDM,,,,INPATIENT,,,297.25,118.9,AETNA,AETNA COMMERCIAL,291.305,98,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
OB DOPPLER,7200018,CDM,,,,INPATIENT,,,204.5,81.8,AETNA,AETNA COMMERCIAL,200.41,98,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
EFM/PER DAY,7200020,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BABY CHECK AND EVAL,99211,CPT,510,RC,,OUTPATIENT,,,102,40.8,AETNA,AETNA COMMERCIAL,99.96,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
FHM INTERNAL FSE,7200030,CDM,,,,INPATIENT,,,394.75,157.9,AETNA,AETNA COMMERCIAL,386.855,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
INFUSION THERAPY,96365,CPT,260,RC,,OUTPATIENT,,,496.25,198.5,AETNA,AETNA COMMERCIAL,486.325,98,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
NIPPLE STIM (INCLUDES EFM),7200034,CDM,,,,INPATIENT,,,424.25,169.7,AETNA,AETNA COMMERCIAL,415.765,98,,,OTHER,318.19,415.77,PERCENT OF TOTAL BILLED CHARGES
OCT (INCLUDES EFM),59020,CPT,720,RC,,OUTPATIENT,,,670,268,AETNA,AETNA COMMERCIAL,656.6,98,,,OTHER,502.5,656.6,PERCENT OF TOTAL BILLED CHARGES
VERSION (INCLUDES EFM),59412,CPT,720,RC,,OUTPATIENT,,,2396,958.4,AETNA,AETNA COMMERCIAL,2348.08,98,,,OTHER,1797,2348.08,PERCENT OF TOTAL BILLED CHARGES
IUPC,7200042,CDM,,,,INPATIENT,,,739.25,295.7,AETNA,AETNA COMMERCIAL,724.465,98,,,OTHER,554.44,724.47,PERCENT OF TOTAL BILLED CHARGES
INJ THER/PROPH/DIAG  SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,AETNA,AETNA COMMERCIAL,186.69,98,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
INJECTION PROCEDURE,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,AETNA,AETNA COMMERCIAL,186.69,98,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
NST/EFM,59025,CPT,720,RC,,OUTPATIENT,,,445.25,178.1,AETNA,AETNA COMMERCIAL,436.345,98,,,OTHER,333.94,436.35,PERCENT OF TOTAL BILLED CHARGES
NURSE ATTENDED TRANSFER,7200120,CDM,,,,INPATIENT,,,334.5,133.8,AETNA,AETNA COMMERCIAL,327.81,98,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,OUTPATIENT,,,2927.25,1170.9,AETNA,AETNA COMMERCIAL,2868.705,98,,,OTHER,2195.44,2868.71,PERCENT OF TOTAL BILLED CHARGES
INFUSION THERAPY EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
OB IM/SQ VACCINE,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,OUTPATIENT,,,5697.98,2279.192,AETNA,AETNA COMMERCIAL,5584.0204,98,,,OTHER,4273.5,5584,PERCENT OF TOTAL BILLED CHARGES
IV PUSH NEW MED ADDON,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SAME MED ADDON,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION (INITIAL),96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,AETNA,AETNA COMMERCIAL,439.04,98,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,AETNA,AETNA COMMERCIAL,134.75,98,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,AETNA,AETNA COMMERCIAL,115.64,98,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
OB THER/DIAG CONCURRENT INF,96368,CPT,450,RC,,OUTPATIENT,,,132.25,52.9,AETNA,AETNA COMMERCIAL,129.605,98,,,OTHER,99.2,129.6,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.1,214.4,PERCENT OF TOTAL BILLED CHARGES
LABOR,7210002,CDM,,,,INPATIENT,,,1247.25,498.9,AETNA,AETNA COMMERCIAL,1222.305,98,,,OTHER,935.44,1222.31,PERCENT OF TOTAL BILLED CHARGES
MATERNAL RESUSCITATION,7210010,CDM,,,,INPATIENT,,,399.75,159.9,AETNA,AETNA COMMERCIAL,391.755,98,,,OTHER,299.81,391.76,PERCENT OF TOTAL BILLED CHARGES
AMNIOCENTESIS PROCEDURE,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,AETNA,AETNA COMMERCIAL,1237.2402,98,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,AETNA,AETNA COMMERCIAL,801.64,98,,,OTHER,613.5,801.64,PERCENT OF TOTAL BILLED CHARGES
BAG/MASK PROCEDURE,7210014,CDM,,,,INPATIENT,,,124.25,49.7,AETNA,AETNA COMMERCIAL,121.765,98,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
OB C-SECTION,7210015,CDM,,,,INPATIENT,,,1540.75,616.3,AETNA,AETNA COMMERCIAL,1509.935,98,,,OTHER,1155.56,1509.94,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHERTERIZATION PROC,7210018,CDM,,,,INPATIENT,,,135.75,54.3,AETNA,AETNA COMMERCIAL,133.035,98,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 1,7210020,CDM,,,,INPATIENT,,,99,39.6,AETNA,AETNA COMMERCIAL,97.02,98,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
CARDIAC MONITOR,7210022,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 2,7210030,CDM,,,,INPATIENT,,,155.75,62.3,AETNA,AETNA COMMERCIAL,152.635,98,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 3,7210040,CDM,,,,INPATIENT,,,285.75,114.3,AETNA,AETNA COMMERCIAL,280.035,98,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 4,7210050,CDM,,,,INPATIENT,,,660.5,264.2,AETNA,AETNA COMMERCIAL,647.29,98,,,OTHER,495.38,647.29,PERCENT OF TOTAL BILLED CHARGES
INTERNAL FM,7210060,CDM,,,,INPATIENT,,,394.75,157.9,AETNA,AETNA COMMERCIAL,386.855,98,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
LOCAL/PUDENDAL PROCEDURE,7210062,CDM,,,,INPATIENT,,,117.5,47,AETNA,AETNA COMMERCIAL,115.15,98,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
NRS ATTENDED TRANSPORT,7210068,CDM,,,,INPATIENT,,,633.25,253.3,AETNA,AETNA COMMERCIAL,620.585,98,,,OTHER,474.94,620.59,PERCENT OF TOTAL BILLED CHARGES
PELVIC EXAM PROCEDURE,7210070,CDM,,,,INPATIENT,,,256.5,102.6,AETNA,AETNA COMMERCIAL,251.37,98,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
SITZ BATH,7210072,CDM,,,,INPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
STAPLE/SUTURE REMOVAL,7210074,CDM,,,,INPATIENT,,,43,17.2,AETNA,AETNA COMMERCIAL,42.14,98,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
TEDS,7210076,CDM,,,,INPATIENT,,,56.5,22.6,AETNA,AETNA COMMERCIAL,55.37,98,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE CATH/IN & OUT,7210078,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
VACUUM EXTRACTION,7210080,CDM,,,,INPATIENT,,,474.25,189.7,AETNA,AETNA COMMERCIAL,464.765,98,,,OTHER,355.69,464.77,PERCENT OF TOTAL BILLED CHARGES
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,AETNA,AETNA COMMERCIAL,609.07,98,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
HEARING SCREEN,92586,CPT,470,RC,,OUTPATIENT,,,289.75,115.9,AETNA,AETNA COMMERCIAL,283.955,98,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,AETNA,AETNA COMMERCIAL,801.64,98,,,OTHER,613.5,801.64,PERCENT OF TOTAL BILLED CHARGES
PHOTOTHERAPY,7220012,CDM,,,,INPATIENT,,,514.25,205.7,AETNA,AETNA COMMERCIAL,503.965,98,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
HABERMAN FEEDER/SOFT FEEDER,7220018,CDM,,,,INPATIENT,,,76.75,30.7,AETNA,AETNA COMMERCIAL,75.215,98,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE,7220020,CDM,,,,INPATIENT,,,290.75,116.3,AETNA,AETNA COMMERCIAL,284.935,98,,,OTHER,218.06,284.94,PERCENT OF TOTAL BILLED CHARGES
SUCTION PROCEDURE,7220022,CDM,,,,INPATIENT,,,92.75,37.1,AETNA,AETNA COMMERCIAL,90.895,98,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL CATH PROCEDURE,36510,CPT,360,RC,,OUTPATIENT,,,548.25,219.3,AETNA,AETNA COMMERCIAL,537.285,98,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
WARMER ISOLETTE,7220026,CDM,,,,INPATIENT,,,161.25,64.5,AETNA,AETNA COMMERCIAL,158.025,98,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
IV ACCESS/VOLUTROL/BURETTE,7220028,CDM,,,,INPATIENT,,,159.5,63.8,AETNA,AETNA COMMERCIAL,156.31,98,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
MATERNAL SUCTION SETUP,7220030,CDM,,,,INPATIENT,,,97,38.8,AETNA,AETNA COMMERCIAL,95.06,98,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
INFANT INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,AETNA,AETNA COMMERCIAL,773.955,98,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
TRANSCUTANEOUS BILIRUBIN,88720,CPT,300,RC,,OUTPATIENT,,,28.75,11.5,AETNA,AETNA COMMERCIAL,28.175,98,,,OTHER,21.56,28.18,PERCENT OF TOTAL BILLED CHARGES
BANKED BREASTMILK PER OUNCE,7220036,CDM,,,,INPATIENT,,,6.25,2.5,AETNA,AETNA COMMERCIAL,6.125,98,,,OTHER,4.69,6.13,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION,54150,CPT,360,RC,,OUTPATIENT,,,1304.5,521.8,AETNA,AETNA COMMERCIAL,1278.41,98,,,OTHER,978.38,1278.41,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY EVALUATION REPEAT(NSY,94760,CPT,460,RC,,OUTPATIENT,,,96.75,38.7,AETNA,AETNA COMMERCIAL,94.815,98,,,OTHER,72.56,94.82,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY/PER DAY,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,AETNA,AETNA COMMERCIAL,188.65,98,,,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
DELIVER PLACENTA,59414,CPT,722,RC,,OUTPATIENT,,,5228.48,2091.392,AETNA,AETNA COMMERCIAL,5123.9104,98,,,OTHER,3921.4,5123.9,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,AETNA,AETNA COMMERCIAL,1239.5432,98,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
OB US LIMITED FETUS(S) BEDSIDE,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,AETNA,AETNA COMMERCIAL,212.856,98,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 1, EST",G0463,HCPCS,510,RC,,INPATIENT,,,51,20.4,AETNA,AETNA COMMERCIAL,49.98,98,,,OTHER,38.3,50,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 2, EST",G0463,HCPCS,510,RC,,INPATIENT,,,112,44.8,AETNA,AETNA COMMERCIAL,109.76,98,,,OTHER,84,109.8,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 3, EST",G0463,HCPCS,510,RC,,INPATIENT,,,185,74,AETNA,AETNA COMMERCIAL,181.3,98,,,OTHER,138.8,181.3,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 4, EST",G0463,HCPCS,510,RC,,INPATIENT,,,274,109.6,AETNA,AETNA COMMERCIAL,268.52,98,,,OTHER,205.5,268.5,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 5, EST",G0463,HCPCS,510,RC,,INPATIENT,,,371,148.4,AETNA,AETNA COMMERCIAL,363.58,98,,,OTHER,278.3,363.6,PERCENT OF TOTAL BILLED CHARGES
EKG,93005,CPT,730,RC,,OUTPATIENT,,,362.25,144.9,AETNA,AETNA COMMERCIAL,355.005,98,,,OTHER,271.69,355.01,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP TRACING ONLY,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,AETNA,AETNA COMMERCIAL,108.7212,98,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
HOLTER MONITOR RECORDING/SETUP,93225,CPT,731,RC,,OUTPATIENT,,,327.75,131.1,AETNA,AETNA COMMERCIAL,321.195,98,,,OTHER,245.81,321.2,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSCOPY PROCEDURE,7310025,CDM,,,,INPATIENT,,,2996.25,1198.5,AETNA,AETNA COMMERCIAL,2936.325,98,,,OTHER,2247.19,2936.33,PERCENT OF TOTAL BILLED CHARGES
CATHETERIZE FRO URINE SPEC,P9612,HCPCS,300,RC,,INPATIENT,,,152.5,61,AETNA,AETNA COMMERCIAL,149.45,98,,,OTHER,114.4,149.5,PERCENT OF TOTAL BILLED CHARGES
OBSERVATION OB,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,AETNA,AETNA COMMERCIAL,76.685,98,,,OTHER,58.69,76.69,PERCENT OF TOTAL BILLED CHARGES
OBSERVATION ROOM,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,AETNA,AETNA COMMERCIAL,76.685,98,,,OTHER,58.69,76.69,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC/DIAG INJ LEVEL I,96372,CPT,260,RC,,OUTPATIENT,,,272.5,109,AETNA,AETNA COMMERCIAL,267.05,98,,,OTHER,204.38,267.05,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC/DIAG INJ LEVEL II,96372,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,AETNA,AETNA COMMERCIAL,159.005,98,,,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
IM VACCINATION <18 YRS OLD,90460,CPT,761,RC,,OUTPATIENT,,,137,54.8,AETNA,AETNA COMMERCIAL,134.26,98,,,OTHER,102.75,134.26,PERCENT OF TOTAL BILLED CHARGES
COLL OF BLOOD BY VENI PUNCTUR,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,AETNA,AETNA COMMERCIAL,25.48,98,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE FLUSH/DRAW,90784,CPT,361,RC,,OUTPATIENT,,,110.25,44.1,AETNA,AETNA COMMERCIAL,108.045,98,,,OTHER,82.69,108.05,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,INPATIENT,,,534.5,213.8,AETNA,AETNA COMMERCIAL,523.81,98,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
IV INFUS THERAPY INIT LVL I,96365,CPT,260,RC,,OUTPATIENT,,,618.25,247.3,AETNA,AETNA COMMERCIAL,605.885,98,,,OTHER,463.69,605.89,PERCENT OF TOTAL BILLED CHARGES
IV INFUS THERAPY INIT LVL II,96365,CPT,260,RC,,OUTPATIENT,,,550.25,220.1,AETNA,AETNA COMMERCIAL,539.245,98,,,OTHER,412.69,539.25,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION THERAPY ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,AETNA,AETNA COMMERCIAL,96.285,98,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
IV INFU THERAPY INIT LVL III,96365,CPT,260,RC,,OUTPATIENT,,,562.75,225.1,AETNA,AETNA COMMERCIAL,551.495,98,,,OTHER,422.06,551.5,PERCENT OF TOTAL BILLED CHARGES
INITIATION OF INFUSION PUMP,96416,CPT,335,RC,,OUTPATIENT,,,830.75,332.3,AETNA,AETNA COMMERCIAL,814.135,98,,,OTHER,623.06,814.14,PERCENT OF TOTAL BILLED CHARGES
OSTOMY CARE VISIT,G0463,HCPCS,510,RC,,INPATIENT,,,104,41.6,AETNA,AETNA COMMERCIAL,101.92,98,,,OTHER,78,101.92,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAIN NECK/CHEST,21501,CPT,761,RC,,OUTPATIENT,,,3972.25,1588.9,AETNA,AETNA COMMERCIAL,3892.805,98,,,OTHER,2979.19,3892.81,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EA ADD'L IVP,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IM/SQ VACCINE,90471,CPT,761,RC,,INPATIENT,,,144,57.6,AETNA,AETNA COMMERCIAL,141.12,98,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
OBS STRAIGHT BLADDER CATHETER,51701,CPT,450,RC,,INPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"OBS FOLEY CATHETER, SIMPLE",51702,CPT,320,RC,,INPATIENT,,,343.75,137.5,AETNA,AETNA COMMERCIAL,336.875,98,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
"OBS FOLEY CATHETER, COMPLEX",51703,CPT,320,RC,,INPATIENT,,,450.5,180.2,AETNA,AETNA COMMERCIAL,441.49,98,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
"OBS CONCURRENT MEDICATED, INF",96368,CPT,450,RC,,INPATIENT,,,132.25,52.9,AETNA,AETNA COMMERCIAL,129.605,98,,,OTHER,99.19,129.61,PERCENT OF TOTAL BILLED CHARGES
OBS BLADDER IRRIGATION,51700,CPT,450,RC,,INPATIENT,,,621.5,248.6,AETNA,AETNA COMMERCIAL,609.07,98,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
OBS CHEST TUBE INSERT,32551,CPT,450,RC,,INPATIENT,,,1144.5,457.8,AETNA,AETNA COMMERCIAL,1121.61,98,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
NG-OG TUBE,43753,CPT,450,RC,,INPATIENT,,,527.09,210.836,AETNA,AETNA COMMERCIAL,516.5482,98,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
BIOPSY DEEP TISSUE OF BACK CT,21925,CPT,361,RC,,OUTPATIENT,,,2552.25,1020.9,AETNA,AETNA COMMERCIAL,2501.205,98,,,OTHER,1914.19,2501.21,PERCENT OF TOTAL BILLED CHARGES
BIOPSY OF LIVER  NEEDLE,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,AETNA,AETNA COMMERCIAL,1496.215,98,,,OTHER,1145.06,1496.22,PERCENT OF TOTAL BILLED CHARGES
NEEDLE BIOPSY ABDOMINAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,AETNA,AETNA COMMERCIAL,1482.74,98,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION INITIAL RAD,99152,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAINAGE,49419,CPT,320,RC,,OUTPATIENT,,,3599.5,1439.8,AETNA,AETNA COMMERCIAL,3527.51,98,,,OTHER,2699.63,3527.51,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION (RAD),99153,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,AETNA,AETNA COMMERCIAL,214.375,98,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM RADIOLOGY,7614946,CDM,,,,INPATIENT,,,638.5,255.4,AETNA,AETNA COMMERCIAL,625.73,98,,,OTHER,478.88,625.73,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM RADIOLOGY ADD'L,7614948,CDM,710,RC,,INPATIENT,,,128.25,51.3,AETNA,AETNA COMMERCIAL,125.685,98,,,OTHER,96.19,125.69,PERCENT OF TOTAL BILLED CHARGES
NEBULIZER TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,AETNA,AETNA COMMERCIAL,366.9806,98,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BLOOD DRAW OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,223.14,89.256,AETNA,AETNA COMMERCIAL,218.6772,98,,,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,223.14,89.256,AETNA,AETNA COMMERCIAL,218.6772,98,,,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,AETNA,AETNA COMMERCIAL,519.8508,98,,,OTHER,397.8,519.9,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE COMPLEX,51710,CPT,320,RC,,OUTPATIENT,,,572.8,229.12,AETNA,AETNA COMMERCIAL,561.344,98,,,OTHER,429.6,561.3,PERCENT OF TOTAL BILLED CHARGES
US LIMITED NONVAS EXTR BILAT,7688250,CPT,450,RC,50,OUTPATIENT,,,554.5,221.8,AETNA,AETNA COMMERCIAL,543.41,98,,,OTHER,415.88,543.41,PERCENT OF TOTAL BILLED CHARGES
MDCR SCREENING EKG,G0404,HCPCS,770,RC,,INPATIENT,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PNEUMOCOCCOL VACCINE,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF HEPATITIS B VACC,G0010,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PNEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PHEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,AETNA,AETNA COMMERCIAL,56.595,98,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
LIVING WITH PAIN (GROUP CLASS),9150000,CDM,,,,OUTPATIENT,,,120,48,AETNA,AETNA COMMERCIAL,117.6,98,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
US CAROTID DUPLEX,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,AETNA,AETNA COMMERCIAL,1322.755,98,,,OTHER,1012.31,1322.76,PERCENT OF TOTAL BILLED CHARGES
VESSEL MAPPING HEMO ACCESS,G0365,HCPCS,402,RC,,INPATIENT,,,717.5,287,AETNA,AETNA COMMERCIAL,703.15,98,,,OTHER,538.13,703.15,PERCENT OF TOTAL BILLED CHARGES
US DUPLEX V/A FLOW BIL,93925,CPT,402,RC,,OUTPATIENT,,,959.25,383.7,AETNA,AETNA COMMERCIAL,940.065,98,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER BILATERAL,93970,CPT,921,RC,,OUTPATIENT,,,1293.25,517.3,AETNA,AETNA COMMERCIAL,1267.385,98,,,OTHER,969.94,1267.39,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER UNILATERAL,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,AETNA,AETNA COMMERCIAL,909.93,98,,,OTHER,696.38,909.93,PERCENT OF TOTAL BILLED CHARGES
DUPLEX V/A FLOW UNILATERAL,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,AETNA,AETNA COMMERCIAL,525.77,98,,,OTHER,402.38,525.77,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER LIMITED,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,AETNA,AETNA COMMERCIAL,572.32,98,,,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER ONLY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,AETNA,AETNA COMMERCIAL,449.5064,98,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
US HEAD DUP EXTRACRANIAL ARTER,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,AETNA,AETNA COMMERCIAL,1322.755,98,,,OTHER,1012.31,1322.76,PERCENT OF TOTAL BILLED CHARGES
LIVER ONLY,76705,CPT,402,RC,,OUTPATIENT,,,620.9,248.36,AETNA,AETNA COMMERCIAL,608.482,98,,,OTHER,465.7,608.5,PERCENT OF TOTAL BILLED CHARGES
AMB BP MONITOR RECORDING,93786,CPT,920,RC,,OUTPATIENT,,,224.25,89.7,AETNA,AETNA COMMERCIAL,219.765,98,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
AMB BP 24 HRS SCAN ANALYSIS,93788,CPT,480,RC,,OUTPATIENT,,,475.5,190.2,AETNA,AETNA COMMERCIAL,465.99,98,,,OTHER,356.63,465.99,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PHLEBOTOMY,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,AETNA,AETNA COMMERCIAL,260.68,98,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
PICC LINE PLACEMENT,36569,CPT,361,RC,,INPATIENT,,,1516.25,606.5,AETNA,AETNA COMMERCIAL,1485.925,98,,,OTHER,1137.19,1485.93,PERCENT OF TOTAL BILLED CHARGES
MEDTRONIC MINIMED INSULIN PUMP,9420009,CDM,,,,INPATIENT,,,300,120,AETNA,AETNA COMMERCIAL,294,98,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
CARDIAC REHAB W/MONITOR,93798,CPT,948,RC,,OUTPATIENT,,,231.33,92.532,AETNA,AETNA COMMERCIAL,226.7034,98,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB WITH EXERCISE,G0424,HCPCS,948,RC,,INPATIENT,,,192,76.8,AETNA,AETNA COMMERCIAL,188.16,98,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
SUPERVISED EXERCISE THERAPY,93668,CPT,943,RC,,OUTPATIENT,,,192,76.8,AETNA,AETNA COMMERCIAL,188.16,98,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
WALK TEST W/O2 SATS 6 MINS,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,AETNA,AETNA COMMERCIAL,218.6674,98,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB MGMT CLASS (1),G0239,HCPCS,410,RC,,INPATIENT,,,192,76.8,AETNA,AETNA COMMERCIAL,188.16,98,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
MED/SURG LEVEL I,1100001,CDM,,,,INPATIENT,,,1891.5,756.6,UC HEALTH,UC HEALTH COMMERCIAL,1645.605,87,,,OTHER,1418.63,1853.67,PERCENT OF TOTAL BILLED CHARGES
MED/SURG LEVEL II,1100002,CDM,,,,INPATIENT,,,2626.5,1050.6,UC HEALTH,UC HEALTH COMMERCIAL,2285.055,87,,,OTHER,1969.88,2573.97,PERCENT OF TOTAL BILLED CHARGES
MED/SURG LEVEL III,1100003,CDM,,,,INPATIENT,,,3571.5,1428.6,UC HEALTH,UC HEALTH COMMERCIAL,3107.205,87,,,OTHER,2678.63,3500.07,PERCENT OF TOTAL BILLED CHARGES
MED/SURG W/TELEMETRY,1100005,CDM,,,,INPATIENT,,,4096.5,1638.6,UC HEALTH,UC HEALTH COMMERCIAL,3563.955,87,,,OTHER,3072.38,4014.57,PERCENT OF TOTAL BILLED CHARGES
ICU LEVEL I,1100010,CDM,,,,INPATIENT,,,4306.5,1722.6,UC HEALTH,UC HEALTH COMMERCIAL,3746.655,87,,,OTHER,3229.88,4220.37,PERCENT OF TOTAL BILLED CHARGES
ICU LEVEL II,1100011,CDM,,,,INPATIENT,,,4831.5,1932.6,UC HEALTH,UC HEALTH COMMERCIAL,4203.405,87,,,OTHER,3623.63,4734.87,PERCENT OF TOTAL BILLED CHARGES
ICU TRANSITIONAL,1100015,CDM,,,,INPATIENT,,,4096.5,1638.6,UC HEALTH,UC HEALTH COMMERCIAL,3563.955,87,,,OTHER,3072.38,4014.57,PERCENT OF TOTAL BILLED CHARGES
ICU MED SURG,1100020,CDM,,,,INPATIENT,,,946.25,378.5,UC HEALTH,UC HEALTH COMMERCIAL,823.2375,87,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
TPAC ROOM RATE,1100030,CDM,,,,INPATIENT,,,400,160,UC HEALTH,UC HEALTH COMMERCIAL,348,87,,,OTHER,300,392,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION ELECTIVE (ICU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,UC HEALTH,UC HEALTH COMMERCIAL,1288.905,87,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
SEMI-PRIVATE ROOM & BOARD,1200001,CDM,,,,INPATIENT,,,946.25,378.5,UC HEALTH,UC HEALTH COMMERCIAL,823.2375,87,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
NEWBORN CARE,1200002,CDM,,,,INPATIENT,,,729.5,291.8,UC HEALTH,UC HEALTH COMMERCIAL,634.665,87,,,OTHER,547.13,714.91,PERCENT OF TOTAL BILLED CHARGES
SEMI-PRIVATE ROOM OB,1200004,CDM,,,,INPATIENT,,,946.25,378.5,UC HEALTH,UC HEALTH COMMERCIAL,823.2375,87,,,OTHER,709.69,927.33,PERCENT OF TOTAL BILLED CHARGES
TRAY CEN VENOUS CATH 5.0 FR,1600000,CDM,,,,INPATIENT,,,500.5,200.2,UC HEALTH,UC HEALTH COMMERCIAL,435.435,87,,,OTHER,375.38,490.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
PRESSURE TRANSDUCER,1600162,CDM,,,,INPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
PORT ACCESS TRAY,1600166,CDM,,,,INPATIENT,,,38,15.2,UC HEALTH,UC HEALTH COMMERCIAL,33.06,87,,,OTHER,28.5,37.24,PERCENT OF TOTAL BILLED CHARGES
PUMP VSCD ANTIEMBIOLIC,1610200,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
KUGEL HERNIA PATCH,1610201,CDM,,,,INPATIENT,,,724.5,289.8,UC HEALTH,UC HEALTH COMMERCIAL,630.315,87,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
SPINAL LUMBAR PUNCTURE,1610210,CDM,,,,INPATIENT,,,249.25,99.7,UC HEALTH,UC HEALTH COMMERCIAL,216.8475,87,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
PUMP IV,1610212,CDM,,,,INPATIENT,,,291.75,116.7,UC HEALTH,UC HEALTH COMMERCIAL,253.8225,87,,,OTHER,218.81,285.92,PERCENT OF TOTAL BILLED CHARGES
PUMP KENDALL,1610218,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
PUMP FEEDING,1610220,CDM,,,,INPATIENT,,,144.25,57.7,UC HEALTH,UC HEALTH COMMERCIAL,125.4975,87,,,OTHER,108.19,141.37,PERCENT OF TOTAL BILLED CHARGES
IV PUMP PER DAY,1610222,CDM,,,,INPATIENT,,,291.75,116.7,UC HEALTH,UC HEALTH COMMERCIAL,253.8225,87,,,OTHER,218.81,285.92,PERCENT OF TOTAL BILLED CHARGES
TRACTION BUCKS BOOT,1610242,CDM,,,,INPATIENT,,,175,70,UC HEALTH,UC HEALTH COMMERCIAL,152.25,87,,,OTHER,131.25,171.5,PERCENT OF TOTAL BILLED CHARGES
PROBE COVER KIT,1610244,CDM,,,,INPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 15MM,1611000,CDM,,,,INPATIENT,,,922.5,369,UC HEALTH,UC HEALTH COMMERCIAL,802.575,87,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 20MM,1611020,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 25MM,1611040,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 30MM,1611060,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 35MM,1611080,CDM,,,,INPATIENT,,,739.5,295.8,UC HEALTH,UC HEALTH COMMERCIAL,643.365,87,,,OTHER,554.63,724.71,PERCENT OF TOTAL BILLED CHARGES
INSUFFLATOR  HEATED,1611900,CDM,,,,INPATIENT,,,199.5,79.8,UC HEALTH,UC HEALTH COMMERCIAL,173.565,87,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 40MM,1612000,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 45MM,1612020,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 50MM,1612040,CDM,,,,INPATIENT,,,929,371.6,UC HEALTH,UC HEALTH COMMERCIAL,808.23,87,,,OTHER,696.75,910.42,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 55MM,1612060,CDM,,,,INPATIENT,,,922.5,369,UC HEALTH,UC HEALTH COMMERCIAL,802.575,87,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON CL 60MM,1612080,CDM,,,,INPATIENT,,,922.5,369,UC HEALTH,UC HEALTH COMMERCIAL,802.575,87,,,OTHER,691.88,904.05,PERCENT OF TOTAL BILLED CHARGES
ENDOBUTTON DRILL PIN 4.5MM,1613000,CDM,,,,INPATIENT,,,382,152.8,UC HEALTH,UC HEALTH COMMERCIAL,332.34,87,,,OTHER,286.5,374.36,PERCENT OF TOTAL BILLED CHARGES
BAG BLOOD TRANSFER,1613030,CDM,,,,INPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
BLANKET FULL BODY ADULT,1613050,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
BLANKET UPPER BODY,1613070,CDM,,,,INPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH EXCELL 5MM BLADELESS,1613100,CDM,,,,INPATIENT,,,261.5,104.6,UC HEALTH,UC HEALTH COMMERCIAL,227.505,87,,,OTHER,196.13,256.27,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH EXCEL 5MM SLEEVE,1613105,CDM,,,,INPATIENT,,,153.25,61.3,UC HEALTH,UC HEALTH COMMERCIAL,133.3275,87,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH 150MM PNEUMONEEDLE,1613110,CDM,,,,INPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ENDOSTITCH,1613115,CDM,,,,INPATIENT,,,328.25,131.3,UC HEALTH,UC HEALTH COMMERCIAL,285.5775,87,,,OTHER,246.19,321.69,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPIC SPOT MARKER,1613117,CDM,,,,INPATIENT,,,102.25,40.9,UC HEALTH,UC HEALTH COMMERCIAL,88.9575,87,,,OTHER,76.69,100.21,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 8MM,1613140,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 10MM,1613142,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
ASPIRATING CURETTE 12MM,1613144,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV 9 INCH,1613154,CDM,,,,INPATIENT,,,168,67.2,UC HEALTH,UC HEALTH COMMERCIAL,146.16,87,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV X-LARGE,1613155,CDM,,,,INPATIENT,,,200.25,80.1,UC HEALTH,UC HEALTH COMMERCIAL,174.2175,87,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV 12 INCH,1613156,CDM,,,,INPATIENT,,,139.25,55.7,UC HEALTH,UC HEALTH COMMERCIAL,121.1475,87,,,OTHER,104.44,136.47,PERCENT OF TOTAL BILLED CHARGES
BINDER ABD UNIV XX-LARGE,1613157,CDM,,,,INPATIENT,,,200.25,80.1,UC HEALTH,UC HEALTH COMMERCIAL,174.2175,87,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
CANNULA SURETAC 7MM,1613202,CDM,,,,INPATIENT,,,125.75,50.3,UC HEALTH,UC HEALTH COMMERCIAL,109.4025,87,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
CATH FEMALE KIT,1613227,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
TRAY CATH 14FR,1613228,CDM,,,,INPATIENT,,,29.75,11.9,UC HEALTH,UC HEALTH COMMERCIAL,25.8825,87,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
CATH THERMO (SWANZ),1613229,CDM,,,,INPATIENT,,,631.75,252.7,UC HEALTH,UC HEALTH COMMERCIAL,549.6225,87,,,OTHER,473.81,619.12,PERCENT OF TOTAL BILLED CHARGES
CATH TRIPLE LUMEN,1613232,CDM,,,,INPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 08FR 3CC PED,1613240,CDM,,,,INPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 10FR 5CC PED,1613241,CDM,,,,INPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 12FR 5CC,1613242,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 14FR 5CC,1613243,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 5CC,1613244,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 18FR 5CC,1613245,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 5CC,1613246,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 22FR 5CC,1613247,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 5CC,1613248,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR W/UR,1613249,CDM,,,,INPATIENT,,,125.75,50.3,UC HEALTH,UC HEALTH COMMERCIAL,109.4025,87,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 30CC,1613250,CDM,,,,INPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 30CC,1613255,CDM,,,,INPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 18FR 30CC,1613256,CDM,,,,INPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 20FR 30CC 3-WAY,1613257,CDM,,,,INPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 22FR 30CC,1613258,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 30CC,1613259,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 24FR 30CC 3-WAY,1613260,CDM,,,,INPATIENT,,,87.75,35.1,UC HEALTH,UC HEALTH COMMERCIAL,76.3425,87,,,OTHER,65.81,86,PERCENT OF TOTAL BILLED CHARGES
CATH FOLEY 16FR 5CC COUNCIL,1613265,CDM,,,,INPATIENT,,,182.75,73.1,UC HEALTH,UC HEALTH COMMERCIAL,158.9925,87,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
POLYPECTOMY SNARE,1613295,CDM,,,,INPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
V-CATH INSERTION,1613315,CDM,,,,INPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
V-CATH MIDLINE 3FR,1613316,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
V-CATH MIDLINE 4FR,1613317,CDM,,,,INPATIENT,,,339.25,135.7,UC HEALTH,UC HEALTH COMMERCIAL,295.1475,87,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
V-CATH KIT 2FR,1613318,CDM,,,,INPATIENT,,,384.5,153.8,UC HEALTH,UC HEALTH COMMERCIAL,334.515,87,,,OTHER,288.38,376.81,PERCENT OF TOTAL BILLED CHARGES
V-CATH PICC 3FR,1613319,CDM,,,,INPATIENT,,,439,175.6,UC HEALTH,UC HEALTH COMMERCIAL,381.93,87,,,OTHER,329.25,430.22,PERCENT OF TOTAL BILLED CHARGES
V-CATH PICC 4FR,1613320,CDM,,,,INPATIENT,,,350,140,UC HEALTH,UC HEALTH COMMERCIAL,304.5,87,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
V-CATH INTRODUCER 3.0FR,1613321,CDM,,,,INPATIENT,,,105.5,42.2,UC HEALTH,UC HEALTH COMMERCIAL,91.785,87,,,OTHER,79.13,103.39,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER 22 X 25MM,1613322,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER HUBER  22 X 3/4,1613324,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NEEDLE HUBER WINGED EXT.,1613327,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLE GRIPPER 20G X 25MM,1613328,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
OXISENSOR MAX-P,1613330,CDM,,,,INPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
CEMENT SIMPLEX,1613350,CDM,,,,INPATIENT,,,516.5,206.6,UC HEALTH,UC HEALTH COMMERCIAL,449.355,87,,,OTHER,387.38,506.17,PERCENT OF TOTAL BILLED CHARGES
CEMENT BONE PALACOS,1613352,CDM,,,,INPATIENT,,,433.5,173.4,UC HEALTH,UC HEALTH COMMERCIAL,377.145,87,,,OTHER,325.13,424.83,PERCENT OF TOTAL BILLED CHARGES
CHEMO - TAXAL SET TUBING,1613355,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
DERMABOND SKIN ADHESIVE,1613358,CDM,,,,INPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
CIRCUITS VENT W/TRAPS,1613370,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
CIRCUIT VENTILATOR HEATED WR,1613371,CDM,,,,INPATIENT,,,120,48,UC HEALTH,UC HEALTH COMMERCIAL,104.4,87,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
CIRCUIT BILEVEL HEATED WIRE,1613372,CDM,,,,INPATIENT,,,230.5,92.2,UC HEALTH,UC HEALTH COMMERCIAL,200.535,87,,,OTHER,172.88,225.89,PERCENT OF TOTAL BILLED CHARGES
EASY CAP II CO2 DETECTOR,1613374,CDM,,,,INPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
FOG REDUCTION DEVICE,1613376,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
COLLECTION SET  DISP TUBING,1613385,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
DRAIN LARGE WOUND 5/8X15,1613450,CDM,,,,INPATIENT,,,184.75,73.9,UC HEALTH,UC HEALTH COMMERCIAL,160.7325,87,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
DRAIN PVC 1/4 CONSTAVAC,1613451,CDM,,,,INPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
DRAIN PVC 1/8 SNYDER,1613452,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
DRAIN BLAKE FLUTED 19FR,1613459,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN BLAKE FLUTED 15FR,1613460,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAPE SURG IOBAN 6650,1613480,CDM,,,,INPATIENT,,,525.75,210.3,UC HEALTH,UC HEALTH COMMERCIAL,457.4025,87,,,OTHER,394.31,515.24,PERCENT OF TOTAL BILLED CHARGES
DRAPE CASSETTE,1613490,CDM,,,,INPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
GERIGLOVE,1613692,CDM,,,,INPATIENT,,,152.25,60.9,UC HEALTH,UC HEALTH COMMERCIAL,132.4575,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
ENDO CLIP 10MM M/L ER320,1613700,CDM,,,,INPATIENT,,,558,223.2,UC HEALTH,UC HEALTH COMMERCIAL,485.46,87,,,OTHER,418.5,546.84,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE FILTERS,1613710,CDM,,,,INPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE DEPLETION FILTER,1613712,CDM,,,,INPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
ENDOPOUCH RETRIEVER,1613720,CDM,,,,INPATIENT,,,516.25,206.5,UC HEALTH,UC HEALTH COMMERCIAL,449.1375,87,,,OTHER,387.19,505.93,PERCENT OF TOTAL BILLED CHARGES
ENDO DISSECTOR 5MM,1613730,CDM,,,,INPATIENT,,,545.75,218.3,UC HEALTH,UC HEALTH COMMERCIAL,474.8025,87,,,OTHER,409.31,534.84,PERCENT OF TOTAL BILLED CHARGES
ENDO RETRACTOR,1613740,CDM,,,,INPATIENT,,,635.75,254.3,UC HEALTH,UC HEALTH COMMERCIAL,553.1025,87,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
END CUTTER 4.2,1613750,CDM,,,,INPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH MULTISEAL CAPS,1613760,CDM,,,,INPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
IV BLOOD SET Y-TYPE,1613805,CDM,,,,INPATIENT,,,28.5,11.4,UC HEALTH,UC HEALTH COMMERCIAL,24.795,87,,,OTHER,21.38,27.93,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 19 GA,1613820,CDM,,,,INPATIENT,,,13.5,5.4,UC HEALTH,UC HEALTH COMMERCIAL,11.745,87,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 21 GA,1613821,CDM,,,,INPATIENT,,,63.75,25.5,UC HEALTH,UC HEALTH COMMERCIAL,55.4625,87,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 23 GA,1613822,CDM,,,,INPATIENT,,,63.75,25.5,UC HEALTH,UC HEALTH COMMERCIAL,55.4625,87,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
IV BUTTERFLY 25 GA,1613823,CDM,,,,INPATIENT,,,13.5,5.4,UC HEALTH,UC HEALTH COMMERCIAL,11.745,87,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
IV CONT EVACUATED 500 ML,1613840,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
IV CONT EVACUATED 1000 ML,1613841,CDM,,,,INPATIENT,,,32.25,12.9,UC HEALTH,UC HEALTH COMMERCIAL,28.0575,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
AGGRESS MENISCUS 4.0MM,1613875,CDM,,,,INPATIENT,,,524.5,209.8,UC HEALTH,UC HEALTH COMMERCIAL,456.315,87,,,OTHER,393.38,514.01,PERCENT OF TOTAL BILLED CHARGES
AGGRESS MENISCUS 5.0,1613880,CDM,,,,INPATIENT,,,573.25,229.3,UC HEALTH,UC HEALTH COMMERCIAL,498.7275,87,,,OTHER,429.94,561.79,PERCENT OF TOTAL BILLED CHARGES
IV PRIMARY VEN/NONVEN SET,1613905,CDM,,,,INPATIENT,,,22,8.8,UC HEALTH,UC HEALTH COMMERCIAL,19.14,87,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
INTERLINK T-CON EXT,1613906,CDM,,,,INPATIENT,,,12,4.8,UC HEALTH,UC HEALTH COMMERCIAL,10.44,87,,,OTHER,9,11.76,PERCENT OF TOTAL BILLED CHARGES
INTERLINK SYSTEM,1613907,CDM,,,,INPATIENT,,,22,8.8,UC HEALTH,UC HEALTH COMMERCIAL,19.14,87,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
IV SECONDARY SET,1613915,CDM,,,,INPATIENT,,,13.5,5.4,UC HEALTH,UC HEALTH COMMERCIAL,11.745,87,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE KNEE (PEDS) IMMOBILIZ,1614100,CDM,,,,INPATIENT,,,117.25,46.9,UC HEALTH,UC HEALTH COMMERCIAL,102.0075,87,,,OTHER,87.94,114.91,PERCENT OF TOTAL BILLED CHARGES
KIT FETAL PRESSURE,1614232,CDM,,,,INPATIENT,,,256.5,102.6,UC HEALTH,UC HEALTH COMMERCIAL,223.155,87,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
KIT GASTRIC LAVAGE,1614234,CDM,,,,INPATIENT,,,144.25,57.7,UC HEALTH,UC HEALTH COMMERCIAL,125.4975,87,,,OTHER,108.19,141.37,PERCENT OF TOTAL BILLED CHARGES
TRAY INTUBATION,1614238,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
LINEAR STAPLER 55MM STAND GIA,1614270,CDM,,,,INPATIENT,,,572.25,228.9,UC HEALTH,UC HEALTH COMMERCIAL,497.8575,87,,,OTHER,429.19,560.81,PERCENT OF TOTAL BILLED CHARGES
LINEAR STAPLER 60MM BLUE,1614280,CDM,,,,INPATIENT,,,532.5,213,UC HEALTH,UC HEALTH COMMERCIAL,463.275,87,,,OTHER,399.38,521.85,PERCENT OF TOTAL BILLED CHARGES
RELOAD 60MM STANDARD 3.5MM BLU,1614282,CDM,,,,INPATIENT,,,346,138.4,UC HEALTH,UC HEALTH COMMERCIAL,301.02,87,,,OTHER,259.5,339.08,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER 35MM VASCULAR,1614285,CDM,,,,INPATIENT,,,1089.75,435.9,UC HEALTH,UC HEALTH COMMERCIAL,948.0825,87,,,OTHER,817.31,1067.96,PERCENT OF TOTAL BILLED CHARGES
35MM STANDARD/VAS. RELOADS,1614290,CDM,,,,INPATIENT,,,501.75,200.7,UC HEALTH,UC HEALTH COMMERCIAL,436.5225,87,,,OTHER,376.31,491.72,PERCENT OF TOTAL BILLED CHARGES
35MM VASCULAR RELOADS,1614295,CDM,,,,INPATIENT,,,501.75,200.7,UC HEALTH,UC HEALTH COMMERCIAL,436.5225,87,,,OTHER,376.31,491.72,PERCENT OF TOTAL BILLED CHARGES
LINENS DRAPE HIP W/C-ARM,1614300,CDM,,,,INPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 3,1614584,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 4,1614586,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
MASK  AMBU LARYNGEAL SIZE 5,1614588,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
NEEDLE WHITACRE 22GX3 1/2,1614609,CDM,,,,INPATIENT,,,59.5,23.8,UC HEALTH,UC HEALTH COMMERCIAL,51.765,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST SMALL,1614706,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST MEDIUM,1614707,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST LARGE,1614708,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST XLG,1614709,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV SMALL,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV MEDIUM,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO COLLAR CERV LARGE,L0120,HCPCS,274,RC,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE MED,1614736,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE LARGE,1614737,CDM,,,,INPATIENT,,,86,34.4,UC HEALTH,UC HEALTH COMMERCIAL,74.82,87,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
ORTHO IM/SHOULDER FEMALE X-LGE,1614738,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO SPLINT CLAVICAL MEDIUM,1614833,CDM,,,,INPATIENT,,,142.75,57.1,UC HEALTH,UC HEALTH COMMERCIAL,124.1925,87,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
ORTHO SPLINT CLAVICAL LARGE,1614834,CDM,,,,INPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
ORTHO SUPPORT KNEE MEDIUM,L1830,HCPCS,274,RC,,INPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PAD HELL & ELBOW PROTECTOR,1614948,CDM,,,,INPATIENT,,,15,6,UC HEALTH,UC HEALTH COMMERCIAL,13.05,87,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
INFUSION SET INTERTIP,1614952,CDM,,,,INPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
INFUSION SET POWER LOC SAFETY,1614954,CDM,,,,INPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
PAD GROUNDING,1614965,CDM,,,,INPATIENT,,,57,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.59,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
DUO THEM PAD HYPO 24X60,1614972,CDM,,,,INPATIENT,,,155.75,62.3,UC HEALTH,UC HEALTH COMMERCIAL,135.5025,87,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
DUO THERM PAD 18X24,1614976,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
PAIN BUSTER,1614980,CDM,,,,INPATIENT,,,724.5,289.8,UC HEALTH,UC HEALTH COMMERCIAL,630.315,87,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
STAPLE SKIN EXTRACTOR,1615135,CDM,,,,INPATIENT,,,4,1.6,UC HEALTH,UC HEALTH COMMERCIAL,3.48,87,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
TENDON SPACER SZ 4,1615141,CDM,,,,INPATIENT,,,1360.25,544.1,UC HEALTH,UC HEALTH COMMERCIAL,1183.4175,87,,,OTHER,1020.19,1333.05,PERCENT OF TOTAL BILLED CHARGES
TENDON SPACER SZ 5,1615142,CDM,,,,INPATIENT,,,1360.25,544.1,UC HEALTH,UC HEALTH COMMERCIAL,1183.4175,87,,,OTHER,1020.19,1333.05,PERCENT OF TOTAL BILLED CHARGES
STRYKERFLOW PUMP & HAND,1615308,CDM,,,,INPATIENT,,,292,116.8,UC HEALTH,UC HEALTH COMMERCIAL,254.04,87,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
STERI CUFF 18 INCH,1615324,CDM,,,,INPATIENT,,,186.5,74.6,UC HEALTH,UC HEALTH COMMERCIAL,162.255,87,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
STERI CUFF 34 INCH,1615326,CDM,,,,INPATIENT,,,236,94.4,UC HEALTH,UC HEALTH COMMERCIAL,205.32,87,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
STOCKING EMB XLG,1615354,CDM,,,,INPATIENT,,,108.5,43.4,UC HEALTH,UC HEALTH COMMERCIAL,94.395,87,,,OTHER,81.38,106.33,PERCENT OF TOTAL BILLED CHARGES
SUCTION TIP KAMVAC MINI,1615421,CDM,,,,INPATIENT,,,150.75,60.3,UC HEALTH,UC HEALTH COMMERCIAL,131.1525,87,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
SUCTION TIP POOLE,1615440,CDM,,,,INPATIENT,,,40.5,16.2,UC HEALTH,UC HEALTH COMMERCIAL,35.235,87,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
SUPPORTER MALE LARGE,1615467,CDM,,,,INPATIENT,,,101.25,40.5,UC HEALTH,UC HEALTH COMMERCIAL,88.0875,87,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,234,93.6,UC HEALTH,UC HEALTH COMMERCIAL,203.58,87,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 5.5,1615510,CDM,,,,INPATIENT,,,265.5,106.2,UC HEALTH,UC HEALTH COMMERCIAL,230.985,87,,,OTHER,199.13,260.19,PERCENT OF TOTAL BILLED CHARGES
TUBE TRACHEOSTOMY #7,1615511,CDM,,,,INPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
TRAY EPIDURAL CONTINUOUS,1615520,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
TRAY LUMBAR PUNCTURE ADULT,1615525,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
TRAY LUMBAR PUNCTURE PEDS,1615526,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
TRAY LACERATION REPAIR,1615536,CDM,,,,INPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
TRAY SUBCLAVIAN #61248,1615539,CDM,,,,INPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
TRAY EYE,1615540,CDM,,,,INPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
TRAY BONE MARROW,1615542,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY CHEST TUBE,1615544,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY THORANCENTESIS,1615545,CDM,,,,INPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
TRAY I&D,1615546,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
TRAY SUTURING,1615548,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
CUSTOM RADIOLOGY TRAY,1615549,CDM,,,,INPATIENT,,,114,45.6,UC HEALTH,UC HEALTH COMMERCIAL,99.18,87,,,OTHER,85.5,111.72,PERCENT OF TOTAL BILLED CHARGES
TRAY TRACH,1615550,CDM,,,,INPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
SPARC SLING SYSTEM W/TENSION,1615852,CDM,,,,INPATIENT,,,2108.75,843.5,UC HEALTH,UC HEALTH COMMERCIAL,1834.6125,87,,,OTHER,1581.56,2066.58,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SYSTEM,1620000,CDM,,,,INPATIENT,,,292,116.8,UC HEALTH,UC HEALTH COMMERCIAL,254.04,87,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
K-PAD PUMP PER DAY,1620100,CDM,,,,INPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
PACIFERS ORTHODONTIC,1621545,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
WIRE GUIDE J 125CM,1621980,CDM,,,,INPATIENT,,,125.75,50.3,UC HEALTH,UC HEALTH COMMERCIAL,109.4025,87,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
PENEDRIL DRILL TIP,1622225,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
LACTATION CONSULT,1622230,CDM,722,RC,,INPATIENT,,,170.25,68.1,UC HEALTH,UC HEALTH COMMERCIAL,148.1175,87,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
LACTATION CONSULT PAST 30 DAYS,99211,CPT,510,RC,,OUTPATIENT,,,170.25,68.1,UC HEALTH,UC HEALTH COMMERCIAL,148.1175,87,,,OTHER,127.7,166.8,PERCENT OF TOTAL BILLED CHARGES
PUMP BREAST,1622240,CDM,,,,INPATIENT,,,129.75,51.9,UC HEALTH,UC HEALTH COMMERCIAL,112.8825,87,,,OTHER,97.31,127.16,PERCENT OF TOTAL BILLED CHARGES
BREAST/NIPPLE SHIELD,1622242,CDM,,,,INPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
BREAST PUMP KIT,1622244,CDM,,,,INPATIENT,,,169.75,67.9,UC HEALTH,UC HEALTH COMMERCIAL,147.6825,87,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
TRAY TRIPLE LUMEN CATH,1622590,CDM,,,,INPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
TRAY TUOHY NEEDLE CATH SET 18G,1622592,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
TUR Y-TYPE SET,1622594,CDM,,,,INPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
BAG URI-METER DRAIN,1622596,CDM,,,,INPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,87.75,35.1,UC HEALTH,UC HEALTH COMMERCIAL,76.3425,87,,,OTHER,65.81,86,PERCENT OF TOTAL BILLED CHARGES
BI PAP DIAP CIRCUITS,1623350,CDM,,,,INPATIENT,,,103.25,41.3,UC HEALTH,UC HEALTH COMMERCIAL,89.8275,87,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,199.5,79.8,UC HEALTH,UC HEALTH COMMERCIAL,173.565,87,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
SUSTAIN VASCULAR COMPRESSION,1624234,CDM,,,,INPATIENT,,,148,59.2,UC HEALTH,UC HEALTH COMMERCIAL,128.76,87,,,OTHER,111,145.04,PERCENT OF TOTAL BILLED CHARGES
STERILMED FOOTPAD STD,1624238,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
STERILMED FOOT PAD LG,1624239,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC LENS MORGAN,V2797,HCPCS,270,RC,,BOTH,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
I/A PAK,1631600,CDM,,,,INPATIENT,,,715.25,286.1,UC HEALTH,UC HEALTH COMMERCIAL,622.2675,87,,,OTHER,536.44,700.95,PERCENT OF TOTAL BILLED CHARGES
NASAL PACK RHINO POCKET MEDIUM,1631831,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
NASAL PACK RHIN0 POCKET LARGE,1631832,CDM,,,,INPATIENT,,,64,25.6,UC HEALTH,UC HEALTH COMMERCIAL,55.68,87,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
NEEDLE HYPO NERVE BLOCK,1631870,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
NERVE BLOCK SET CONTINUOUS,1631880,CDM,,,,INPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
INSULATED BLOCK SET,1631890,CDM,,,,INPATIENT,,,136.5,54.6,UC HEALTH,UC HEALTH COMMERCIAL,118.755,87,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
CUTTING LOOP 24FR,1639376,CDM,,,,INPATIENT,,,496.25,198.5,UC HEALTH,UC HEALTH COMMERCIAL,431.7375,87,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER 75MM,1639377,CDM,,,,INPATIENT,,,995,398,UC HEALTH,UC HEALTH COMMERCIAL,865.65,87,,,OTHER,746.25,975.1,PERCENT OF TOTAL BILLED CHARGES
CUSHION RING - DONUT,1639378,CDM,,,,INPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
ACDA ANTICOAGULANT,1641000,CDM,,,,INPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 70 LT,1641025,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 55 RT,1641026,CDM,,,,INPATIENT,,,5414.5,2165.8,UC HEALTH,UC HEALTH COMMERCIAL,4710.615,87,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 55 LT,1641027,CDM,,,,INPATIENT,,,5414.5,2165.8,UC HEALTH,UC HEALTH COMMERCIAL,4710.615,87,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 60 RT,1641028,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 60 LT,C1776,HCPCS,278,RC,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 70 RT,C1776,HCPCS,278,RC,,INPATIENT,,,5825.75,2330.3,UC HEALTH,UC HEALTH COMMERCIAL,5068.4025,87,,,OTHER,4369.31,5709.24,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 65 RT,1641031,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 65 LT,1641032,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 75 RT,1641033,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL COMP 75 LT,1641034,CDM,,,,INPATIENT,,,7982.75,3193.1,UC HEALTH,UC HEALTH COMMERCIAL,6944.9925,87,,,OTHER,5987.06,7823.1,PERCENT OF TOTAL BILLED CHARGES
GEL RATIO APPLICATION ASSEM,1641111,CDM,,,,INPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
GEL APPLICATOR TIP,1641112,CDM,,,,INPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
DRESSING HYDROCOLLOID REPLICAR,1641635,CDM,,,,INPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 10MM 155306",C1776,HCPCS,278,RC,,INPATIENT,,,6282.5,2513,UC HEALTH,UC HEALTH COMMERCIAL,5465.775,87,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 65,1641694,CDM,,,,INPATIENT,,,6282.5,2513,UC HEALTH,UC HEALTH COMMERCIAL,5465.775,87,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 65,1641695,CDM,,,,INPATIENT,,,6282.5,2513,UC HEALTH,UC HEALTH COMMERCIAL,5465.775,87,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 65,C1776,HCPCS,278,RC,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 65,1641697,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 70,1641698,CDM,,,,INPATIENT,,,4822.75,1929.1,UC HEALTH,UC HEALTH COMMERCIAL,4195.7925,87,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 70,1641699,CDM,,,,INPATIENT,,,6282.5,2513,UC HEALTH,UC HEALTH COMMERCIAL,5465.775,87,,,OTHER,4711.88,6156.85,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 70,1641700,CDM,,,,INPATIENT,,,4822.75,1929.1,UC HEALTH,UC HEALTH COMMERCIAL,4195.7925,87,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 70,1641701,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 70,1641702,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 75,1641703,CDM,,,,INPATIENT,,,4587,1834.8,UC HEALTH,UC HEALTH COMMERCIAL,3990.69,87,,,OTHER,3440.25,4495.26,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 75,1641704,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 75,1641705,CDM,,,,INPATIENT,,,3980,1592,UC HEALTH,UC HEALTH COMMERCIAL,3462.6,87,,,OTHER,2985,3900.4,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 75,1641706,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 75,1641707,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 80,C1776,HCPCS,278,RC,,INPATIENT,,,4822.75,1929.1,UC HEALTH,UC HEALTH COMMERCIAL,4195.7925,87,,,OTHER,3617.06,4726.3,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 80,1641709,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 80,1641710,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 80,1641711,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 80,1641712,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 10 X 85,1641713,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 12 X 85,1641714,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 14 X 85,1641715,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 16 X 85,1641716,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE TIBIAL COMP 20 X 85,1641717,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON SMALL,C1776,HCPCS,278,RC,,INPATIENT,,,2730.75,1092.3,UC HEALTH,UC HEALTH COMMERCIAL,2375.7525,87,,,OTHER,2048.06,2676.14,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON MEDIUM,1641900,CDM,,,,INPATIENT,,,2730.75,1092.3,UC HEALTH,UC HEALTH COMMERCIAL,2375.7525,87,,,OTHER,2048.06,2676.14,PERCENT OF TOTAL BILLED CHARGES
KNEE PATELLA BUTTON LARGE,C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,UC HEALTH,UC HEALTH COMMERCIAL,1740.87,87,,,OTHER,1500.75,1960.98,PERCENT OF TOTAL BILLED CHARGES
BLADE GIGLI SAW,1642020,CDM,,,,INPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
BLADE BEAVER TYMPANOPLASTY,1642055,CDM,,,,INPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
BLADE CUDA 4.2  C9254,1642056,CDM,,,,INPATIENT,,,330,132,UC HEALTH,UC HEALTH COMMERCIAL,287.1,87,,,OTHER,247.5,323.4,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG WIDE MED,1642097,CDM,,,,INPATIENT,,,334.5,133.8,UC HEALTH,UC HEALTH COMMERCIAL,291.015,87,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
ANKLE TREATMENT KIT CUSTOM LG,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
ANKLE TREATMENT KIT CUSTOM SM,L4350,HCPCS,274,RC,,INPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
BRUSH INTRAMEDULLARY,1642150,CDM,,,,INPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
FEMORAL PRESSURIZER,1642218,CDM,,,,INPATIENT,,,158.25,63.3,UC HEALTH,UC HEALTH COMMERCIAL,137.6775,87,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
DRAIN IRRIGATION,1642361,CDM,,,,INPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
SCANDIPHARM FLUTTER VALVE,1642600,CDM,,,,INPATIENT,,,279,111.6,UC HEALTH,UC HEALTH COMMERCIAL,242.73,87,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
SCISSORS 5MM CURVED W/CAUTERY,1642605,CDM,,,,INPATIENT,,,360.75,144.3,UC HEALTH,UC HEALTH COMMERCIAL,313.8525,87,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 3 X 12,1642720,CDM,271,RC,,INPATIENT,,,29.75,11.9,UC HEALTH,UC HEALTH COMMERCIAL,25.8825,87,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 4 X 30,1642723,CDM,271,RC,,INPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
SUTURE RETRIEVER HEWSON,1642750,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
WIRE GUIDE 60CM,1642900,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
WRIST JACK AGEE,1642950,CDM,,,,INPATIENT,,,5844.5,2337.8,UC HEALTH,UC HEALTH COMMERCIAL,5084.715,87,,,OTHER,4383.38,5727.61,PERCENT OF TOTAL BILLED CHARGES
LINEAR CUTTER RELOADS 75MM,1644010,CDM,,,,INPATIENT,,,665,266,UC HEALTH,UC HEALTH COMMERCIAL,578.55,87,,,OTHER,498.75,651.7,PERCENT OF TOTAL BILLED CHARGES
CIRCULAR STAPLER 29MM EEA,1644020,CDM,,,,INPATIENT,,,1741.25,696.5,UC HEALTH,UC HEALTH COMMERCIAL,1514.8875,87,,,OTHER,1305.94,1706.43,PERCENT OF TOTAL BILLED CHARGES
STAPLER TA90 LONG,1644025,CDM,,,,INPATIENT,,,977.5,391,UC HEALTH,UC HEALTH COMMERCIAL,850.425,87,,,OTHER,733.13,957.95,PERCENT OF TOTAL BILLED CHARGES
ENDO LINEAR CUTTER 45MM 2.5 WH,1644030,CDM,,,,INPATIENT,,,1050.75,420.3,UC HEALTH,UC HEALTH COMMERCIAL,914.1525,87,,,OTHER,788.06,1029.74,PERCENT OF TOTAL BILLED CHARGES
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,589.25,235.7,UC HEALTH,UC HEALTH COMMERCIAL,512.6475,87,,,OTHER,441.94,577.47,PERCENT OF TOTAL BILLED CHARGES
RELOAD ENDO CUTTER 45MM 2.5MM,1644035,CDM,,,,INPATIENT,,,598.25,239.3,UC HEALTH,UC HEALTH COMMERCIAL,520.4775,87,,,OTHER,448.69,586.29,PERCENT OF TOTAL BILLED CHARGES
LINEAR ENDO CUTTER 45MM 3.5MM,1644060,CDM,,,,INPATIENT,,,1462,584.8,UC HEALTH,UC HEALTH COMMERCIAL,1271.94,87,,,OTHER,1096.5,1432.76,PERCENT OF TOTAL BILLED CHARGES
GIA RELOAD 55MM STAND. BLUE,1644065,CDM,,,,INPATIENT,,,384.25,153.7,UC HEALTH,UC HEALTH COMMERCIAL,334.2975,87,,,OTHER,288.19,376.57,PERCENT OF TOTAL BILLED CHARGES
MULTIFIRE GIA CART. 60-3.8,1644066,CDM,,,,INPATIENT,,,786.5,314.6,UC HEALTH,UC HEALTH COMMERCIAL,684.255,87,,,OTHER,589.88,770.77,PERCENT OF TOTAL BILLED CHARGES
GIA RELOAD 55MM STAND. WHITE,1644070,CDM,,,,INPATIENT,,,404.25,161.7,UC HEALTH,UC HEALTH COMMERCIAL,351.6975,87,,,OTHER,303.19,396.17,PERCENT OF TOTAL BILLED CHARGES
SUTURE PASSER SWANSON,1644074,CDM,,,,INPATIENT,,,295.25,118.1,UC HEALTH,UC HEALTH COMMERCIAL,256.8675,87,,,OTHER,221.44,289.35,PERCENT OF TOTAL BILLED CHARGES
SUTURE SKIN STAPLER,1644077,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STAPLES INT TA-55 3.5 BLUE,1644095,CDM,,,,INPATIENT,,,440,176,UC HEALTH,UC HEALTH COMMERCIAL,382.8,87,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
STAPLES INT TA-55 4.8 GREEN,1644096,CDM,,,,INPATIENT,,,269.85,107.94,UC HEALTH,UC HEALTH COMMERCIAL,234.7695,87,,,OTHER,202.39,264.45,PERCENT OF TOTAL BILLED CHARGES
KIT DUAL LUMEN (REPAIR),1644222,CDM,,,,INPATIENT,,,649.25,259.7,UC HEALTH,UC HEALTH COMMERCIAL,564.8475,87,,,OTHER,486.94,636.27,PERCENT OF TOTAL BILLED CHARGES
INSULSCAN WAND MOBILE INSTRUMT,1644822,CDM,,,,INPATIENT,,,130,52,UC HEALTH,UC HEALTH COMMERCIAL,113.1,87,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
BLADE SAGITAL K-123,1645025,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG K-124,1645026,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADE OSC,1645028,CDM,,,,INPATIENT,,,153.5,61.4,UC HEALTH,UC HEALTH COMMERCIAL,133.545,87,,,OTHER,115.13,150.43,PERCENT OF TOTAL BILLED CHARGES
TEAR RASP-LARGE,1645029,CDM,,,,INPATIENT,,,27.25,10.9,UC HEALTH,UC HEALTH COMMERCIAL,23.7075,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
BLADE SAG 3M  K 121,1645030,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLADES 15 DEGREE EYES,1645032,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
IRR CANNULA 27 GA - EYES,1645034,CDM,,,,INPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
BURR ROUND 5.5MM,1645035,CDM,,,,INPATIENT,,,261.75,104.7,UC HEALTH,UC HEALTH COMMERCIAL,227.7225,87,,,OTHER,196.31,256.52,PERCENT OF TOTAL BILLED CHARGES
CYSTITOME FORMED RC SHORT RAD,1645036,CDM,,,,INPATIENT,,,48.5,19.4,UC HEALTH,UC HEALTH COMMERCIAL,42.195,87,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
KNIFE CRESENT STRAIGHT,1645200,CDM,,,,INPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
KNIFE  OPHTHALMIC,1645230,CDM,,,,INPATIENT,,,269.75,107.9,UC HEALTH,UC HEALTH COMMERCIAL,234.6825,87,,,OTHER,202.31,264.36,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON MTA,1645300,CDM,,,,INPATIENT,,,532.75,213.1,UC HEALTH,UC HEALTH COMMERCIAL,463.4925,87,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
HEALON .85 ML,1645301,CDM,,,,INPATIENT,,,524.5,209.8,UC HEALTH,UC HEALTH COMMERCIAL,456.315,87,,,OTHER,393.38,514.01,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA 912,1645302,CDM,,,,INPATIENT,,,635.75,254.3,UC HEALTH,UC HEALTH COMMERCIAL,553.1025,87,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA 920,1645303,CDM,,,,INPATIENT,,,635.75,254.3,UC HEALTH,UC HEALTH COMMERCIAL,553.1025,87,,,OTHER,476.81,623.04,PERCENT OF TOTAL BILLED CHARGES
LENS  MODEL 911A,1645307,CDM,,,,INPATIENT,,,820,328,UC HEALTH,UC HEALTH COMMERCIAL,713.4,87,,,OTHER,615,803.6,PERCENT OF TOTAL BILLED CHARGES
LENS  MODEL 913A,1645308,CDM,,,,INPATIENT,,,607.5,243,UC HEALTH,UC HEALTH COMMERCIAL,528.525,87,,,OTHER,455.63,595.35,PERCENT OF TOTAL BILLED CHARGES
LENS PHARMACIA Z9000,1645312,CDM,,,,INPATIENT,,,727.25,290.9,UC HEALTH,UC HEALTH COMMERCIAL,632.7075,87,,,OTHER,545.44,712.71,PERCENT OF TOTAL BILLED CHARGES
LENS TECNIS Z9001,1645314,CDM,,,,INPATIENT,,,708,283.2,UC HEALTH,UC HEALTH COMMERCIAL,615.96,87,,,OTHER,531,693.84,PERCENT OF TOTAL BILLED CHARGES
LENS TECHNIS ZA9003,1645315,CDM,,,,INPATIENT,,,583.5,233.4,UC HEALTH,UC HEALTH COMMERCIAL,507.645,87,,,OTHER,437.63,571.83,PERCENT OF TOTAL BILLED CHARGES
LENS AMO ZCBOO,1645316,CDM,,,,INPATIENT,,,487.5,195,UC HEALTH,UC HEALTH COMMERCIAL,424.125,87,,,OTHER,365.63,477.75,PERCENT OF TOTAL BILLED CHARGES
LENS AR40,1645317,CDM,,,,INPATIENT,,,532.75,213.1,UC HEALTH,UC HEALTH COMMERCIAL,463.4925,87,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
LENS AMO ZMBOO,1645318,CDM,,,,INPATIENT,,,1200,480,UC HEALTH,UC HEALTH COMMERCIAL,1044,87,,,OTHER,900,1176,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZLBOO,1645320,CDM,,,,INPATIENT,,,939.75,375.9,UC HEALTH,UC HEALTH COMMERCIAL,817.5825,87,,,OTHER,704.81,920.96,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON SA60AT,1645454,CDM,,,,INPATIENT,,,835.5,334.2,UC HEALTH,UC HEALTH COMMERCIAL,726.885,87,,,OTHER,626.63,818.79,PERCENT OF TOTAL BILLED CHARGES
LENS  ALCON SN60WF,C1780,HCPCS,276,RC,,INPATIENT,,,338,135.2,UC HEALTH,UC HEALTH COMMERCIAL,294.06,87,,,OTHER,253.5,331.24,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL SN6,V2787,HCPCS,276,RC,,INPATIENT,,,495,198,UC HEALTH,UC HEALTH COMMERCIAL,430.65,87,,,OTHER,371.25,485.1,PERCENT OF TOTAL BILLED CHARGES
LENS ALCON MA60AC,1645566,CDM,,,,INPATIENT,,,752.5,301,UC HEALTH,UC HEALTH COMMERCIAL,654.675,87,,,OTHER,564.38,737.45,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT400,1645568,CDM,,,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL AMO ZCT225,1645570,CDM,,,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT300,1645572,CDM,,,,INPATIENT,,,519.75,207.9,UC HEALTH,UC HEALTH COMMERCIAL,452.1825,87,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL ZCT150,1645574,CDM,,,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
LENS MULTIFOCAL 450,1645576,CDM,,,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
PACK VITRECTOMY,1645689,CDM,,,,INPATIENT,,,1748.25,699.3,UC HEALTH,UC HEALTH COMMERCIAL,1520.9775,87,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
PACK HOT REHEATER LG,1645700,CDM,,,,INPATIENT,,,170.25,68.1,UC HEALTH,UC HEALTH COMMERCIAL,148.1175,87,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
POLAR PAD KNEE/SHOULDER,1645775,CDM,,,,INPATIENT,,,233.25,93.3,UC HEALTH,UC HEALTH COMMERCIAL,202.9275,87,,,OTHER,174.94,228.59,PERCENT OF TOTAL BILLED CHARGES
CARPEL TUNNELL RELEASE KIT,1646100,CDM,,,,INPATIENT,,,646.25,258.5,UC HEALTH,UC HEALTH COMMERCIAL,562.2375,87,,,OTHER,484.69,633.33,PERCENT OF TOTAL BILLED CHARGES
MAGNETIC PAD,1646350,CDM,,,,INPATIENT,,,111.25,44.5,UC HEALTH,UC HEALTH COMMERCIAL,96.7875,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
TUBING INSUFLATION EC1101,1646650,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BAG ENDO 3X6,1647055,CDM,,,,INPATIENT,,,168,67.2,UC HEALTH,UC HEALTH COMMERCIAL,146.16,87,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
BANDAGE ESMARK 6 INCH,1647090,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CANISTER W/GEL,1647092,CDM,,,,INPATIENT,,,576.5,230.6,UC HEALTH,UC HEALTH COMMERCIAL,501.555,87,,,OTHER,432.38,564.97,PERCENT OF TOTAL BILLED CHARGES
CATH HICKMAN INTRO KIT 10FR,1647232,CDM,,,,INPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 16FR 5CC,1647240,CDM,,,,INPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 18FR 5CC,1647241,CDM,,,,INPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CATH COUDE 20FR 5CC,1647242,CDM,,,,INPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
CAUTERY COAGULATOR SUCTION,1647350,CDM,,,,INPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
DRAIN MALECTO 24FR,1647435,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
DRAPE C ARM,1647445,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
DRAIN HYER SCHULTE SUCT,1647450,CDM,,,,INPATIENT,,,59.5,23.8,UC HEALTH,UC HEALTH COMMERCIAL,51.765,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN 10FR J VAC,1647452,CDM,,,,INPATIENT,,,50.25,20.1,UC HEALTH,UC HEALTH COMMERCIAL,43.7175,87,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
DRAPE ORTHO U,1647455,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
KALTOSTAT WOUND PACKING,1647487,CDM,,,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE SCALP FETAL,1647590,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE PACING,1647592,CDM,,,,INPATIENT,,,283.25,113.3,UC HEALTH,UC HEALTH COMMERCIAL,246.4275,87,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
FLOWMETER  PEAK ADULT,1647594,CDM,,,,INPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FLOWMETER PEAK PED,1647596,CDM,,,,INPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FALOPE RING BAND APPL KIT,1647700,CDM,,,,INPATIENT,,,783.75,313.5,UC HEALTH,UC HEALTH COMMERCIAL,681.8625,87,,,OTHER,587.81,768.08,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE .038,1647708,CDM,,,,INPATIENT,,,68.25,27.3,UC HEALTH,UC HEALTH COMMERCIAL,59.3775,87,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE .035 STIFF TYPE,1647709,CDM,,,,INPATIENT,,,381.75,152.7,UC HEALTH,UC HEALTH COMMERCIAL,332.1225,87,,,OTHER,286.31,374.12,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 20 FR,1647710,CDM,,,,INPATIENT,,,654.25,261.7,UC HEALTH,UC HEALTH COMMERCIAL,569.1975,87,,,OTHER,490.69,641.17,PERCENT OF TOTAL BILLED CHARGES
GROSHONG 8FR SINGLE LUMEM,C1751,HCPCS,272,RC,,INPATIENT,,,1355.5,542.2,UC HEALTH,UC HEALTH COMMERCIAL,1179.285,87,,,OTHER,1016.63,1328.39,PERCENT OF TOTAL BILLED CHARGES
GELSYTE,1647718,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
DRESS OP-SITE 5-1/2 X 10,1647722,CDM,,,,INPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
LOOPS DISP RESECTING 24FR,1647820,CDM,,,,INPATIENT,,,564.75,225.9,UC HEALTH,UC HEALTH COMMERCIAL,491.3325,87,,,OTHER,423.56,553.46,PERCENT OF TOTAL BILLED CHARGES
METZENBAUM DETACH-A TIP CRVD,1647830,CDM,,,,INPATIENT,,,245,98,UC HEALTH,UC HEALTH COMMERCIAL,213.15,87,,,OTHER,183.75,240.1,PERCENT OF TOTAL BILLED CHARGES
MESH MARLEX PRE-SHAPED W/CUT,1647850,CDM,278,RC,,INPATIENT,,,227.45,90.98,UC HEALTH,UC HEALTH COMMERCIAL,197.8815,87,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
MESH MARLEX 10 X 14,1647855,CDM,278,RC,,INPATIENT,,,971.75,388.7,UC HEALTH,UC HEALTH COMMERCIAL,845.4225,87,,,OTHER,728.81,952.32,PERCENT OF TOTAL BILLED CHARGES
OSTOMY LOOP SYS 2 3/4,1647880,CDM,,,,INPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
OSTOMY LOOP SYS 4,1647882,CDM,,,,INPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
IRRAGATOR VISIFLOW,1647910,CDM,,,,INPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
TROCAR 1 ENDOPATH TRISTER,1647968,CDM,,,,INPATIENT,,,432.5,173,UC HEALTH,UC HEALTH COMMERCIAL,376.275,87,,,OTHER,324.38,423.85,PERCENT OF TOTAL BILLED CHARGES
TROCAR 1 ENDOPATH BLADELESS,1647969,CDM,,,,INPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSAPORT PLUS 5MM,1647972,CDM,,,,INPATIENT,,,440,176,UC HEALTH,UC HEALTH COMMERCIAL,382.8,87,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
VOLDYNE BREATHING UNIT,1647998,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
PACING PATCH COMBO DEFIB,1648005,CDM,,,,INPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,UC HEALTH,UC HEALTH COMMERCIAL,3527.6325,87,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
HANDSWITCH DISP SUCT COAG,1649020,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
FORCEP BIOPSY HOT/COLD,1649090,CDM,,,,INPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
DISPOSABLE FORCEPS,1649092,CDM,,,,INPATIENT,,,65.25,26.1,UC HEALTH,UC HEALTH COMMERCIAL,56.7675,87,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 16GAX1-1/4,1649340,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CATH URETERAL WHISTLE TIP 5 FR,1649355,CDM,,,,INPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
CATH URETERAL WHISTLE TIP/AD 5,1649365,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
CONCHA THERM COLE IRR,1649375,CDM,,,,INPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
BIS MONITOR SENSORS,1649376,CDM,,,,INPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL OPEN PORT,1649377,CDM,,,,INPATIENT,,,73,29.2,UC HEALTH,UC HEALTH COMMERCIAL,63.51,87,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
ELECTRODE FAST PATCH,1649381,CDM,,,,INPATIENT,,,150.75,60.3,UC HEALTH,UC HEALTH COMMERCIAL,131.1525,87,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
BASKET DISP FOREIGN BODY,1649430,CDM,,,,INPATIENT,,,445.25,178.1,UC HEALTH,UC HEALTH COMMERCIAL,387.3675,87,,,OTHER,333.94,436.35,PERCENT OF TOTAL BILLED CHARGES
STERI-CATH DL TRACH SIZE,1649555,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
SOFT URETRAL STENT 7FRX24,1649565,CDM,,,,INPATIENT,,,303.25,121.3,UC HEALTH,UC HEALTH COMMERCIAL,263.8275,87,,,OTHER,227.44,297.19,PERCENT OF TOTAL BILLED CHARGES
BLADE SAW 2108-377,1649650,CDM,,,,INPATIENT,,,334.5,133.8,UC HEALTH,UC HEALTH COMMERCIAL,291.015,87,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
KNIFE  MYRINGOTOMY SICKLE,1649700,CDM,,,,INPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
ANCHOR OGDEN 7.4MM NON ST,1651000,CDM,,,,INPATIENT,,,721.25,288.5,UC HEALTH,UC HEALTH COMMERCIAL,627.4875,87,,,OTHER,540.94,706.83,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS RC W ETHI,1652000,CDM,,,,INPATIENT,,,1408.75,563.5,UC HEALTH,UC HEALTH COMMERCIAL,1225.6125,87,,,OTHER,1056.56,1380.58,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS W PANACRYL,1653000,CDM,,,,INPATIENT,,,1237.5,495,UC HEALTH,UC HEALTH COMMERCIAL,1076.625,87,,,OTHER,928.13,1212.75,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS 6.5X32MM",1670001,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BAG RESUSCITATION ADULT DISP,1671045,CDM,,,,INPATIENT,,,103.25,41.3,UC HEALTH,UC HEALTH COMMERCIAL,89.8275,87,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
CATH CHOLANGIOGRAM TAUT,1671085,CDM,,,,INPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
CATH CHOLANGIOGRAPHY 19GA,1671090,CDM,,,,INPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA EXT SET 20,1671094,CDM,,,,INPATIENT,,,2.75,1.1,UC HEALTH,UC HEALTH COMMERCIAL,2.3925,87,,,OTHER,2.06,2.7,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 18GA X 2,1671095,CDM,,,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 18GA X 1-1/4,1671096,CDM,,,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 22GA X 1,1671097,CDM,,,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 24GA X 3/4,1671098,CDM,,,,INPATIENT,,,20.5,8.2,UC HEALTH,UC HEALTH COMMERCIAL,17.835,87,,,OTHER,15.38,20.09,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 20GA X 1-1/4,1671099,CDM,,,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH INSYTE 16GA X 2,1671100,CDM,,,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
CATH FOGARTY BILIARY 5FR,1671115,CDM,,,,INPATIENT,,,394.75,157.9,UC HEALTH,UC HEALTH COMMERCIAL,343.4325,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
FEMORAL CANAL TIP W/SUCTION,1671375,CDM,,,,INPATIENT,,,119.75,47.9,UC HEALTH,UC HEALTH COMMERCIAL,104.1825,87,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
NEEDLES  NON-CORING 22GX1,1671480,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLES WHITACRE 23GX3,1671481,CDM,,,,INPATIENT,,,59.5,23.8,UC HEALTH,UC HEALTH COMMERCIAL,51.765,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
"NEEDLES 20 X 1 GRIPPER""",1671482,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
NEEDLE CATH INSYTE 24GU X 0.56,1671486,CDM,,,,INPATIENT,,,13,5.2,UC HEALTH,UC HEALTH COMMERCIAL,11.31,87,,,OTHER,9.75,12.74,PERCENT OF TOTAL BILLED CHARGES
PAPARELLA TYPE 1 VENT TUBE,1671580,CDM,,,,INPATIENT,,,130,52,UC HEALTH,UC HEALTH COMMERCIAL,113.1,87,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
PAPARELLA II EAR TUBE,1671582,CDM,,,,INPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PROBE ANTERIOR VITRECTOMY,1671635,CDM,,,,INPATIENT,,,820.75,328.3,UC HEALTH,UC HEALTH COMMERCIAL,714.0525,87,,,OTHER,615.56,804.34,PERCENT OF TOTAL BILLED CHARGES
FINGER PROBE PEDIATRIC,1671637,CDM,,,,INPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
SEGURA BASKET 3FR,1671650,CDM,,,,INPATIENT,,,484,193.6,UC HEALTH,UC HEALTH COMMERCIAL,421.08,87,,,OTHER,363,474.32,PERCENT OF TOTAL BILLED CHARGES
TRAY SPINAL TAP,1671687,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
SURGICEL #1953,1671688,CDM,,,,INPATIENT,,,160.75,64.3,UC HEALTH,UC HEALTH COMMERCIAL,139.8525,87,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
CANNULA KIT CONCEPT,1674025,CDM,,,,INPATIENT,,,66.25,26.5,UC HEALTH,UC HEALTH COMMERCIAL,57.6375,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
OPTI-GUARD,1674440,CDM,,,,INPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
PILLOW ABDUCTION,1674500,CDM,,,,INPATIENT,,,221.25,88.5,UC HEALTH,UC HEALTH COMMERCIAL,192.4875,87,,,OTHER,165.94,216.83,PERCENT OF TOTAL BILLED CHARGES
PIN GUIDE 3/32MM,1674562,CDM,,,,INPATIENT,,,151.5,60.6,UC HEALTH,UC HEALTH COMMERCIAL,131.805,87,,,OTHER,113.63,148.47,PERCENT OF TOTAL BILLED CHARGES
PILLOW  PRONE,1674600,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
M.R.I IMPLANTED PORT,1675077,CDM,,,,INPATIENT,,,1668.25,667.3,UC HEALTH,UC HEALTH COMMERCIAL,1451.3775,87,,,OTHER,1251.19,1634.89,PERCENT OF TOTAL BILLED CHARGES
SCREW  CORTICAL 24MM DEPUY,1675502,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE MULCH 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,UC HEALTH,UC HEALTH COMMERCIAL,1706.2875,87,,,OTHER,1470.94,1922.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 12MM 202.812",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,84.5,33.8,UC HEALTH,UC HEALTH COMMERCIAL,73.515,87,,,OTHER,63.38,82.81,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.834",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,UC HEALTH,UC HEALTH COMMERCIAL,56.2107,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.838",C1713,HCPCS,278,RC,,INPATIENT,,,64.61,25.844,UC HEALTH,UC HEALTH COMMERCIAL,56.2107,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS/DCS 12.7MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,1021.25,408.5,UC HEALTH,UC HEALTH COMMERCIAL,888.4875,87,,,OTHER,765.94,1000.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, COMPRESS DHC/DCS 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,159.75,63.9,UC HEALTH,UC HEALTH COMMERCIAL,138.9825,87,,,OTHER,119.81,156.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 5MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,578.25,231.3,UC HEALTH,UC HEALTH COMMERCIAL,503.0775,87,,,OTHER,433.69,566.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UC HEALTH,UC HEALTH COMMERCIAL,495.9,87,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UC HEALTH,UC HEALTH COMMERCIAL,495.9,87,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UC HEALTH,UC HEALTH COMMERCIAL,495.9,87,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UC HEALTH,UC HEALTH COMMERCIAL,55.8975,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 62MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 74MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SYS 3.0MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,1270,508,UC HEALTH,UC HEALTH COMMERCIAL,1104.9,87,,,OTHER,952.5,1244.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 78MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UC HEALTH,UC HEALTH COMMERCIAL,219.675,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK W/HEX RECES 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UC HEALTH,UC HEALTH COMMERCIAL,55.8975,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UC HEALTH,UC HEALTH COMMERCIAL,88.74,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 4.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UC HEALTH,UC HEALTH COMMERCIAL,344.6418,87,,,OTHER,493.13,644.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 5.0MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UC HEALTH,UC HEALTH COMMERCIAL,207.843,87,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,656,262.4,UC HEALTH,UC HEALTH COMMERCIAL,570.72,87,,,OTHER,492,642.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.0MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.0MM 54MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN LOCK 7.3MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,832.55,333.02,UC HEALTH,UC HEALTH COMMERCIAL,724.3185,87,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UC HEALTH,UC HEALTH COMMERCIAL,56.4108,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 214.836",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UC HEALTH,UC HEALTH COMMERCIAL,56.4108,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UC HEALTH,UC HEALTH COMMERCIAL,56.4108,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UC HEALTH,UC HEALTH COMMERCIAL,88.74,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 66MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,UC HEALTH,UC HEALTH COMMERCIAL,86.3475,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,102,40.8,UC HEALTH,UC HEALTH COMMERCIAL,88.74,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,UC HEALTH,UC HEALTH COMMERCIAL,486.9912,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.76,223.904,UC HEALTH,UC HEALTH COMMERCIAL,486.9912,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 5.0MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 2.4MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 7.3MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,UC HEALTH,UC HEALTH COMMERCIAL,809.97,87,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, TAPERED 8-10MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,739.5,295.8,UC HEALTH,UC HEALTH COMMERCIAL,643.365,87,,,OTHER,554.63,724.71,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,375.5,150.2,UC HEALTH,UC HEALTH COMMERCIAL,326.685,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.4MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,212.75,85.1,UC HEALTH,UC HEALTH COMMERCIAL,185.0925,87,,,OTHER,159.56,208.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,130.75,52.3,UC HEALTH,UC HEALTH COMMERCIAL,113.7525,87,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,96.39,38.556,UC HEALTH,UC HEALTH COMMERCIAL,83.8593,87,,,OTHER,108.38,141.61,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,UC HEALTH,UC HEALTH COMMERCIAL,71.1051,87,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,153.75,61.5,UC HEALTH,UC HEALTH COMMERCIAL,133.7625,87,,,OTHER,108.38,141.61,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE 6.5MM 30MM 103533",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM",1680071,CDM,,,,INPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UC HEALTH,UC HEALTH COMMERCIAL,219.675,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 22MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 20MM 245844",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,UC HEALTH,UC HEALTH COMMERCIAL,698.61,87,,,OTHER,602.25,786.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 24MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 6.5MM 245-846",C1713,HCPCS,278,RC,,INPATIENT,,,803,321.2,UC HEALTH,UC HEALTH COMMERCIAL,698.61,87,,,OTHER,602.25,786.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81.73,32.692,UC HEALTH,UC HEALTH COMMERCIAL,71.1051,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 2.4MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,235.87,94.348,UC HEALTH,UC HEALTH COMMERCIAL,205.2069,87,,,OTHER,281.63,367.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, SD SCHANZ 4.0MM 2.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,338.69,135.476,UC HEALTH,UC HEALTH COMMERCIAL,294.6603,87,,,OTHER,357.75,467.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 10MM",C1713,HCPCS,278,RC,,INPATIENT,,,388,155.2,UC HEALTH,UC HEALTH COMMERCIAL,337.56,87,,,OTHER,291,380.24,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UC HEALTH,UC HEALTH COMMERCIAL,219.675,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UC HEALTH,UC HEALTH COMMERCIAL,219.675,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI LONG TRD 46MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UC HEALTH,UC HEALTH COMMERCIAL,344.6418,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI LT 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,396.14,158.456,UC HEALTH,UC HEALTH COMMERCIAL,344.6418,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, SCHANZ SD 4.0MM 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,378,151.2,UC HEALTH,UC HEALTH COMMERCIAL,328.86,87,,,OTHER,398.81,521.12,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,UC HEALTH,UC HEALTH COMMERCIAL,475.455,87,,,OTHER,409.88,535.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN PT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE CAN FT 4.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TAPS 3.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,370.25,148.1,UC HEALTH,UC HEALTH COMMERCIAL,322.1175,87,,,OTHER,277.69,362.85,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 407.650",C1713,HCPCS,278,RC,,INPATIENT,,,682,272.8,UC HEALTH,UC HEALTH COMMERCIAL,593.34,87,,,OTHER,511.5,668.36,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 45MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 50MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 60MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.05,25.62,UC HEALTH,UC HEALTH COMMERCIAL,55.7235,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 65MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 70MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 80MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS12.7MM 280.900",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UC HEALTH,UC HEALTH COMMERCIAL,599.8389,87,,,OTHER,750.56,980.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5MM 90MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,UC HEALTH,UC HEALTH COMMERCIAL,452.5131,87,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, 7.3MM 95MM TL 95MM",C1713,HCPCS,278,RC,,INPATIENT,,,520.13,208.052,UC HEALTH,UC HEALTH COMMERCIAL,452.5131,87,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 12MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX SP 2.0MM 8MM",C1713,HCPCS,278,RC,,INPATIENT,,,125.5,50.2,UC HEALTH,UC HEALTH COMMERCIAL,109.185,87,,,OTHER,94.13,122.99,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TAPS 2.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,UC HEALTH,UC HEALTH COMMERCIAL,274.485,87,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,570,228,UC HEALTH,UC HEALTH COMMERCIAL,495.9,87,,,OTHER,427.5,558.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 3.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.25,25.7,UC HEALTH,UC HEALTH COMMERCIAL,55.8975,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, NONLOCKING 4.5MM 32MM",C1713,HCPCS,278,RC,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 36MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UC HEALTH,UC HEALTH COMMERCIAL,431.52,87,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 34MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UC HEALTH,UC HEALTH COMMERCIAL,431.52,87,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UC HEALTH,UC HEALTH COMMERCIAL,431.52,87,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 4.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,496,198.4,UC HEALTH,UC HEALTH COMMERCIAL,431.52,87,,,OTHER,372,486.08,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI ST 4.0MM 48MM",C1713,HCPCS,278,RC,,INPATIENT,,,654.75,261.9,UC HEALTH,UC HEALTH COMMERCIAL,569.6325,87,,,OTHER,491.06,641.66,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,252.5,101,UC HEALTH,UC HEALTH COMMERCIAL,219.675,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,559,223.6,UC HEALTH,UC HEALTH COMMERCIAL,486.33,87,,,OTHER,419.25,547.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING TI 5.0MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,546.5,218.6,UC HEALTH,UC HEALTH COMMERCIAL,475.455,87,,,OTHER,409.88,535.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 14MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST TI 2.7MM 10MM",1680148,CDM,,,,INPATIENT,,,373.25,149.3,UC HEALTH,UC HEALTH COMMERCIAL,324.7275,87,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK STT8 2.7MM 202.214",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UC HEALTH,UC HEALTH COMMERCIAL,207.843,87,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX TI 3.5MM 18MM",C1713,HCPCS,278,RC,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T8 2.7MM 16MM",C1713,HCPCS,278,RC,,INPATIENT,,,238.9,95.56,UC HEALTH,UC HEALTH COMMERCIAL,207.843,87,,,OTHER,279.94,365.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN BONE FT 4.0MM 35MM",C1713,HCPCS,278,RC,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 28MM",C1713,HCPCS,278,RC,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,99.25,39.7,UC HEALTH,UC HEALTH COMMERCIAL,86.3475,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 38MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE MULCH 10.5MM 30MM",C1713,HCPCS,278,RC,,INPATIENT,,,1961.25,784.5,UC HEALTH,UC HEALTH COMMERCIAL,1706.2875,87,,,OTHER,1470.94,1922.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING W/HX 42MM",C1713,HCPCS,278,RC,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN WASHERLOC 8MM 52MM",C1713,HCPCS,278,RC,,INPATIENT,,,551.25,220.5,UC HEALTH,UC HEALTH COMMERCIAL,479.5875,87,,,OTHER,413.44,540.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,629.75,251.9,UC HEALTH,UC HEALTH COMMERCIAL,547.8825,87,,,OTHER,472.31,617.16,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING CANNULATED 55MM",C1713,HCPCS,278,RC,,INPATIENT,,,931,372.4,UC HEALTH,UC HEALTH COMMERCIAL,809.97,87,,,OTHER,698.25,912.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX ST 4.5MM 40MM",C1713,HCPCS,278,RC,,INPATIENT,,,64.84,25.936,UC HEALTH,UC HEALTH COMMERCIAL,56.4108,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG DHS 12.7MM 103535",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UC HEALTH,UC HEALTH COMMERCIAL,599.8389,87,,,OTHER,765.94,1000.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UC HEALTH,UC HEALTH COMMERCIAL,400.635,87,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UC HEALTH,UC HEALTH COMMERCIAL,400.635,87,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCK ST T25 5.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,460.5,184.2,UC HEALTH,UC HEALTH COMMERCIAL,400.635,87,,,OTHER,345.38,451.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, DHS/DCS LAG 12.7MM 85MM",C1713,HCPCS,278,RC,,INPATIENT,,,689.47,275.788,UC HEALTH,UC HEALTH COMMERCIAL,599.8389,87,,,OTHER,794.44,1038.07,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE DRILL POINT,C1769,HCPCS,278,RC,,INPATIENT,,,523.75,209.5,UC HEALTH,UC HEALTH COMMERCIAL,455.6625,87,,,OTHER,392.81,513.28,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 3.2MM 400MM,C1769,HCPCS,278,RC,,INPATIENT,,,315.5,126.2,UC HEALTH,UC HEALTH COMMERCIAL,274.485,87,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 0.38MM 18MM,C1769,HCPCS,278,RC,,INPATIENT,,,432.75,173.1,UC HEALTH,UC HEALTH COMMERCIAL,376.4925,87,,,OTHER,324.56,424.1,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRETHRD1.25MM 900.722,C1769,HCPCS,278,RC,,INPATIENT,,,74.46,29.784,UC HEALTH,UC HEALTH COMMERCIAL,64.7802,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 2.5MM 200MM,C1769,HCPCS,278,RC,,INPATIENT,,,263,105.2,UC HEALTH,UC HEALTH COMMERCIAL,228.81,87,,,OTHER,197.25,257.74,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 2.5MM 900.723",C1769,HCPCS,278,RC,,INPATIENT,,,121.91,48.764,UC HEALTH,UC HEALTH COMMERCIAL,106.0617,87,,,OTHER,141.19,184.49,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE,C1769,HCPCS,278,RC,,INPATIENT,,,50.35,20.14,UC HEALTH,UC HEALTH COMMERCIAL,43.8045,87,,,OTHER,392.25,512.54,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 2.8MM 292.68",C1769,HCPCS,278,RC,,INPATIENT,,,115.29,46.116,UC HEALTH,UC HEALTH COMMERCIAL,100.3023,87,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
"GUIDEWIRE,THRD 1.25MM 292.62",C1769,HCPCS,278,RC,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
GUIDE PIN 3/32MM 35-329640,C1776,HCPCS,278,RC,,INPATIENT,,,654.25,261.7,UC HEALTH,UC HEALTH COMMERCIAL,569.1975,87,,,OTHER,490.69,641.17,PERCENT OF TOTAL BILLED CHARGES
"PIN, POSITION 4.5MM 298.3803S",C1776,HCPCS,278,RC,,INPATIENT,,,504.5,201.8,UC HEALTH,UC HEALTH COMMERCIAL,438.915,87,,,OTHER,378.38,494.41,PERCENT OF TOTAL BILLED CHARGES
"PIN, RESTORE BAYONET W/EYELET",C1776,HCPCS,278,RC,,INPATIENT,,,657.5,263,UC HEALTH,UC HEALTH COMMERCIAL,572.025,87,,,OTHER,493.13,644.35,PERCENT OF TOTAL BILLED CHARGES
"LOCKING, SCREW 26MM",C1713,HCPCS,278,RC,,INPATIENT,,,559.25,223.7,UC HEALTH,UC HEALTH COMMERCIAL,486.5475,87,,,OTHER,419.44,548.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DHS 4 HOLE 25MM 135DEG",C1713,HCPCS,278,RC,,INPATIENT,,,1661.5,664.6,UC HEALTH,UC HEALTH COMMERCIAL,1445.505,87,,,OTHER,1246.13,1628.27,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON 184764",C1776,HCPCS,278,RC,,INPATIENT,,,2001,800.4,UC HEALTH,UC HEALTH COMMERCIAL,1740.87,87,,,OTHER,1500.75,1960.98,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON 37MM",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UC HEALTH,UC HEALTH COMMERCIAL,670.8744,87,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR 34MM 11-150842",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UC HEALTH,UC HEALTH COMMERCIAL,670.8744,87,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTN 11-150840",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UC HEALTH,UC HEALTH COMMERCIAL,670.8744,87,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, PATELLAR BUTTON ALL POLY",C1776,HCPCS,278,RC,,INPATIENT,,,771.12,308.448,UC HEALTH,UC HEALTH COMMERCIAL,670.8744,87,,,OTHER,833.33,1088.88,PERCENT OF TOTAL BILLED CHARGES
IMPLANT SYSTEM SPEEDBRIDGE,C1776,HCPCS,278,RC,,INPATIENT,,,3323,1329.2,UC HEALTH,UC HEALTH COMMERCIAL,2891.01,87,,,OTHER,2492.25,3256.54,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC 103205",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,10397.25,4158.9,UC HEALTH,UC HEALTH COMMERCIAL,9045.6075,87,,,OTHER,7797.94,10189.31,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC 103202",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL TAPERLOC",C1776,HCPCS,278,RC,,INPATIENT,,,5779.38,2311.752,UC HEALTH,UC HEALTH COMMERCIAL,5028.0606,87,,,OTHER,4334.54,5663.79,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1713,HCPCS,278,RC,,INPATIENT,,,8257.75,3303.1,UC HEALTH,UC HEALTH COMMERCIAL,7184.2425,87,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589,1835.6,UC HEALTH,UC HEALTH COMMERCIAL,3992.43,87,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UC HEALTH,UC HEALTH COMMERCIAL,3178.197,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOC 183028",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UC HEALTH,UC HEALTH COMMERCIAL,3178.197,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK 183006",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,UC HEALTH,UC HEALTH COMMERCIAL,3993.3,87,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UC HEALTH,UC HEALTH COMMERCIAL,3178.197,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK RT VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,6193.31,8092.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK 183034",C1776,HCPCS,278,RC,,INPATIENT,,,3653.1,1461.24,UC HEALTH,UC HEALTH COMMERCIAL,3178.197,87,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL INTERLOK LF VNGR",C1776,HCPCS,278,RC,,INPATIENT,,,4590,1836,UC HEALTH,UC HEALTH COMMERCIAL,3993.3,87,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING I-BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UC HEALTH,UC HEALTH COMMERCIAL,6648.105,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UC HEALTH,UC HEALTH COMMERCIAL,1811.5488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING ANT STAB",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL EARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UC HEALTH,UC HEALTH COMMERCIAL,6648.105,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 183480",C1776,HCPCS,278,RC,,INPATIENT,,,2967.5,1187,UC HEALTH,UC HEALTH COMMERCIAL,2581.725,87,,,OTHER,2225.63,2908.15,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189064",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UC HEALTH,UC HEALTH COMMERCIAL,1811.5488,87,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING I BEAM",C1776,HCPCS,278,RC,,INPATIENT,,,4099.1,1639.64,UC HEALTH,UC HEALTH COMMERCIAL,3566.217,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UC HEALTH,UC HEALTH COMMERCIAL,6648.105,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING DCM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UC HEALTH,UC HEALTH COMMERCIAL,1811.5488,87,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UC HEALTH,UC HEALTH COMMERCIAL,3694.7682,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,7641.5,3056.6,UC HEALTH,UC HEALTH COMMERCIAL,6648.105,87,,,OTHER,5731.13,7488.67,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UC HEALTH,UC HEALTH COMMERCIAL,3694.7682,87,,,OTHER,3185.15,4161.92,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189062",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 90MM 135'",1680231,CDM,,,,INPATIENT,,,1369,547.6,UC HEALTH,UC HEALTH COMMERCIAL,1191.03,87,,,OTHER,1026.75,1341.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 135'",1680232,CDM,,,,INPATIENT,,,1369,547.6,UC HEALTH,UC HEALTH COMMERCIAL,1191.03,87,,,OTHER,1026.75,1341.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 135'",1680234,CDM,,,,INPATIENT,,,1338.25,535.3,UC HEALTH,UC HEALTH COMMERCIAL,1164.2775,87,,,OTHER,1003.69,1311.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 135'",1680235,CDM,,,,INPATIENT,,,1308,523.2,UC HEALTH,UC HEALTH COMMERCIAL,1137.96,87,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 140'",1680236,CDM,,,,INPATIENT,,,1247.25,498.9,UC HEALTH,UC HEALTH COMMERCIAL,1085.1075,87,,,OTHER,935.44,1222.31,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 140'",1680237,CDM,,,,INPATIENT,,,1107.5,443,UC HEALTH,UC HEALTH COMMERCIAL,963.525,87,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 140'",1680238,CDM,,,,INPATIENT,,,1308,523.2,UC HEALTH,UC HEALTH COMMERCIAL,1137.96,87,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 150'",1680239,CDM,,,,INPATIENT,,,1107.5,443,UC HEALTH,UC HEALTH COMMERCIAL,963.525,87,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 150'",1680240,CDM,,,,INPATIENT,,,1107.5,443,UC HEALTH,UC HEALTH COMMERCIAL,963.525,87,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 150'",1680242,CDM,,,,INPATIENT,,,1308,523.2,UC HEALTH,UC HEALTH COMMERCIAL,1137.96,87,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 100MM 145'",1680243,CDM,,,,INPATIENT,,,1107.5,443,UC HEALTH,UC HEALTH COMMERCIAL,963.525,87,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 130MM 145'",1680244,CDM,,,,INPATIENT,,,1107.5,443,UC HEALTH,UC HEALTH COMMERCIAL,963.525,87,,,OTHER,830.63,1085.35,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LAG 160MM 145'",1680245,CDM,,,,INPATIENT,,,1308,523.2,UC HEALTH,UC HEALTH COMMERCIAL,1137.96,87,,,OTHER,981,1281.84,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 20MM",1680246,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 22MM",1680247,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 24MM",1680248,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 26MM",1680249,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 28MM",1680250,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 30MM",1680252,CDM,,,,INPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 32MM",1680253,CDM,,,,INPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 34MM",1680254,CDM,,,,INPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 36MM",1680255,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 38MM",1680256,CDM,,,,INPATIENT,,,78.5,31.4,UC HEALTH,UC HEALTH COMMERCIAL,68.295,87,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 40MM",1680257,CDM,,,,INPATIENT,,,78.5,31.4,UC HEALTH,UC HEALTH COMMERCIAL,68.295,87,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 42MM",1680258,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 44MM",1680259,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 46MM",1680260,CDM,,,,INPATIENT,,,82.75,33.1,UC HEALTH,UC HEALTH COMMERCIAL,71.9925,87,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 48MM",1680262,CDM,,,,INPATIENT,,,82.75,33.1,UC HEALTH,UC HEALTH COMMERCIAL,71.9925,87,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 50MM",1680263,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 52MM",1680264,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 56MM",1680265,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 60MM",1680266,CDM,,,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 70MM",1680268,CDM,,,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 75MM",1680269,CDM,,,,INPATIENT,,,114.75,45.9,UC HEALTH,UC HEALTH COMMERCIAL,99.8325,87,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 80MM",1680270,CDM,,,,INPATIENT,,,114.75,45.9,UC HEALTH,UC HEALTH COMMERCIAL,99.8325,87,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTICAL BONE 85MM",1680272,CDM,,,,INPATIENT,,,114.75,45.9,UC HEALTH,UC HEALTH COMMERCIAL,99.8325,87,,,OTHER,86.06,112.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.14",1680273,CDM,,,,INPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.16",1680274,CDM,,,,INPATIENT,,,34,13.6,UC HEALTH,UC HEALTH COMMERCIAL,29.58,87,,,OTHER,25.5,33.32,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.18",1680275,CDM,,,,INPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.20",1680276,CDM,,,,INPATIENT,,,48.25,19.3,UC HEALTH,UC HEALTH COMMERCIAL,41.9775,87,,,OTHER,36.19,47.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.22",1680277,CDM,,,,INPATIENT,,,23.25,9.3,UC HEALTH,UC HEALTH COMMERCIAL,20.2275,87,,,OTHER,17.44,22.79,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.24",1680278,CDM,,,,INPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.26",1680279,CDM,,,,INPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.28",1680280,CDM,,,,INPATIENT,,,48.25,19.3,UC HEALTH,UC HEALTH COMMERCIAL,41.9775,87,,,OTHER,36.19,47.29,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.30",1680282,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.32",1680283,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.34",1680284,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.36",1680285,CDM,,,,INPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.38",1680286,CDM,,,,INPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.40",1680287,CDM,,,,INPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.42",1680288,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.44",1680289,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.46",1680290,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.48",1680292,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.50",1680293,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.52",1680294,CDM,,,,INPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.54",1680295,CDM,,,,INPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.56",1680296,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.58",1680297,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.60",1680298,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.64",1680299,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.68",1680300,CDM,,,,INPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.70",1680302,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.72",1680303,CDM,,,,INPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.76",1680304,CDM,,,,INPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.80",1680305,CDM,,,,INPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.85",1680306,CDM,,,,INPATIENT,,,76.25,30.5,UC HEALTH,UC HEALTH COMMERCIAL,66.3375,87,,,OTHER,57.19,74.73,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.90",1680307,CDM,,,,INPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.844",1680308,CDM,,,,INPATIENT,,,99.25,39.7,UC HEALTH,UC HEALTH COMMERCIAL,86.3475,87,,,OTHER,74.44,97.27,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.95",1680309,CDM,,,,INPATIENT,,,65.75,26.3,UC HEALTH,UC HEALTH COMMERCIAL,57.2025,87,,,OTHER,49.31,64.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.05",1680310,CDM,,,,INPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 4.5MM 214.06",1680311,CDM,,,,INPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.025",1680312,CDM,,,,INPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.030",1680313,CDM,,,,INPATIENT,,,69.5,27.8,UC HEALTH,UC HEALTH COMMERCIAL,60.465,87,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.035",1680314,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.040",1680316,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.045",1680317,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.050",1680318,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.055",1680319,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.060",1680320,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.065",1680322,CDM,,,,INPATIENT,,,69.5,27.8,UC HEALTH,UC HEALTH COMMERCIAL,60.465,87,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, MALLEOLAR 215.070",1680323,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,70.75,28.3,UC HEALTH,UC HEALTH COMMERCIAL,61.5525,87,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UC HEALTH,UC HEALTH COMMERCIAL,108.5325,87,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UC HEALTH,UC HEALTH COMMERCIAL,108.5325,87,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,UC HEALTH,UC HEALTH COMMERCIAL,63.2925,87,,,OTHER,54.56,71.3,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,72.75,29.1,UC HEALTH,UC HEALTH COMMERCIAL,63.2925,87,,,OTHER,54.56,71.3,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UC HEALTH,UC HEALTH COMMERCIAL,108.5325,87,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,117.25,46.9,UC HEALTH,UC HEALTH COMMERCIAL,102.0075,87,,,OTHER,87.94,114.91,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,124.75,49.9,UC HEALTH,UC HEALTH COMMERCIAL,108.5325,87,,,OTHER,93.56,122.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,88.75,35.5,UC HEALTH,UC HEALTH COMMERCIAL,77.2125,87,,,OTHER,66.56,86.98,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM 70MM",1680350,CDM,,,,INPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM 75MM",C1713,HCPCS,278,RC,,INPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN BONE 6.5MM",C1713,HCPCS,278,RC,,INPATIENT,,,70.75,28.3,UC HEALTH,UC HEALTH COMMERCIAL,61.5525,87,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,83.5,33.4,UC HEALTH,UC HEALTH COMMERCIAL,72.645,87,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,81.75,32.7,UC HEALTH,UC HEALTH COMMERCIAL,71.1225,87,,,OTHER,61.31,80.12,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,74.5,29.8,UC HEALTH,UC HEALTH COMMERCIAL,64.815,87,,,OTHER,55.88,73.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,49,19.6,UC HEALTH,UC HEALTH COMMERCIAL,42.63,87,,,OTHER,36.75,48.02,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 20MM 245848",C1713,HCPCS,278,RC,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANCELLOUS BONE 6.5MM",1680324,CDM,,,,INPATIENT,,,69.25,27.7,UC HEALTH,UC HEALTH COMMERCIAL,60.2475,87,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.06",1680365,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.07",1680366,CDM,,,,INPATIENT,,,89.25,35.7,UC HEALTH,UC HEALTH COMMERCIAL,77.6475,87,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.08",1680367,CDM,,,,INPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.09",1680368,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.10",1680369,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.11",1680370,CDM,,,,INPATIENT,,,123.5,49.4,UC HEALTH,UC HEALTH COMMERCIAL,107.445,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.12",1680372,CDM,,,,INPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.14",1680373,CDM,,,,INPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 1.5MM 200.16",1680374,CDM,,,,INPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.06",1680375,CDM,,,,INPATIENT,,,46.25,18.5,UC HEALTH,UC HEALTH COMMERCIAL,40.2375,87,,,OTHER,34.69,45.33,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.008",1680376,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.010",1680377,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.012",1680378,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.014",1680379,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.16",1680380,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.18",1680382,CDM,,,,INPATIENT,,,59.75,23.9,UC HEALTH,UC HEALTH COMMERCIAL,51.9825,87,,,OTHER,44.81,58.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.0MM 201.20",1680383,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.06",1680384,CDM,,,,INPATIENT,,,43.5,17.4,UC HEALTH,UC HEALTH COMMERCIAL,37.845,87,,,OTHER,32.63,42.63,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.08",1680385,CDM,,,,INPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.10",1680386,CDM,,,,INPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.12",1680387,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.14",1680388,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.16",1680389,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.18",1680390,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.20",1680392,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.22",1680393,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.24",1680394,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.10",1680395,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.12",1680396,CDM,,,,INPATIENT,,,53.5,21.4,UC HEALTH,UC HEALTH COMMERCIAL,46.545,87,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.14",1680397,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.16",1680398,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.18",1680400,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.20",1680402,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.22",1680403,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.24",1680404,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.28",1680406,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.32",1680407,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.36",1680408,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.40",1680409,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.45",1680410,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 204.50",1680412,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,81,32.4,UC HEALTH,UC HEALTH COMMERCIAL,70.47,87,,,OTHER,60.75,79.38,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,26.75,10.7,UC HEALTH,UC HEALTH COMMERCIAL,23.2725,87,,,OTHER,20.06,26.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UC HEALTH,UC HEALTH COMMERCIAL,44.1525,87,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UC HEALTH,UC HEALTH COMMERCIAL,44.1525,87,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.75,20.3,UC HEALTH,UC HEALTH COMMERCIAL,44.1525,87,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,49,19.6,UC HEALTH,UC HEALTH COMMERCIAL,42.63,87,,,OTHER,36.75,48.02,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,59.75,23.9,UC HEALTH,UC HEALTH COMMERCIAL,51.9825,87,,,OTHER,44.81,58.56,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,57.25,22.9,UC HEALTH,UC HEALTH COMMERCIAL,49.8075,87,,,OTHER,42.94,56.11,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,27,10.8,UC HEALTH,UC HEALTH COMMERCIAL,23.49,87,,,OTHER,20.25,26.46,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UC HEALTH,UC HEALTH COMMERCIAL,43.935,87,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UC HEALTH,UC HEALTH COMMERCIAL,43.935,87,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.5,19.4,UC HEALTH,UC HEALTH COMMERCIAL,42.195,87,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,28.25,11.3,UC HEALTH,UC HEALTH COMMERCIAL,24.5775,87,,,OTHER,21.19,27.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UC HEALTH,UC HEALTH COMMERCIAL,43.935,87,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,50.5,20.2,UC HEALTH,UC HEALTH COMMERCIAL,43.935,87,,,OTHER,37.88,49.49,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
"SCREW, BONE SMALL CANCELL 4.0",1680413,CDM,,,,INPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.98,1680447,CDM,,,,INPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.95S,1680448,CDM,,,,INPATIENT,,,87.5,35,UC HEALTH,UC HEALTH COMMERCIAL,76.125,87,,,OTHER,65.63,85.75,PERCENT OF TOTAL BILLED CHARGES
WASHER 219.99,1680449,CDM,,,,INPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
"NUTS,LAG BOLT 219.96",1680450,CDM,,,,INPATIENT,,,28.5,11.4,UC HEALTH,UC HEALTH COMMERCIAL,24.795,87,,,OTHER,21.38,27.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.32",1680451,CDM,,,,INPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.33",1680452,CDM,,,,INPATIENT,,,51,20.4,UC HEALTH,UC HEALTH COMMERCIAL,44.37,87,,,OTHER,38.25,49.98,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.34",1680453,CDM,,,,INPATIENT,,,103.5,41.4,UC HEALTH,UC HEALTH COMMERCIAL,90.045,87,,,OTHER,77.63,101.43,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.35",1680454,CDM,,,,INPATIENT,,,125.25,50.1,UC HEALTH,UC HEALTH COMMERCIAL,108.9675,87,,,OTHER,93.94,122.75,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.36",1680455,CDM,,,,INPATIENT,,,244.25,97.7,UC HEALTH,UC HEALTH COMMERCIAL,212.4975,87,,,OTHER,183.19,239.37,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.37",1680456,CDM,,,,INPATIENT,,,297.5,119,UC HEALTH,UC HEALTH COMMERCIAL,258.825,87,,,OTHER,223.13,291.55,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 241.38",1680457,CDM,,,,INPATIENT,,,269.5,107.8,UC HEALTH,UC HEALTH COMMERCIAL,234.465,87,,,OTHER,202.13,264.11,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.13",1680458,CDM,,,,INPATIENT,,,127,50.8,UC HEALTH,UC HEALTH COMMERCIAL,110.49,87,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.14",1680459,CDM,,,,INPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.15",1680460,CDM,,,,INPATIENT,,,145,58,UC HEALTH,UC HEALTH COMMERCIAL,126.15,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR 242.16",1680461,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/4 TUBULAR 242.17",1680462,CDM,,,,INPATIENT,,,137.75,55.1,UC HEALTH,UC HEALTH COMMERCIAL,119.8425,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/4 TUBULAR 242.18",1680463,CDM,,,,INPATIENT,,,145,58,UC HEALTH,UC HEALTH COMMERCIAL,126.15,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.02",1680464,CDM,,,,INPATIENT,,,56,22.4,UC HEALTH,UC HEALTH COMMERCIAL,48.72,87,,,OTHER,42,54.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.03",1680465,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.04",1680466,CDM,,,,INPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.05",1680467,CDM,,,,INPATIENT,,,69.5,27.8,UC HEALTH,UC HEALTH COMMERCIAL,60.465,87,,,OTHER,52.13,68.11,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.06",1680468,CDM,,,,INPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.07",1680469,CDM,,,,INPATIENT,,,78.5,31.4,UC HEALTH,UC HEALTH COMMERCIAL,68.295,87,,,OTHER,58.88,76.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.08",1680470,CDM,,,,INPATIENT,,,82.75,33.1,UC HEALTH,UC HEALTH COMMERCIAL,71.9925,87,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.09",1680471,CDM,,,,INPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.10",1680472,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.11",1680473,CDM,,,,INPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SEMI-TUBULAR 222.12",1680474,CDM,,,,INPATIENT,,,84.75,33.9,UC HEALTH,UC HEALTH COMMERCIAL,73.7325,87,,,OTHER,63.56,83.06,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,179.25,71.7,UC HEALTH,UC HEALTH COMMERCIAL,155.9475,87,,,OTHER,134.44,175.67,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.04",1680476,CDM,,,,INPATIENT,,,183.5,73.4,UC HEALTH,UC HEALTH COMMERCIAL,159.645,87,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.05",1680477,CDM,,,,INPATIENT,,,225,90,UC HEALTH,UC HEALTH COMMERCIAL,195.75,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.06",1680478,CDM,,,,INPATIENT,,,251.75,100.7,UC HEALTH,UC HEALTH COMMERCIAL,219.0225,87,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.07",1680479,CDM,,,,INPATIENT,,,251.75,100.7,UC HEALTH,UC HEALTH COMMERCIAL,219.0225,87,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.02",1680475,CDM,,,,INPATIENT,,,153,61.2,UC HEALTH,UC HEALTH COMMERCIAL,133.11,87,,,OTHER,114.75,149.94,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.09",1680481,CDM,,,,INPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.10",1680482,CDM,,,,INPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 2.7MM 244.12",1680483,CDM,,,,INPATIENT,,,194.75,77.9,UC HEALTH,UC HEALTH COMMERCIAL,169.4325,87,,,OTHER,146.06,190.86,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.02",1680484,CDM,,,,INPATIENT,,,92.25,36.9,UC HEALTH,UC HEALTH COMMERCIAL,80.2575,87,,,OTHER,69.19,90.41,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.03",1680485,CDM,,,,INPATIENT,,,96,38.4,UC HEALTH,UC HEALTH COMMERCIAL,83.52,87,,,OTHER,72,94.08,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.04",1680486,CDM,,,,INPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.05",1680487,CDM,,,,INPATIENT,,,247.75,99.1,UC HEALTH,UC HEALTH COMMERCIAL,215.5425,87,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.06",1680488,CDM,,,,INPATIENT,,,263.5,105.4,UC HEALTH,UC HEALTH COMMERCIAL,229.245,87,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.07",1680489,CDM,,,,INPATIENT,,,274.5,109.8,UC HEALTH,UC HEALTH COMMERCIAL,238.815,87,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.08",1680490,CDM,,,,INPATIENT,,,276.75,110.7,UC HEALTH,UC HEALTH COMMERCIAL,240.7725,87,,,OTHER,207.56,271.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 3.5MM 248.10",1680491,CDM,,,,INPATIENT,,,145,58,UC HEALTH,UC HEALTH COMMERCIAL,126.15,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.06",1680492,CDM,,,,INPATIENT,,,187,74.8,UC HEALTH,UC HEALTH COMMERCIAL,162.69,87,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.07",1680493,CDM,,,,INPATIENT,,,187,74.8,UC HEALTH,UC HEALTH COMMERCIAL,162.69,87,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.10",1680495,CDM,,,,INPATIENT,,,221.5,88.6,UC HEALTH,UC HEALTH COMMERCIAL,192.705,87,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.12",1680496,CDM,,,,INPATIENT,,,221.5,88.6,UC HEALTH,UC HEALTH COMMERCIAL,192.705,87,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.14",1680497,CDM,,,,INPATIENT,,,244.5,97.8,UC HEALTH,UC HEALTH COMMERCIAL,212.715,87,,,OTHER,183.38,239.61,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.16",1680498,CDM,,,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DCP 4.5MM BROAD 226.18",1680499,CDM,,,,INPATIENT,,,396,158.4,UC HEALTH,UC HEALTH COMMERCIAL,344.52,87,,,OTHER,297,388.08,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T OBLIQUE ANG. 241.23",1680500,CDM,,,,INPATIENT,,,33.25,13.3,UC HEALTH,UC HEALTH COMMERCIAL,28.9275,87,,,OTHER,24.94,32.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T OBLIQUE ANG. 241.25",1680501,CDM,,,,INPATIENT,,,323.75,129.5,UC HEALTH,UC HEALTH COMMERCIAL,281.6625,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.13",1680502,CDM,,,,INPATIENT,,,187,74.8,UC HEALTH,UC HEALTH COMMERCIAL,162.69,87,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.14",1680503,CDM,,,,INPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T RIGHT ANG. 241.16",1680504,CDM,,,,INPATIENT,,,160.75,64.3,UC HEALTH,UC HEALTH COMMERCIAL,139.8525,87,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.31(L)",1680505,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.33(L)",1680507,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 242.34",1680508,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.31(L)",1680509,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.32(R)",1680510,CDM,,,,INPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.33 (L)",1680511,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.0MM 243.34(R)",1680512,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.13",1680513,CDM,,,,INPATIENT,,,190.75,76.3,UC HEALTH,UC HEALTH COMMERCIAL,165.9525,87,,,OTHER,143.06,186.94,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.14",1680514,CDM,,,,INPATIENT,,,366,146.4,UC HEALTH,UC HEALTH COMMERCIAL,318.42,87,,,OTHER,274.5,358.68,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.15",1680515,CDM,,,,INPATIENT,,,312.25,124.9,UC HEALTH,UC HEALTH COMMERCIAL,271.6575,87,,,OTHER,234.19,306.01,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.16",1680516,CDM,,,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 240.18",1680517,CDM,,,,INPATIENT,,,554.25,221.7,UC HEALTH,UC HEALTH COMMERCIAL,482.1975,87,,,OTHER,415.69,543.17,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,178.5,71.4,UC HEALTH,UC HEALTH COMMERCIAL,155.295,87,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T 2.0MM 243.41",1680518,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.13",1680520,CDM,,,,INPATIENT,,,53.5,21.4,UC HEALTH,UC HEALTH COMMERCIAL,46.545,87,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.14",1680521,CDM,,,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.15",1680522,CDM,,,,INPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, STRAIGHT 2.0MM 243.16",1680523,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CLOVERLEAF 240.23",1680524,CDM,,,,INPATIENT,,,229,91.6,UC HEALTH,UC HEALTH COMMERCIAL,199.23,87,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CLOVERLEAF 240.24",1680525,CDM,,,,INPATIENT,,,247.75,99.1,UC HEALTH,UC HEALTH COMMERCIAL,215.5425,87,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SPOON 240.05",1680526,CDM,,,,INPATIENT,,,233,93.2,UC HEALTH,UC HEALTH COMMERCIAL,202.71,87,,,OTHER,174.75,228.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, SPOON 240.06",1680527,CDM,,,,INPATIENT,,,233,93.2,UC HEALTH,UC HEALTH COMMERCIAL,202.71,87,,,OTHER,174.75,228.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.34",1680528,CDM,,,,INPATIENT,,,308,123.2,UC HEALTH,UC HEALTH COMMERCIAL,267.96,87,,,OTHER,231,301.84,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.35",1680529,CDM,,,,INPATIENT,,,444.75,177.9,UC HEALTH,UC HEALTH COMMERCIAL,386.9325,87,,,OTHER,333.56,435.86,PERCENT OF TOTAL BILLED CHARGES
"PLATE, T-BUTTRESS 240.36",1680530,CDM,,,,INPATIENT,,,343.25,137.3,UC HEALTH,UC HEALTH COMMERCIAL,298.6275,87,,,OTHER,257.44,336.39,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L-BUTTRESS 240.44",1680531,CDM,,,,INPATIENT,,,323.75,129.5,UC HEALTH,UC HEALTH COMMERCIAL,281.6625,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L-BUTTRESS 240.54",1680532,CDM,,,,INPATIENT,,,490.25,196.1,UC HEALTH,UC HEALTH COMMERCIAL,426.5175,87,,,OTHER,367.69,480.45,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,593.75,237.5,UC HEALTH,UC HEALTH COMMERCIAL,516.5625,87,,,OTHER,445.31,581.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,563.5,225.4,UC HEALTH,UC HEALTH COMMERCIAL,490.245,87,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,991.75,396.7,UC HEALTH,UC HEALTH COMMERCIAL,862.8225,87,,,OTHER,743.81,971.92,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,UC HEALTH,UC HEALTH COMMERCIAL,889.575,87,,,OTHER,766.88,1002.05,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1022.5,409,UC HEALTH,UC HEALTH COMMERCIAL,889.575,87,,,OTHER,766.88,1002.05,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1055.75,422.3,UC HEALTH,UC HEALTH COMMERCIAL,918.5025,87,,,OTHER,791.81,1034.64,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,732.5,293,UC HEALTH,UC HEALTH COMMERCIAL,637.275,87,,,OTHER,549.38,717.85,PERCENT OF TOTAL BILLED CHARGES
"PLATE, CONDYLAR BUTTRESS",1680534,CDM,,,,INPATIENT,,,1085.75,434.3,UC HEALTH,UC HEALTH COMMERCIAL,944.6025,87,,,OTHER,814.31,1064.04,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 245.35",1680543,CDM,,,,INPATIENT,,,694,277.6,UC HEALTH,UC HEALTH COMMERCIAL,603.78,87,,,OTHER,520.5,680.12,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 245.32",1680544,CDM,,,,INPATIENT,,,539,215.6,UC HEALTH,UC HEALTH COMMERCIAL,468.93,87,,,OTHER,404.25,528.22,PERCENT OF TOTAL BILLED CHARGES
"PLATE, RECONSTRUCTION 229.44",1680545,CDM,,,,INPATIENT,,,660.5,264.2,UC HEALTH,UC HEALTH COMMERCIAL,574.635,87,,,OTHER,495.38,647.29,PERCENT OF TOTAL BILLED CHARGES
"WIRE, CERCLAGE EYE 291.11",1680546,CDM,,,,INPATIENT,,,123.75,49.5,UC HEALTH,UC HEALTH COMMERCIAL,107.6625,87,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
"WIRE, CERCLAGE COIL 291.05",1680547,CDM,,,,INPATIENT,,,104.75,41.9,UC HEALTH,UC HEALTH COMMERCIAL,91.1325,87,,,OTHER,78.56,102.66,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,111.5,44.6,UC HEALTH,UC HEALTH COMMERCIAL,97.005,87,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,UC HEALTH,UC HEALTH COMMERCIAL,172.4775,87,,,OTHER,148.69,194.29,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,198.25,79.3,UC HEALTH,UC HEALTH COMMERCIAL,172.4775,87,,,OTHER,148.69,194.29,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,265.25,106.1,UC HEALTH,UC HEALTH COMMERCIAL,230.7675,87,,,OTHER,198.94,259.95,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UC HEALTH,UC HEALTH COMMERCIAL,139.8525,87,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UC HEALTH,UC HEALTH COMMERCIAL,139.8525,87,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,160.75,64.3,UC HEALTH,UC HEALTH COMMERCIAL,139.8525,87,,,OTHER,120.56,157.54,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DYNAMIC COMPRESSION,1680548,CDM,,,,INPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 2-HOLE,1680562,CDM,,,,INPATIENT,,,748.75,299.5,UC HEALTH,UC HEALTH COMMERCIAL,651.4125,87,,,OTHER,561.56,733.78,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 4-HOLE,1680563,CDM,,,,INPATIENT,,,897.25,358.9,UC HEALTH,UC HEALTH COMMERCIAL,780.6075,87,,,OTHER,672.94,879.31,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 6-HOLE,1680564,CDM,,,,INPATIENT,,,748.75,299.5,UC HEALTH,UC HEALTH COMMERCIAL,651.4125,87,,,OTHER,561.56,733.78,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED 8-HOLE,1680565,CDM,,,,INPATIENT,,,824.75,329.9,UC HEALTH,UC HEALTH COMMERCIAL,717.5325,87,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,824.75,329.9,UC HEALTH,UC HEALTH COMMERCIAL,717.5325,87,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,824.75,329.9,UC HEALTH,UC HEALTH COMMERCIAL,717.5325,87,,,OTHER,618.56,808.26,PERCENT OF TOTAL BILLED CHARGES
HIP SET DEPUY CAPTURED,1680566,CDM,,,,INPATIENT,,,1049.5,419.8,UC HEALTH,UC HEALTH COMMERCIAL,913.065,87,,,OTHER,787.13,1028.51,PERCENT OF TOTAL BILLED CHARGES
"PIN, CANNULATED GUIDE",1680569,CDM,,,,INPATIENT,,,320.25,128.1,UC HEALTH,UC HEALTH COMMERCIAL,278.6175,87,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
TOMCAT SHAVER 4.0,1680570,CDM,,,,INPATIENT,,,1089.25,435.7,UC HEALTH,UC HEALTH COMMERCIAL,947.6475,87,,,OTHER,816.94,1067.47,PERCENT OF TOTAL BILLED CHARGES
MITEK MINI QUICKANCHOR,1680571,CDM,,,,INPATIENT,,,982.75,393.1,UC HEALTH,UC HEALTH COMMERCIAL,854.9925,87,,,OTHER,737.06,963.1,PERCENT OF TOTAL BILLED CHARGES
MITEK GII QUICKANCHOR,1680572,CDM,,,,INPATIENT,,,1004.25,401.7,UC HEALTH,UC HEALTH COMMERCIAL,873.6975,87,,,OTHER,753.19,984.17,PERCENT OF TOTAL BILLED CHARGES
MITEK SUPER QUICKANCHOR,1680573,CDM,,,,INPATIENT,,,1748.25,699.3,UC HEALTH,UC HEALTH COMMERCIAL,1520.9775,87,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
CANCELLOUS BONE CHIPS 30CC,1680574,CDM,,,,INPATIENT,,,1323,529.2,UC HEALTH,UC HEALTH COMMERCIAL,1151.01,87,,,OTHER,992.25,1296.54,PERCENT OF TOTAL BILLED CHARGES
BIOMET ACL WASHER 14MM,1680575,CDM,,,,INPATIENT,,,402,160.8,UC HEALTH,UC HEALTH COMMERCIAL,349.74,87,,,OTHER,301.5,393.96,PERCENT OF TOTAL BILLED CHARGES
"WASHER, ACL 18MM",1680576,CDM,,,,INPATIENT,,,578.5,231.4,UC HEALTH,UC HEALTH COMMERCIAL,503.295,87,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 30MM",1680577,CDM,,,,INPATIENT,,,183.5,73.4,UC HEALTH,UC HEALTH COMMERCIAL,159.645,87,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 35MM",1680578,CDM,,,,INPATIENT,,,183.5,73.4,UC HEALTH,UC HEALTH COMMERCIAL,159.645,87,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 40MM",1680579,CDM,,,,INPATIENT,,,210,84,UC HEALTH,UC HEALTH COMMERCIAL,182.7,87,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 45MM",1680580,CDM,,,,INPATIENT,,,225,90,UC HEALTH,UC HEALTH COMMERCIAL,195.75,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 50MM",1680581,CDM,,,,INPATIENT,,,225,90,UC HEALTH,UC HEALTH COMMERCIAL,195.75,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 55MM",1680582,CDM,,,,INPATIENT,,,225,90,UC HEALTH,UC HEALTH COMMERCIAL,195.75,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
"SCREW, ANCHORING 60MM",1680583,CDM,,,,INPATIENT,,,164.25,65.7,UC HEALTH,UC HEALTH COMMERCIAL,142.8975,87,,,OTHER,123.19,160.97,PERCENT OF TOTAL BILLED CHARGES
CANN. INTERSCREW 7X25MM,1680584,CDM,,,,INPATIENT,,,339.25,135.7,UC HEALTH,UC HEALTH COMMERCIAL,295.1475,87,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
CANN. INTERSCREW,1680585,CDM,,,,INPATIENT,,,339.25,135.7,UC HEALTH,UC HEALTH COMMERCIAL,295.1475,87,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
"WASHER, SPIKED",1680586,CDM,,,,INPATIENT,,,87.5,35,UC HEALTH,UC HEALTH COMMERCIAL,76.125,87,,,OTHER,65.63,85.75,PERCENT OF TOTAL BILLED CHARGES
OGDEN ANCHOR 7.4MM,1680567,CDM,,,,INPATIENT,,,426.75,170.7,UC HEALTH,UC HEALTH COMMERCIAL,371.2725,87,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
ANCHOR BIOKNOTLESS W/ETHIBOND,1680588,CDM,,,,INPATIENT,,,1000.75,400.3,UC HEALTH,UC HEALTH COMMERCIAL,870.6525,87,,,OTHER,750.56,980.74,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 46MM",1680589,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 48MM",1680590,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 50MM",1680591,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 52MM",1680592,CDM,,,,INPATIENT,,,2742.5,1097,UC HEALTH,UC HEALTH COMMERCIAL,2385.975,87,,,OTHER,2056.88,2687.65,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 54MM",1680593,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 56MM",1680594,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 58MM",1680595,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 60MM",1680596,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 62MM",1680597,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 64MM",1680598,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 66MM",1680599,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL 68MM",1680600,CDM,,,,INPATIENT,,,2660,1064,UC HEALTH,UC HEALTH COMMERCIAL,2314.2,87,,,OTHER,1995,2606.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 42MM",1680601,CDM,,,,INPATIENT,,,2362.5,945,UC HEALTH,UC HEALTH COMMERCIAL,2055.375,87,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 45MM",1680602,CDM,,,,INPATIENT,,,2362.5,945,UC HEALTH,UC HEALTH COMMERCIAL,2055.375,87,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 48MM",1680603,CDM,,,,INPATIENT,,,2362.5,945,UC HEALTH,UC HEALTH COMMERCIAL,2055.375,87,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE SHELL W/PEGS 51MM",1680604,CDM,,,,INPATIENT,,,2362.5,945,UC HEALTH,UC HEALTH COMMERCIAL,2055.375,87,,,OTHER,1771.88,2315.25,PERCENT OF TOTAL BILLED CHARGES
HIP ACE LINER 42MM,1680606,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
HIP ACE LINER 43MM,1680607,CDM,,,,INPATIENT,,,1533,613.2,UC HEALTH,UC HEALTH COMMERCIAL,1333.71,87,,,OTHER,1149.75,1502.34,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 44MM",1680608,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 45MM",1680609,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 46MM",1680610,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 47MM",1680611,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"HIP, ACE LINER 48MM",1680612,CDM,,,,INPATIENT,,,1487,594.8,UC HEALTH,UC HEALTH COMMERCIAL,1293.69,87,,,OTHER,1115.25,1457.26,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 15MM 103530",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 20MM",1680614,CDM,,,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 25MM",1680615,CDM,,,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 30MM",1680616,CDM,,,,INPATIENT,,,263.5,105.4,UC HEALTH,UC HEALTH COMMERCIAL,229.245,87,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 35MM 103534",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TIT 40MM 103535",1680618,CDM,,,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 45MM",1680619,CDM,,,,INPATIENT,,,263.5,105.4,UC HEALTH,UC HEALTH COMMERCIAL,229.245,87,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 50MM",1680620,CDM,,,,INPATIENT,,,274.5,109.8,UC HEALTH,UC HEALTH COMMERCIAL,238.815,87,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 60MM",1680621,CDM,,,,INPATIENT,,,263.5,105.4,UC HEALTH,UC HEALTH COMMERCIAL,229.245,87,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 70MM",1680622,CDM,,,,INPATIENT,,,263.5,105.4,UC HEALTH,UC HEALTH COMMERCIAL,229.245,87,,,OTHER,197.63,258.23,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 20MM",1680623,CDM,,,,INPATIENT,,,229,91.6,UC HEALTH,UC HEALTH COMMERCIAL,199.23,87,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 30MM",1680624,CDM,,,,INPATIENT,,,240.25,96.1,UC HEALTH,UC HEALTH COMMERCIAL,209.0175,87,,,OTHER,180.19,235.45,PERCENT OF TOTAL BILLED CHARGES
"HIP, Q/C DRILL BIT 40MM",1680625,CDM,,,,INPATIENT,,,172,68.8,UC HEALTH,UC HEALTH COMMERCIAL,149.64,87,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5510,2204,UC HEALTH,UC HEALTH COMMERCIAL,4793.7,87,,,OTHER,4132.5,5399.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL COMP  12-162611",1680627,CDM,,,,INPATIENT,,,3248.25,1299.3,UC HEALTH,UC HEALTH COMMERCIAL,2825.9775,87,,,OTHER,2436.19,3183.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, FEMORAL COMP 12-162613",1680628,CDM,,,,INPATIENT,,,4781,1912.4,UC HEALTH,UC HEALTH COMMERCIAL,4159.47,87,,,OTHER,3585.75,4685.38,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,5379.5,2151.8,UC HEALTH,UC HEALTH COMMERCIAL,4680.165,87,,,OTHER,4034.63,5271.91,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL INTERLOCK",1680626,CDM,,,,INPATIENT,,,3248.25,1299.3,UC HEALTH,UC HEALTH COMMERCIAL,2825.9775,87,,,OTHER,2436.19,3183.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,UC HEALTH,UC HEALTH COMMERCIAL,4963.35,87,,,OTHER,4278.75,5590.9,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL POROUS",1680631,CDM,,,,INPATIENT,,,5705,2282,UC HEALTH,UC HEALTH COMMERCIAL,4963.35,87,,,OTHER,4278.75,5590.9,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UC HEALTH,UC HEALTH COMMERCIAL,1045.305,87,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1803.25,721.3,UC HEALTH,UC HEALTH COMMERCIAL,1568.8275,87,,,OTHER,1352.44,1767.19,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1134.5,453.8,UC HEALTH,UC HEALTH COMMERCIAL,987.015,87,,,OTHER,850.88,1111.81,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1748.25,699.3,UC HEALTH,UC HEALTH COMMERCIAL,1520.9775,87,,,OTHER,1311.19,1713.29,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UC HEALTH,UC HEALTH COMMERCIAL,1045.305,87,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1091.5,436.6,UC HEALTH,UC HEALTH COMMERCIAL,949.605,87,,,OTHER,818.63,1069.67,PERCENT OF TOTAL BILLED CHARGES
"HIP, MOD HEAD COMPONENT",1680633,CDM,,,,INPATIENT,,,1201.5,480.6,UC HEALTH,UC HEALTH COMMERCIAL,1045.305,87,,,OTHER,901.13,1177.47,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UC HEALTH,UC HEALTH COMMERCIAL,311.2425,87,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UC HEALTH,UC HEALTH COMMERCIAL,311.2425,87,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,377,150.8,UC HEALTH,UC HEALTH COMMERCIAL,327.99,87,,,OTHER,282.75,369.46,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UC HEALTH,UC HEALTH COMMERCIAL,311.2425,87,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, INTEGRAL DISTAL",1680640,CDM,,,,INPATIENT,,,357.75,143.1,UC HEALTH,UC HEALTH COMMERCIAL,311.2425,87,,,OTHER,268.31,350.6,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163005",1680646,CDM,,,,INPATIENT,,,247.75,99.1,UC HEALTH,UC HEALTH COMMERCIAL,215.5425,87,,,OTHER,185.81,242.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163010",1680647,CDM,,,,INPATIENT,,,289.75,115.9,UC HEALTH,UC HEALTH COMMERCIAL,252.0825,87,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163015",1680648,CDM,,,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163020",1680649,CDM,,,,INPATIENT,,,301,120.4,UC HEALTH,UC HEALTH COMMERCIAL,261.87,87,,,OTHER,225.75,294.98,PERCENT OF TOTAL BILLED CHARGES
"HIP, BONE PLUG CEMENT 163025",1680650,CDM,,,,INPATIENT,,,301,120.4,UC HEALTH,UC HEALTH COMMERCIAL,261.87,87,,,OTHER,225.75,294.98,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 16 X 65",1680654,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UC HEALTH,UC HEALTH COMMERCIAL,2483.415,87,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UC HEALTH,UC HEALTH COMMERCIAL,2483.415,87,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMPONENT",1680656,CDM,,,,INPATIENT,,,2854.5,1141.8,UC HEALTH,UC HEALTH COMMERCIAL,2483.415,87,,,OTHER,2140.88,2797.41,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 12 X 85",1680676,CDM,,,,INPATIENT,,,4474.5,1789.8,UC HEALTH,UC HEALTH COMMERCIAL,3892.815,87,,,OTHER,3355.88,4385.01,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 14 X 85",1680677,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 16 X 85",1680678,CDM,,,,INPATIENT,,,4260.75,1704.3,UC HEALTH,UC HEALTH COMMERCIAL,3706.8525,87,,,OTHER,3195.56,4175.54,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL COMP 20 X 85",1680679,CDM,,,,INPATIENT,,,4261.25,1704.5,UC HEALTH,UC HEALTH COMMERCIAL,3707.2875,87,,,OTHER,3195.94,4176.03,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM SPLINED 141614,1680681,CDM,,,,INPATIENT,,,5414.5,2165.8,UC HEALTH,UC HEALTH COMMERCIAL,4710.615,87,,,OTHER,4060.88,5306.21,PERCENT OF TOTAL BILLED CHARGES
SCREW CORTEX 16MM 202.816,1680682,CDM,,,,INPATIENT,,,145.5,58.2,UC HEALTH,UC HEALTH COMMERCIAL,126.585,87,,,OTHER,109.13,142.59,PERCENT OF TOTAL BILLED CHARGES
TIBIAL TRAY OFFSET  141491,1680690,CDM,,,,INPATIENT,,,2402,960.8,UC HEALTH,UC HEALTH COMMERCIAL,2089.74,87,,,OTHER,1801.5,2353.96,PERCENT OF TOTAL BILLED CHARGES
LOCKING INSERT 141496,1680691,CDM,,,,INPATIENT,,,611.75,244.7,UC HEALTH,UC HEALTH COMMERCIAL,532.2225,87,,,OTHER,458.81,599.52,PERCENT OF TOTAL BILLED CHARGES
TIBIAL TRAY BIOMET 141483,1680692,CDM,,,,INPATIENT,,,5988.75,2395.5,UC HEALTH,UC HEALTH COMMERCIAL,5210.2125,87,,,OTHER,4491.56,5868.98,PERCENT OF TOTAL BILLED CHARGES
FEMORAL 65MM W/SCREW 183324,1680693,CDM,,,,INPATIENT,,,16906,6762.4,UC HEALTH,UC HEALTH COMMERCIAL,14708.22,87,,,OTHER,12679.5,16567.88,PERCENT OF TOTAL BILLED CHARGES
FEMORAL DISTAL AUGMENT 184184,1680694,CDM,,,,INPATIENT,,,2831.75,1132.7,UC HEALTH,UC HEALTH COMMERCIAL,2463.6225,87,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORAL DISTAL AUGMENT 184204,1680695,CDM,,,,INPATIENT,,,2831.75,1132.7,UC HEALTH,UC HEALTH COMMERCIAL,2463.6225,87,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORAL POSTERIOR AGMNT 184144,1680696,CDM,,,,INPATIENT,,,2831.75,1132.7,UC HEALTH,UC HEALTH COMMERCIAL,2463.6225,87,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
FEMORALPOSTERIOR AGMNT 184164,1680697,CDM,,,,INPATIENT,,,2831.75,1132.7,UC HEALTH,UC HEALTH COMMERCIAL,2463.6225,87,,,OTHER,2123.81,2775.12,PERCENT OF TOTAL BILLED CHARGES
TISSUE FIXATION,C1776,HCPCS,278,RC,,INPATIENT,,,1675.5,670.2,UC HEALTH,UC HEALTH COMMERCIAL,1457.685,87,,,OTHER,1256.63,1641.99,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT CALIBRATED,1680703,CDM,,,,INPATIENT,,,346.25,138.5,UC HEALTH,UC HEALTH COMMERCIAL,301.2375,87,,,OTHER,259.69,339.33,PERCENT OF TOTAL BILLED CHARGES
MAGNUM TAPER ADAPTER 6MM,C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,UC HEALTH,UC HEALTH COMMERCIAL,1129.9125,87,,,OTHER,974.06,1272.78,PERCENT OF TOTAL BILLED CHARGES
MEDULLARY TUBE 2.5MM,C1776,HCPCS,278,RC,,INPATIENT,,,355,142,UC HEALTH,UC HEALTH COMMERCIAL,308.85,87,,,OTHER,266.25,347.9,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 3 FLUTED 4.2MM,1680709,CDM,,,,INPATIENT,,,590,236,UC HEALTH,UC HEALTH COMMERCIAL,513.3,87,,,OTHER,442.5,578.2,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 3 FLUTED 4.2MM 145MM,1680710,CDM,,,,INPATIENT,,,524,209.6,UC HEALTH,UC HEALTH COMMERCIAL,455.88,87,,,OTHER,393,513.52,PERCENT OF TOTAL BILLED CHARGES
GUIDEWIRE 3.2MM 400MM 357.399,1680712,CDM,,,,INPATIENT,,,372.5,149,UC HEALTH,UC HEALTH COMMERCIAL,324.075,87,,,OTHER,279.38,365.05,PERCENT OF TOTAL BILLED CHARGES
MINI ARC PRECISE,C1776,HCPCS,278,RC,,INPATIENT,,,3661.25,1464.5,UC HEALTH,UC HEALTH COMMERCIAL,3185.2875,87,,,OTHER,2745.94,3588.03,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 3.5MM 110MM,1680717,CDM,,,,INPATIENT,,,297.75,119.1,UC HEALTH,UC HEALTH COMMERCIAL,259.0425,87,,,OTHER,223.31,291.8,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TIBIAL FIXED 141233",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UC HEALTH,UC HEALTH COMMERCIAL,1612.3536,87,,,OTHER,3203.25,4185.58,PERCENT OF TOTAL BILLED CHARGES
TIBIAL PLATE 75MM 141234,C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UC HEALTH,UC HEALTH COMMERCIAL,1612.3536,87,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.5MM 310.25,1680730,CDM,,,,INPATIENT,,,280,112,UC HEALTH,UC HEALTH COMMERCIAL,243.6,87,,,OTHER,210,274.4,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 2.8MM 165MM,1680731,CDM,,,,INPATIENT,,,346.25,138.5,UC HEALTH,UC HEALTH COMMERCIAL,301.2375,87,,,OTHER,259.69,339.33,PERCENT OF TOTAL BILLED CHARGES
WASHER 7.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,98.5,39.4,UC HEALTH,UC HEALTH COMMERCIAL,85.695,87,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.7MM 310.67,1680733,CDM,,,,INPATIENT,,,1380.5,552.2,UC HEALTH,UC HEALTH COMMERCIAL,1201.035,87,,,OTHER,1035.38,1352.89,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.0MM 140MM,1680735,CDM,,,,INPATIENT,,,490.5,196.2,UC HEALTH,UC HEALTH COMMERCIAL,426.735,87,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
CABLE 1.7X 750MM,C1776,HCPCS,278,RC,,INPATIENT,,,988.85,395.54,UC HEALTH,UC HEALTH COMMERCIAL,860.2995,87,,,OTHER,1110.75,1451.38,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING MONO LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,6776,2710.4,UC HEALTH,UC HEALTH COMMERCIAL,5895.12,87,,,OTHER,5082,6640.48,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL, PLATE 87MM 141237",C1776,HCPCS,278,RC,,INPATIENT,,,4271,1708.4,UC HEALTH,UC HEALTH COMMERCIAL,3715.77,87,,,OTHER,3203.25,4185.58,PERCENT OF TOTAL BILLED CHARGES
HEAD ENDO II 46MM 12-139016,C1776,HCPCS,278,RC,,INPATIENT,,,970.25,388.1,UC HEALTH,UC HEALTH COMMERCIAL,844.1175,87,,,OTHER,727.69,950.85,PERCENT OF TOTAL BILLED CHARGES
"TAPER ADAPTER, ENDO II 64MM",C1776,HCPCS,278,RC,,INPATIENT,,,324,129.6,UC HEALTH,UC HEALTH COMMERCIAL,281.88,87,,,OTHER,246.75,322.42,PERCENT OF TOTAL BILLED CHARGES
"SUTURE, ENDOBUTTON ULTRA",1680756,CDM,,,,INPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL,INTRAFIX SHEATH",C1776,HCPCS,278,RC,,INPATIENT,,,767.5,307,UC HEALTH,UC HEALTH COMMERCIAL,667.725,87,,,OTHER,575.63,752.15,PERCENT OF TOTAL BILLED CHARGES
"PLATE, 1/3 TUBULAR",C1713,HCPCS,278,RC,,INPATIENT,,,288.25,115.3,UC HEALTH,UC HEALTH COMMERCIAL,250.7775,87,,,OTHER,216.19,282.49,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 1.5MM,1680760,CDM,,,,INPATIENT,,,275.25,110.1,UC HEALTH,UC HEALTH COMMERCIAL,239.4675,87,,,OTHER,206.44,269.75,PERCENT OF TOTAL BILLED CHARGES
"PLATE, ONE-THIRD TUBULAR",C1776,HCPCS,278,RC,,INPATIENT,,,365.9,146.36,UC HEALTH,UC HEALTH COMMERCIAL,318.333,87,,,OTHER,456,595.84,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 2.7MM,1680771,CDM,,,,INPATIENT,,,364.75,145.9,UC HEALTH,UC HEALTH COMMERCIAL,317.3325,87,,,OTHER,273.56,357.46,PERCENT OF TOTAL BILLED CHARGES
PLATE 7-HOLE LCP,C1776,HCPCS,278,RC,,INPATIENT,,,347.76,139.104,UC HEALTH,UC HEALTH COMMERCIAL,302.5512,87,,,OTHER,433.69,566.69,PERCENT OF TOTAL BILLED CHARGES
"SCREW, INSTRUMENTS FOR 3.0MM",C1713,HCPCS,278,RC,,INPATIENT,,,110,44,UC HEALTH,UC HEALTH COMMERCIAL,95.7,87,,,OTHER,82.5,107.8,PERCENT OF TOTAL BILLED CHARGES
"STARDRIVE, TI END CAP T40 0MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UC HEALTH,UC HEALTH COMMERCIAL,552.015,87,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
"STARDRIVE, TI END CAP T40 15MM",C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UC HEALTH,UC HEALTH COMMERCIAL,552.015,87,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL CR MONO-LOCK",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UC HEALTH,UC HEALTH COMMERCIAL,3694.7682,87,,,OTHER,4839.94,6324.19,PERCENT OF TOTAL BILLED CHARGES
"TAPER ADAPTER, MAGNUM",C1776,HCPCS,278,RC,,INPATIENT,,,1298.75,519.5,UC HEALTH,UC HEALTH COMMERCIAL,1129.9125,87,,,OTHER,974.06,1272.78,PERCENT OF TOTAL BILLED CHARGES
FEMORAL INTER LOCK 65MM 183008,C1776,HCPCS,278,RC,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 42MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UC HEALTH,UC HEALTH COMMERCIAL,583.3002,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD COMPONENT,C1776,HCPCS,278,RC,,INPATIENT,,,1074.25,429.7,UC HEALTH,UC HEALTH COMMERCIAL,934.5975,87,,,OTHER,805.69,1052.77,PERCENT OF TOTAL BILLED CHARGES
"LINER, E1 RINGLOC EP-108222",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UC HEALTH,UC HEALTH COMMERCIAL,4049.85,87,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
CLAMP FIXATION MATERIAL 4.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1691.93,676.772,UC HEALTH,UC HEALTH COMMERCIAL,1471.9791,87,,,OTHER,1961.63,2563.19,PERCENT OF TOTAL BILLED CHARGES
"ROD, CARBON FIBER 8.0 - 200MM",C1776,HCPCS,278,RC,,INPATIENT,,,331.28,132.512,UC HEALTH,UC HEALTH COMMERCIAL,288.2136,87,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
FIXATION NAIL 340MM (RT),C1776,HCPCS,278,RC,,INPATIENT,,,4446.75,1778.7,UC HEALTH,UC HEALTH COMMERCIAL,3868.6725,87,,,OTHER,3335.06,4357.82,PERCENT OF TOTAL BILLED CHARGES
REAMING ROD W/BAL,C1776,HCPCS,278,RC,,INPATIENT,,,348.5,139.4,UC HEALTH,UC HEALTH COMMERCIAL,303.195,87,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
BLADES 11.0MM TITANIUM,C1776,HCPCS,278,RC,,INPATIENT,,,1758.5,703.4,UC HEALTH,UC HEALTH COMMERCIAL,1529.895,87,,,OTHER,1318.88,1723.33,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TUBULAR W/COLLAR 10 HL",C1713,HCPCS,278,RC,,INPATIENT,,,184.28,73.712,UC HEALTH,UC HEALTH COMMERCIAL,160.3236,87,,,OTHER,211.5,276.36,PERCENT OF TOTAL BILLED CHARGES
ENDO 11 HEAD 49MM,C1776,HCPCS,278,RC,,INPATIENT,,,1243.75,497.5,UC HEALTH,UC HEALTH COMMERCIAL,1082.0625,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
MAGNUM HEAD 44MM,C1776,HCPCS,278,RC,,INPATIENT,,,3879.75,1551.9,UC HEALTH,UC HEALTH COMMERCIAL,3375.3825,87,,,OTHER,2909.81,3802.16,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 43MM,1680802,CDM,,,,INPATIENT,,,1243.75,497.5,UC HEALTH,UC HEALTH COMMERCIAL,1082.0625,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 26MM",1680805,CDM,,,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 34MM",1680806,CDM,,,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 38MM",1680807,CDM,,,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"SCREW, LOCKING ST 3.5MM 40MM",1680808,CDM,,,,INPATIENT,,,411.25,164.5,UC HEALTH,UC HEALTH COMMERCIAL,357.7875,87,,,OTHER,308.44,403.03,PERCENT OF TOTAL BILLED CHARGES
"PLATE,LCP CLAVICLE 02.112.080",1680810,CDM,,,,INPATIENT,,,1382.5,553,UC HEALTH,UC HEALTH COMMERCIAL,1202.775,87,,,OTHER,1036.88,1354.85,PERCENT OF TOTAL BILLED CHARGES
"PLATES, CONDYLAR 8-HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3842.5,1537,UC HEALTH,UC HEALTH COMMERCIAL,3342.975,87,,,OTHER,2881.88,3765.65,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 44MM,1680893,CDM,,,,INPATIENT,,,880,352,UC HEALTH,UC HEALTH COMMERCIAL,765.6,87,,,OTHER,660,862.4,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL ANT STAB BEARING",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,2315.81,3026,PERCENT OF TOTAL BILLED CHARGES
STEINMANN PIN,C1776,HCPCS,278,RC,,INPATIENT,,,208.5,83.4,UC HEALTH,UC HEALTH COMMERCIAL,181.395,87,,,OTHER,156.38,204.33,PERCENT OF TOTAL BILLED CHARGES
COPELAND HA RSRF HD 11-114644,C1776,HCPCS,278,RC,,INPATIENT,,,8996.5,3598.6,UC HEALTH,UC HEALTH COMMERCIAL,7826.955,87,,,OTHER,6747.38,8816.57,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX SP 12MM 202.872",1680898,CDM,,,,INPATIENT,,,145.5,58.2,UC HEALTH,UC HEALTH COMMERCIAL,126.585,87,,,OTHER,109.13,142.59,PERCENT OF TOTAL BILLED CHARGES
"PLATE, D 2.4MM 242.467 (L)",1680899,CDM,,,,INPATIENT,,,2494.25,997.7,UC HEALTH,UC HEALTH COMMERCIAL,2169.9975,87,,,OTHER,1870.69,2444.37,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.4MM 310.530,1680900,CDM,,,,INPATIENT,,,495.5,198.2,UC HEALTH,UC HEALTH COMMERCIAL,431.085,87,,,OTHER,371.63,485.59,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 50MM 12-139024,1680903,CDM,,,,INPATIENT,,,1243.75,497.5,UC HEALTH,UC HEALTH COMMERCIAL,1082.0625,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
CUP ACETABULAR 52MM PT-104052,1680904,CDM,,,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"PORT, INDWELLING",C1788,HCPCS,278,RC,,INPATIENT,,,433,173.2,UC HEALTH,UC HEALTH COMMERCIAL,376.71,87,,,OTHER,324.75,424.34,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DISTAL RADIUS 2.4MM 7HL",C1776,HCPCS,278,RC,,INPATIENT,,,2494.25,997.7,UC HEALTH,UC HEALTH COMMERCIAL,2169.9975,87,,,OTHER,1870.69,2444.37,PERCENT OF TOTAL BILLED CHARGES
"WIRE, KIRSCHNER W/TROCAR POINT",C1776,HCPCS,278,RC,,INPATIENT,,,223.02,89.208,UC HEALTH,UC HEALTH COMMERCIAL,194.0274,87,,,OTHER,42,54.88,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 2.0MM 100MM,1681000,CDM,,,,INPATIENT,,,315.5,126.2,UC HEALTH,UC HEALTH COMMERCIAL,274.485,87,,,OTHER,236.63,309.19,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT 1.8MM W/DEPT MARK,1681001,CDM,,,,INPATIENT,,,490.5,196.2,UC HEALTH,UC HEALTH COMMERCIAL,426.735,87,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 189080",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
ENDO II TAPER/ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,328.5,131.4,UC HEALTH,UC HEALTH COMMERCIAL,285.795,87,,,OTHER,246.38,321.93,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 48MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UC HEALTH,UC HEALTH COMMERCIAL,583.3002,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"PLATE, HUMERUS 3.5MM 3 HOLE",C1713,HCPCS,278,RC,,INPATIENT,,,3627.25,1450.9,UC HEALTH,UC HEALTH COMMERCIAL,3155.7075,87,,,OTHER,2720.44,3554.71,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DISTAL RADIUS 2.4MM 3HL",C1713,HCPCS,278,RC,,INPATIENT,,,1652.62,661.048,UC HEALTH,UC HEALTH COMMERCIAL,1437.7794,87,,,OTHER,1808.25,2362.78,PERCENT OF TOTAL BILLED CHARGES
SHOULDER SYSTEM STD ADAPTER,C1776,HCPCS,278,RC,,INPATIENT,,,429.84,171.936,UC HEALTH,UC HEALTH COMMERCIAL,373.9608,87,,,OTHER,427.13,558.11,PERCENT OF TOTAL BILLED CHARGES
TIBIAL PLATE 63MM,C1776,HCPCS,278,RC,,INPATIENT,,,1788.8,715.52,UC HEALTH,UC HEALTH COMMERCIAL,1556.256,87,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARNG 10 X 63MM",C1776,HCPCS,278,RC,,INPATIENT,,,1542.24,616.896,UC HEALTH,UC HEALTH COMMERCIAL,1341.7488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL PLATE 79MM 141235",C1776,HCPCS,278,RC,,INPATIENT,,,1853.28,741.312,UC HEALTH,UC HEALTH COMMERCIAL,1612.3536,87,,,OTHER,1779.77,2325.56,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 10MMX79MM",C1776,HCPCS,278,RC,,INPATIENT,,,2082.24,832.896,UC HEALTH,UC HEALTH COMMERCIAL,1811.5488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
"PLATE, TUBULAR 1/3 W/COLLAR",C1713,HCPCS,278,RC,,INPATIENT,,,172.94,69.176,UC HEALTH,UC HEALTH COMMERCIAL,150.4578,87,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
"LINER, SIZE 23 EP-108223",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UC HEALTH,UC HEALTH COMMERCIAL,4049.85,87,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 36MM 11-363660,C1776,HCPCS,278,RC,,INPATIENT,,,820.8,328.32,UC HEALTH,UC HEALTH COMMERCIAL,714.096,87,,,OTHER,767.24,1002.52,PERCENT OF TOTAL BILLED CHARGES
"LINER, RINGLOC 40MM EP-108424",C1776,HCPCS,278,RC,,INPATIENT,,,4655,1862,UC HEALTH,UC HEALTH COMMERCIAL,4049.85,87,,,OTHER,3491.25,4561.9,PERCENT OF TOTAL BILLED CHARGES
MAGNUM MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,1964.48,785.792,UC HEALTH,UC HEALTH COMMERCIAL,1709.0976,87,,,OTHER,1473.36,1925.19,PERCENT OF TOTAL BILLED CHARGES
"PLATE, DHS-DCP HOLES 4",C1713,HCPCS,278,RC,,INPATIENT,,,1079.57,431.828,UC HEALTH,UC HEALTH COMMERCIAL,939.2259,87,,,OTHER,1176.19,1536.89,PERCENT OF TOTAL BILLED CHARGES
MESH LF LG 10.8CM X 16.0CM,1681031,CDM,278,RC,,INPATIENT,,,536,214.4,UC HEALTH,UC HEALTH COMMERCIAL,466.32,87,,,OTHER,402,525.28,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CAN WASHERLOC 50MM",C1776,HCPCS,278,RC,,INPATIENT,,,612.5,245,UC HEALTH,UC HEALTH COMMERCIAL,532.875,87,,,OTHER,459.38,600.25,PERCENT OF TOTAL BILLED CHARGES
"MESH, DIMENSIONAL KNITTED 6X4",1681037,CDM,278,RC,,INPATIENT,,,400.75,160.3,UC HEALTH,UC HEALTH COMMERCIAL,348.6525,87,,,OTHER,300.56,392.74,PERCENT OF TOTAL BILLED CHARGES
FEMORAL MEDIUM 154601,C1776,HCPCS,278,RC,,INPATIENT,,,8880.25,3552.1,UC HEALTH,UC HEALTH COMMERCIAL,7725.8175,87,,,OTHER,6660.19,8702.65,PERCENT OF TOTAL BILLED CHARGES
BEARING MED LF 4MM 159548,C1776,HCPCS,278,RC,,INPATIENT,,,1988.93,795.572,UC HEALTH,UC HEALTH COMMERCIAL,1730.3691,87,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD 47MM,C1776,HCPCS,278,RC,,INPATIENT,,,670.46,268.184,UC HEALTH,UC HEALTH COMMERCIAL,583.3002,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEARING 12MMX63MM",C1776,HCPCS,278,RC,,INPATIENT,,,2610.5,1044.2,UC HEALTH,UC HEALTH COMMERCIAL,2271.135,87,,,OTHER,1957.88,2558.29,PERCENT OF TOTAL BILLED CHARGES
"TIBIAL,FIXED CRUCIATE PLATE EA",C1776,HCPCS,278,RC,,INPATIENT,,,2373.62,949.448,UC HEALTH,UC HEALTH COMMERCIAL,2065.0494,87,,,OTHER,1780.22,2326.15,PERCENT OF TOTAL BILLED CHARGES
VENTRALEX PATCH CIRCLE 4.3,1681147,CDM,,,,INPATIENT,,,1198.5,479.4,UC HEALTH,UC HEALTH COMMERCIAL,1042.695,87,,,OTHER,898.88,1174.53,PERCENT OF TOTAL BILLED CHARGES
END CAP TI W/T40 5MM STARDRIVE,C1776,HCPCS,278,RC,,INPATIENT,,,634.5,253.8,UC HEALTH,UC HEALTH COMMERCIAL,552.015,87,,,OTHER,475.88,621.81,PERCENT OF TOTAL BILLED CHARGES
PLATE FIBULA DSTL 2.7MM 3.5MM,C1713,HCPCS,278,RC,,INPATIENT,,,1271.59,508.636,UC HEALTH,UC HEALTH COMMERCIAL,1106.2833,87,,,OTHER,1560.19,2038.65,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD COMP 32MM 163667,C1776,HCPCS,278,RC,,INPATIENT,,,1836.75,734.7,UC HEALTH,UC HEALTH COMMERCIAL,1597.9725,87,,,OTHER,1377.56,1800.02,PERCENT OF TOTAL BILLED CHARGES
CABLE W/CRIMP 1.0MM,C1776,HCPCS,278,RC,,INPATIENT,,,1481,592.4,UC HEALTH,UC HEALTH COMMERCIAL,1288.47,87,,,OTHER,1110.75,1451.38,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 3.2MM 310.31,1681161,CDM,,,,INPATIENT,,,279.25,111.7,UC HEALTH,UC HEALTH COMMERCIAL,242.9475,87,,,OTHER,209.44,273.67,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QC 4.5MM,1681164,CDM,,,,INPATIENT,,,279.25,111.7,UC HEALTH,UC HEALTH COMMERCIAL,242.9475,87,,,OTHER,209.44,273.67,PERCENT OF TOTAL BILLED CHARGES
MOUULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,3534.25,1413.7,UC HEALTH,UC HEALTH COMMERCIAL,3074.7975,87,,,OTHER,2650.69,3463.57,PERCENT OF TOTAL BILLED CHARGES
"LINER, E1 RINGLOC ACETABULAR",C1776,HCPCS,278,RC,,INPATIENT,,,2995.75,1198.3,UC HEALTH,UC HEALTH COMMERCIAL,2606.3025,87,,,OTHER,2246.81,2935.84,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 40MM,C1776,HCPCS,278,RC,,INPATIENT,,,2274.5,909.8,UC HEALTH,UC HEALTH COMMERCIAL,1978.815,87,,,OTHER,1705.88,2229.01,PERCENT OF TOTAL BILLED CHARGES
COPELAND HA RSRF HD 11-114643,C1776,HCPCS,278,RC,,INPATIENT,,,10278.75,4111.5,UC HEALTH,UC HEALTH COMMERCIAL,8942.5125,87,,,OTHER,7709.06,10073.18,PERCENT OF TOTAL BILLED CHARGES
CURVED BROAD LCP 4.5MM PL,C1776,HCPCS,278,RC,,INPATIENT,,,2623,1049.2,UC HEALTH,UC HEALTH COMMERCIAL,2282.01,87,,,OTHER,1967.25,2570.54,PERCENT OF TOTAL BILLED CHARGES
ALLODERM 6X16,1681180,CDM,,,,INPATIENT,,,8932.5,3573,UC HEALTH,UC HEALTH COMMERCIAL,7771.275,87,,,OTHER,6699.38,8753.85,PERCENT OF TOTAL BILLED CHARGES
SUTURE ANCHOR 5.5MM 904922P,C1713,HCPCS,278,RC,,INPATIENT,,,912.75,365.1,UC HEALTH,UC HEALTH COMMERCIAL,794.0925,87,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
BLADE HYPER,C1776,HCPCS,278,RC,,INPATIENT,,,423.5,169.4,UC HEALTH,UC HEALTH COMMERCIAL,368.445,87,,,OTHER,317.63,415.03,PERCENT OF TOTAL BILLED CHARGES
"KNEE, TIBIAL BEAR 10MM 189720",C1776,HCPCS,278,RC,,INPATIENT,,,4246.86,1698.744,UC HEALTH,UC HEALTH COMMERCIAL,3694.7682,87,,,OTHER,3185.15,4161.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, PEEK TENODESIS 6.25X15",C1713,HCPCS,278,RC,,INPATIENT,,,867.25,346.9,UC HEALTH,UC HEALTH COMMERCIAL,754.5075,87,,,OTHER,650.44,849.91,PERCENT OF TOTAL BILLED CHARGES
LIMITED REGENEREX RINGLOC 58MM,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT RINGLOC 3.2MM,1681192,CDM,,,,INPATIENT,,,220.32,88.128,UC HEALTH,UC HEALTH COMMERCIAL,191.6784,87,,,OTHER,165.24,215.91,PERCENT OF TOTAL BILLED CHARGES
APICAL PLUG,C1776,HCPCS,278,RC,,INPATIENT,,,575.5,230.2,UC HEALTH,UC HEALTH COMMERCIAL,500.685,87,,,OTHER,431.63,563.99,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 56MM PT-104056,C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
PEEK ANCHOR 4.5MM 904840P,1681195,CDM,,,,INPATIENT,,,912.75,365.1,UC HEALTH,UC HEALTH COMMERCIAL,794.0925,87,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
"CUP, RINGLOC 50MM PT-116050",C1776,HCPCS,278,RC,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 20MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"SCREW, HIP TITANIUM 25MM",C1713,HCPCS,278,RC,,INPATIENT,,,360,144,UC HEALTH,UC HEALTH COMMERCIAL,313.2,87,,,OTHER,270,352.8,PERCENT OF TOTAL BILLED CHARGES
"PACK, OXFORD KNEE RESECTION",1681201,CDM,,,,INPATIENT,,,1909.75,763.9,UC HEALTH,UC HEALTH COMMERCIAL,1661.4825,87,,,OTHER,1432.31,1871.56,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL BLADE,1681202,CDM,,,,INPATIENT,,,274.5,109.8,UC HEALTH,UC HEALTH COMMERCIAL,238.815,87,,,OTHER,205.88,269.01,PERCENT OF TOTAL BILLED CHARGES
DRILL CANN 2.0MM 310.221,1681207,CDM,,,,INPATIENT,,,1272.5,509,UC HEALTH,UC HEALTH COMMERCIAL,1107.075,87,,,OTHER,954.38,1247.05,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 2.7MM 202.874",1681208,CDM,,,,INPATIENT,,,153.75,61.5,UC HEALTH,UC HEALTH COMMERCIAL,133.7625,87,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
"PLATE, L 2.7MM 02.112.139(L)",1681209,CDM,,,,INPATIENT,,,2052.5,821,UC HEALTH,UC HEALTH COMMERCIAL,1785.675,87,,,OTHER,1539.38,2011.45,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CORTEX 3.5MM 204.850",1681210,CDM,,,,INPATIENT,,,83.25,33.3,UC HEALTH,UC HEALTH COMMERCIAL,72.4275,87,,,OTHER,62.44,81.59,PERCENT OF TOTAL BILLED CHARGES
SAFETY KNIFE BC378235,1681211,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN TI 4.0MM 407.646",1681212,CDM,,,,INPATIENT,,,613,245.2,UC HEALTH,UC HEALTH COMMERCIAL,533.31,87,,,OTHER,459.75,600.74,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD   12-139014,1681213,CDM,,,,INPATIENT,,,1243.75,497.5,UC HEALTH,UC HEALTH COMMERCIAL,1082.0625,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 10X71 103535,1681214,CDM,,,,INPATIENT,,,5525,2210,UC HEALTH,UC HEALTH COMMERCIAL,4806.75,87,,,OTHER,4143.75,5414.5,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM BIOMET 141616,1681215,CDM,,,,INPATIENT,,,3551.5,1420.6,UC HEALTH,UC HEALTH COMMERCIAL,3089.805,87,,,OTHER,2663.63,3480.47,PERCENT OF TOTAL BILLED CHARGES
"KNEE, FEMORAL 72.5MM 183013",1681216,CDM,278,RC,,INPATIENT,,,3653.1,1461.24,UC HEALTH,UC HEALTH COMMERCIAL,3178.197,87,,,OTHER,3442.5,4498.2,PERCENT OF TOTAL BILLED CHARGES
"PLATE,DHS 38MM 4HOLE 281.040",1681217,CDM,,,,INPATIENT,,,1661.5,664.6,UC HEALTH,UC HEALTH COMMERCIAL,1445.505,87,,,OTHER,1246.13,1628.27,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 25MM PT-104060,1681218,CDM,,,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
"LINER, RINGLOC 44MM EP-108625",1681219,CDM,,,,INPATIENT,,,7179.75,2871.9,UC HEALTH,UC HEALTH COMMERCIAL,6246.3825,87,,,OTHER,5384.81,7036.16,PERCENT OF TOTAL BILLED CHARGES
FEMORAL TAPERLOC 18.5 103216,1681220,CDM,,,,INPATIENT,,,8781.5,3512.6,UC HEALTH,UC HEALTH COMMERCIAL,7639.905,87,,,OTHER,6586.13,8605.87,PERCENT OF TOTAL BILLED CHARGES
FEMORAL TAPERLOC 20.0 103210,1681221,CDM,,,,INPATIENT,,,6016.25,2406.5,UC HEALTH,UC HEALTH COMMERCIAL,5234.1375,87,,,OTHER,4512.19,5895.93,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM OXFORD 154721,1681222,CDM,,,,INPATIENT,,,5998.75,2399.5,UC HEALTH,UC HEALTH COMMERCIAL,5218.9125,87,,,OTHER,4499.06,5878.78,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM OXFORD 159577,1681223,CDM,,,,INPATIENT,,,2804.5,1121.8,UC HEALTH,UC HEALTH COMMERCIAL,2439.915,87,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
BLADES TIT HELICAL 456.301,1681224,CDM,,,,INPATIENT,,,1973,789.2,UC HEALTH,UC HEALTH COMMERCIAL,1716.51,87,,,OTHER,1479.75,1933.54,PERCENT OF TOTAL BILLED CHARGES
ENDO II HEAD  12-139014,1681225,CDM,,,,INPATIENT,,,1243.75,497.5,UC HEALTH,UC HEALTH COMMERCIAL,1082.0625,87,,,OTHER,932.81,1218.88,PERCENT OF TOTAL BILLED CHARGES
TIBAL TRAY BIOMET OFFSET,1681226,CDM,,,,INPATIENT,,,611.75,244.7,UC HEALTH,UC HEALTH COMMERCIAL,532.2225,87,,,OTHER,458.81,599.52,PERCENT OF TOTAL BILLED CHARGES
KNEE SYSTEM TRAY PAR 154723,1681227,CDM,,,,INPATIENT,,,5998.75,2399.5,UC HEALTH,UC HEALTH COMMERCIAL,5218.9125,87,,,OTHER,4499.06,5878.78,PERCENT OF TOTAL BILLED CHARGES
KNEE FEMORAL PEGGED 161469,1681228,CDM,,,,INPATIENT,,,5194.89,2077.956,UC HEALTH,UC HEALTH COMMERCIAL,4519.5543,87,,,OTHER,3896.17,5090.99,PERCENT OF TOTAL BILLED CHARGES
KNEE MENISCAL BEARING 159578,1681230,CDM,,,,INPATIENT,,,2804.5,1121.8,UC HEALTH,UC HEALTH COMMERCIAL,2439.915,87,,,OTHER,2103.38,2748.41,PERCENT OF TOTAL BILLED CHARGES
SHOULDER CUFF,1681232,CDM,,,,INPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,INPATIENT,,,2315.72,926.288,UC HEALTH,UC HEALTH COMMERCIAL,2014.6764,87,,,OTHER,1736.8,2269.4,PERCENT OF TOTAL BILLED CHARGES
MESH (IMPLANTABLE),C1781,HCPCS,278,RC,,INPATIENT,,,2738.44,1095.376,UC HEALTH,UC HEALTH COMMERCIAL,2382.4428,87,,,OTHER,2053.8,2683.7,PERCENT OF TOTAL BILLED CHARGES
"LEAD, NEUROSTIMULATOR",C1778,HCPCS,278,RC,,INPATIENT,,,9708.61,3883.444,UC HEALTH,UC HEALTH COMMERCIAL,8446.4907,87,,,OTHER,7281.5,9514.4,PERCENT OF TOTAL BILLED CHARGES
TISSUE LOCALIZATION EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,545.42,218.168,UC HEALTH,UC HEALTH COMMERCIAL,474.5154,87,,,OTHER,409.1,534.5,PERCENT OF TOTAL BILLED CHARGES
"STENT, NON-COR, TEM W/O DEL",C2617,HCPCS,278,RC,,INPATIENT,,,941.08,376.432,UC HEALTH,UC HEALTH COMMERCIAL,818.7396,87,,,OTHER,705.8,922.3,PERCENT OF TOTAL BILLED CHARGES
GENERATOR NEURO RECHG BAT SY,C1820,HCPCS,278,RC,,INPATIENT,,,42327.52,16931.008,UC HEALTH,UC HEALTH COMMERCIAL,36824.9424,87,,,OTHER,31745.6,41481,PERCENT OF TOTAL BILLED CHARGES
"PATIENT PROGR, NEUROSTIM",C1787,HCPCS,278,RC,,INPATIENT,,,4370.67,1748.268,UC HEALTH,UC HEALTH COMMERCIAL,3802.4829,87,,,OTHER,3278,4283.3,PERCENT OF TOTAL BILLED CHARGES
MONARCH SLING SYSTEM,1648400,CDM,,,,INPATIENT,,,4054.75,1621.9,UC HEALTH,UC HEALTH COMMERCIAL,3527.6325,87,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
APOGEE SYSTEM W/INTEXEN LP,1684010,CDM,,,,INPATIENT,,,6369.75,2547.9,UC HEALTH,UC HEALTH COMMERCIAL,5541.6825,87,,,OTHER,4777.31,6242.36,PERCENT OF TOTAL BILLED CHARGES
MONARC + SUBFASCIAL HAMMOCK,1684020,CDM,,,,INPATIENT,,,4054.75,1621.9,UC HEALTH,UC HEALTH COMMERCIAL,3527.6325,87,,,OTHER,3041.06,3973.66,PERCENT OF TOTAL BILLED CHARGES
PERIGEE SYSTEM W/INTEXEN LP,1684030,CDM,,,,INPATIENT,,,7041.75,2816.7,UC HEALTH,UC HEALTH COMMERCIAL,6126.3225,87,,,OTHER,5281.31,6900.92,PERCENT OF TOTAL BILLED CHARGES
"SCREW, TITANIUM CANN 48MM",1684037,CDM,,,,INPATIENT,,,613,245.2,UC HEALTH,UC HEALTH COMMERCIAL,533.31,87,,,OTHER,459.75,600.74,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 52MM PT-116052,1684038,CDM,,,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
ENDO TAPER/ADAPTER 139247,1684043,CDM,,,,INPATIENT,,,329,131.6,UC HEALTH,UC HEALTH COMMERCIAL,286.23,87,,,OTHER,246.75,322.42,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 20MM 245842",1684044,CDM,,,,INPATIENT,,,846.25,338.5,UC HEALTH,UC HEALTH COMMERCIAL,736.2375,87,,,OTHER,634.69,829.33,PERCENT OF TOTAL BILLED CHARGES
"SCREW, CANN 16MM 3213-065-0805",1684045,CDM,,,,INPATIENT,,,912.75,365.1,UC HEALTH,UC HEALTH COMMERCIAL,794.0925,87,,,OTHER,684.56,894.5,PERCENT OF TOTAL BILLED CHARGES
THREAD TIP GUIDE 3.2MM,1684046,CDM,,,,INPATIENT,,,82.75,33.1,UC HEALTH,UC HEALTH COMMERCIAL,71.9925,87,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
FEMORAL VANGUARD CR 183033,1684047,CDM,,,,INPATIENT,,,4589.01,1835.604,UC HEALTH,UC HEALTH COMMERCIAL,3992.4387,87,,,OTHER,3441.76,4497.23,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 12X79 183462,1684048,CDM,,,,INPATIENT,,,2967.5,1187,UC HEALTH,UC HEALTH COMMERCIAL,2581.725,87,,,OTHER,2225.63,2908.15,PERCENT OF TOTAL BILLED CHARGES
CUP RINGLOC 54MM PT-104054,1684049,CDM,,,,INPATIENT,,,5939,2375.6,UC HEALTH,UC HEALTH COMMERCIAL,5166.93,87,,,OTHER,4454.25,5820.22,PERCENT OF TOTAL BILLED CHARGES
MODULAR HEAD 36MM 11-363661,1684050,CDM,,,,INPATIENT,,,3134.75,1253.9,UC HEALTH,UC HEALTH COMMERCIAL,2727.2325,87,,,OTHER,2351.06,3072.06,PERCENT OF TOTAL BILLED CHARGES
VANGRD RT INTRLCK 60MM 183004,1684051,CDM,,,,INPATIENT,,,4589,1835.6,UC HEALTH,UC HEALTH COMMERCIAL,3992.43,87,,,OTHER,3441.75,4497.22,PERCENT OF TOTAL BILLED CHARGES
TIBIAL BEARING 12X67 189042,1684052,CDM,,,,INPATIENT,,,2082.24,832.896,UC HEALTH,UC HEALTH COMMERCIAL,1811.5488,87,,,OTHER,1561.68,2040.6,PERCENT OF TOTAL BILLED CHARGES
POWER PORT TITANIUM SM,C1788,HCPCS,278,RC,,INPATIENT,,,561.6,224.64,UC HEALTH,UC HEALTH COMMERCIAL,488.592,87,,,OTHER,982.69,1284.05,PERCENT OF TOTAL BILLED CHARGES
POWER PORT MRI DEVICE 8FR,C1788,HCPCS,278,RC,,INPATIENT,,,540,216,UC HEALTH,UC HEALTH COMMERCIAL,469.8,87,,,OTHER,982.69,1284.05,PERCENT OF TOTAL BILLED CHARGES
GUIDE WIRE,C1769,HCPCS,278,RC,,INPATIENT,,,307.87,123.148,UC HEALTH,UC HEALTH COMMERCIAL,267.8469,87,,,OTHER,230.9,301.7,PERCENT OF TOTAL BILLED CHARGES
WASHER 6.5 /CANCELLOUS SCREW,1690001,CDM,,,,INPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
NURSERY SPECIAL CARE,1790010,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 4-8 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UC HEALTH,UC HEALTH COMMERCIAL,1261.2825,87,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 2-4 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UC HEALTH,UC HEALTH COMMERCIAL,1087.2825,87,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA ADD'L SEQ THERA DGN,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV CONCURRENTLY INFUSED,96368,CPT,450,RC,,OUTPATIENT,,,216,86.4,UC HEALTH,UC HEALTH COMMERCIAL,187.92,87,,,OTHER,162,211.68,PERCENT OF TOTAL BILLED CHARGES
IV INFUSED SEQ EA ADD'L,96367,CPT,450,RC,,OUTPATIENT,,,156,62.4,UC HEALTH,UC HEALTH COMMERCIAL,135.72,87,,,OTHER,117,152.88,PERCENT OF TOTAL BILLED CHARGES
CHEMO INJ SQ IM NONHORMONAL,96401,CPT,331,RC,,OUTPATIENT,,,271,108.4,UC HEALTH,UC HEALTH COMMERCIAL,235.77,87,,,OTHER,203.25,265.58,PERCENT OF TOTAL BILLED CHARGES
CHEMO INJ SQ IM HORMONAL AGENT,96402,CPT,331,RC,,OUTPATIENT,,,272,108.8,UC HEALTH,UC HEALTH COMMERCIAL,236.64,87,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
APPLICATION ON BODY INJECTOR,96377,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,UC HEALTH,UC HEALTH COMMERCIAL,141.1575,87,,,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL I,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,270.94,354.03,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL II,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,219.94,287.39,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INTL THER/DIAG LVL III,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
OBS IV INFUS > 16 MINS INITIAL,96365,CPT,260,RC,,INPATIENT,,,475.75,190.3,UC HEALTH,UC HEALTH COMMERCIAL,413.9025,87,,,OTHER,356.81,466.24,PERCENT OF TOTAL BILLED CHARGES
OBS IV INFUS EA ADD'L HR,96366,CPT,450,RC,,INPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH (FIRST MED),96374,CPT,450,RC,,INPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH NEW MED ADDON,96375,CPT,450,RC,,INPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IV PUSH SAME MED ADDON,96376,CPT,260,RC,,INPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IM/SQ INJ,96372,CPT,260,RC,,INPATIENT,,,190.5,76.2,UC HEALTH,UC HEALTH COMMERCIAL,165.735,87,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
OBS IV HYDRATION (INITIAL),96360,CPT,450,RC,,INPATIENT,,,448,179.2,UC HEALTH,UC HEALTH COMMERCIAL,389.76,87,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
OBS SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,INPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
OBS IV HYDRATION ADD'L HR,96361,CPT,450,RC,,INPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
BAMLANIVIMAB,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,UC HEALTH,UC HEALTH COMMERCIAL,285.1077,87,,,OTHER,245.8,321.2,PERCENT OF TOTAL BILLED CHARGES
BAMLANIVIMAB MS,M0239,HCPCS,771,RC,,INPATIENT,,,327.71,131.084,UC HEALTH,UC HEALTH COMMERCIAL,285.1077,87,,,OTHER,245.8,321.2,PERCENT OF TOTAL BILLED CHARGES
REGENERON,M0243,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UC HEALTH,UC HEALTH COMMERCIAL,406.4118,87,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
REGENERON MS,M0243,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,UC HEALTH,UC HEALTH COMMERCIAL,406.2117,87,,,OTHER,350.2,457.6,PERCENT OF TOTAL BILLED CHARGES
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UC HEALTH,UC HEALTH COMMERCIAL,406.4118,87,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
BAMLAN AND ETESEV INFUSION MS,M0245,HCPCS,771,RC,,INPATIENT,,,466.91,186.764,UC HEALTH,UC HEALTH COMMERCIAL,406.2117,87,,,OTHER,350.2,457.6,PERCENT OF TOTAL BILLED CHARGES
SOTROVIMAB INFUSION,M0247,HCPCS,771,RC,,INPATIENT,,,467.14,186.856,UC HEALTH,UC HEALTH COMMERCIAL,406.4118,87,,,OTHER,350.4,457.8,PERCENT OF TOTAL BILLED CHARGES
SOTROVIMAB INFUSION MS,M0247,HCPCS,771,RC,,INPATIENT,,,897.92,359.168,UC HEALTH,UC HEALTH COMMERCIAL,781.1904,87,,,OTHER,673.4,880,PERCENT OF TOTAL BILLED CHARGES
"TIXAGEV AND CILGAV, INJ",M0220,HCPCS,771,RC,,INPATIENT,,,156.17,62.468,UC HEALTH,UC HEALTH COMMERCIAL,135.8679,87,,,OTHER,117.1,153,PERCENT OF TOTAL BILLED CHARGES
BEBTELOVIMAB INJECTION,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,UC HEALTH,UC HEALTH COMMERCIAL,316.4103,87,,,OTHER,272.8,356.4,PERCENT OF TOTAL BILLED CHARGES
BEBTELOVIMAB INJECTION MS,M0222,HCPCS,771,RC,,INPATIENT,,,363.69,145.476,UC HEALTH,UC HEALTH COMMERCIAL,316.4103,87,,,OTHER,272.8,356.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNIZATION ADMIN,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
IMMUNIZATION ADMIN EACH ADD,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,UC HEALTH,UC HEALTH COMMERCIAL,79.8225,87,,,OTHER,68.8,89.9,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 1-2 HOURS,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UC HEALTH,UC HEALTH COMMERCIAL,1000.2825,87,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
CONCURRENT ADMIN OF CHEMO,96549,CPT,261,RC,,OUTPATIENT,,,301.75,120.7,UC HEALTH,UC HEALTH COMMERCIAL,262.5225,87,,,OTHER,226.31,295.72,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS SER 0-1 HOUR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UC HEALTH,UC HEALTH COMMERCIAL,913.2825,87,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
TRAY DRESSING,2700010,CDM,,,,INPATIENT,,,30.25,12.1,UC HEALTH,UC HEALTH COMMERCIAL,26.3175,87,,,OTHER,22.69,29.65,PERCENT OF TOTAL BILLED CHARGES
SAFE EXAM,2700012,CDM,,,,INPATIENT,,,389,155.6,UC HEALTH,UC HEALTH COMMERCIAL,338.43,87,,,OTHER,291.75,381.22,PERCENT OF TOTAL BILLED CHARGES
EVIDENCE COLLECTION,2700014,CDM,,,,INPATIENT,,,389,155.6,UC HEALTH,UC HEALTH COMMERCIAL,338.43,87,,,OTHER,291.75,381.22,PERCENT OF TOTAL BILLED CHARGES
ADAPTER REMOTE RES SPIKE,2700020,CDM,,,,INPATIENT,,,155.75,62.3,UC HEALTH,UC HEALTH COMMERCIAL,135.5025,87,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
AERO CHAMBER,2700030,CDM,,,,INPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
BAG BILE REG,2700040,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
CROSSFLOW OUTFLOW TUBING,2700060,CDM,,,,INPATIENT,,,147.75,59.1,UC HEALTH,UC HEALTH COMMERCIAL,128.5425,87,,,OTHER,110.81,144.8,PERCENT OF TOTAL BILLED CHARGES
ARM SLING LG,2700070,CDM,,,,INPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
ARM SLING MD,2700080,CDM,,,,INPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
ARM SLING SM,2700090,CDM,,,,INPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
LOWER BODY WARMER BLANKET,2700092,CDM,,,,INPATIENT,,,27.25,10.9,UC HEALTH,UC HEALTH COMMERCIAL,23.7075,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
ATHLETIC SUPPORTER MD,2700100,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ATHLETIC SUPPORTER SM,2700110,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM CHILD W/PAD,2700120,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
BAG RESUS W/MASK ADULT,2700130,CDM,,,,INPATIENT,,,103.25,41.3,UC HEALTH,UC HEALTH COMMERCIAL,89.8275,87,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
BAG RESUS W/MASK CHILD,2700140,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
BANDAGE ESMARK W/O LINER,2700170,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
BITE PROOF BITE BLOCK,2700180,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
BITE BLOCK DISPOSIBLE,2700200,CDM,,,,INPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
FLUTTER VALVE (BLUE),2700211,CDM,,,,INPATIENT,,,135.5,54.2,UC HEALTH,UC HEALTH COMMERCIAL,117.885,87,,,OTHER,101.63,132.79,PERCENT OF TOTAL BILLED CHARGES
ORTHO BOOT CAST XLG OPEN,2700240,CDM,,,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
CUFF CRYO KNEE MED W/COOLER,2700242,CDM,,,,INPATIENT,,,170.75,68.3,UC HEALTH,UC HEALTH COMMERCIAL,148.5525,87,,,OTHER,128.06,167.34,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS ANES TRAY,2700270,CDM,,,,INPATIENT,,,267.75,107.1,UC HEALTH,UC HEALTH COMMERCIAL,232.9425,87,,,OTHER,200.81,262.4,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 5CM,2700300,CDM,,,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 7CM,2700301,CDM,,,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 9CM,2700302,CDM,,,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
KOPANS NEEDLE 20G 15CM,2700303,CDM,,,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 5CM,2700304,CDM,,,,INPATIENT,,,118.75,47.5,UC HEALTH,UC HEALTH COMMERCIAL,103.3125,87,,,OTHER,89.06,116.38,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOR 20G 7.5CM,2700305,CDM,,,,INPATIENT,,,126.75,50.7,UC HEALTH,UC HEALTH COMMERCIAL,110.2725,87,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 10CM,2700306,CDM,,,,INPATIENT,,,126.75,50.7,UC HEALTH,UC HEALTH COMMERCIAL,110.2725,87,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
HOMER MAMMOLOK 20G 12.5CM,2700307,CDM,,,,INPATIENT,,,118.75,47.5,UC HEALTH,UC HEALTH COMMERCIAL,103.3125,87,,,OTHER,89.06,116.38,PERCENT OF TOTAL BILLED CHARGES
GALACTOGRAPHY INFUSION UNIT,2700308,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
GALACTOGRAPHY KIT DGK002X,2700309,CDM,,,,INPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
YUEH CENTESIS NEEDLE 9646,2700310,CDM,,,,INPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
TRAY CENTRAL VEIN CATH,2700500,CDM,,,,INPATIENT,,,132,52.8,UC HEALTH,UC HEALTH COMMERCIAL,114.84,87,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
TRAY CENTRAL LINE,2700501,CDM,,,,INPATIENT,,,300,120,UC HEALTH,UC HEALTH COMMERCIAL,261,87,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
BAG CLOSED URINARY DRAIN,2700630,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
CONSTAVAC PVC BLOOD KIT,2700720,CDM,,,,INPATIENT,,,851.25,340.5,UC HEALTH,UC HEALTH COMMERCIAL,740.5875,87,,,OTHER,638.44,834.23,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC,2701000,CDM,,,,INPATIENT,,,899.5,359.8,UC HEALTH,UC HEALTH COMMERCIAL,782.565,87,,,OTHER,674.63,881.51,PERCENT OF TOTAL BILLED CHARGES
BLADDER FOLEY TRAY 18FR,2701210,CDM,,,,INPATIENT,,,111.25,44.5,UC HEALTH,UC HEALTH COMMERCIAL,96.7875,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
BLADDER FOLEY TRAY 16FR,2701230,CDM,,,,INPATIENT,,,111.25,44.5,UC HEALTH,UC HEALTH COMMERCIAL,96.7875,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA MEDIUM,2701310,CDM,,,,INPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA LG,2701320,CDM,,,,INPATIENT,,,142.75,57.1,UC HEALTH,UC HEALTH COMMERCIAL,124.1925,87,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
HIP SPICA XLG,2701330,CDM,,,,INPATIENT,,,142.75,57.1,UC HEALTH,UC HEALTH COMMERCIAL,124.1925,87,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
HUMID VENT PED.,2701340,CDM,,,,INPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
PREFIL HUMIDIFER 650ML,2701360,CDM,,,,INPATIENT,,,27.25,10.9,UC HEALTH,UC HEALTH COMMERCIAL,23.7075,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER MD,2701370,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER SM,2701380,CDM,,,,INPATIENT,,,38.5,15.4,UC HEALTH,UC HEALTH COMMERCIAL,33.495,87,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
IMMOB   SHOULDER XLG,2701390,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
IMMOB  SHOULDER LG,2701400,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
IMMOB  SHOULDER XXLG,2701410,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
BARRIER CREAM,2701420,CDM,,,,INPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
PERCUTAN INTROD KIT,2701430,CDM,,,,INPATIENT,,,314.75,125.9,UC HEALTH,UC HEALTH COMMERCIAL,273.8325,87,,,OTHER,236.06,308.46,PERCENT OF TOTAL BILLED CHARGES
IV CATH EXT. SET,2701460,CDM,,,,INPATIENT,,,22.75,9.1,UC HEALTH,UC HEALTH COMMERCIAL,19.7925,87,,,OTHER,17.06,22.3,PERCENT OF TOTAL BILLED CHARGES
IV WARMING SET HOTLINE,2701470,CDM,,,,INPATIENT,,,93.75,37.5,UC HEALTH,UC HEALTH COMMERCIAL,81.5625,87,,,OTHER,70.31,91.88,PERCENT OF TOTAL BILLED CHARGES
POUCH CADD PUMP DISP,2701500,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 20 SMALL""",2701540,CDM,,,,INPATIENT,,,168,67.2,UC HEALTH,UC HEALTH COMMERCIAL,146.16,87,,,OTHER,126,164.64,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 22 MEDIUM""",2701550,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 18 X-SMALL""",2701560,CDM,,,,INPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
"KNEE BRACE 24 LARGE""",L1830,HCPCS,274,RC,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
"KNEE, BRACE HINGED LONG",2701572,CDM,,,,INPATIENT,,,308.75,123.5,UC HEALTH,UC HEALTH COMMERCIAL,268.6125,87,,,OTHER,231.56,302.58,PERCENT OF TOTAL BILLED CHARGES
"KNEE, BRACE HINGED SHORT",L1833,HCPCS,274,RC,,INPATIENT,,,299.75,119.9,UC HEALTH,UC HEALTH COMMERCIAL,260.7825,87,,,OTHER,224.81,293.76,PERCENT OF TOTAL BILLED CHARGES
WRIST HOLDER,2701590,CDM,,,,INPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
RESERVOIR SUCTION 100CC,2701610,CDM,,,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
SAL. SUMP ANTI-REFLUX ADDPT,2701620,CDM,,,,INPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
MASK SEAL EASY,2701630,CDM,,,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PRESS. MONIT. KIT W/TRAN,2701640,CDM,,,,INPATIENT,,,130.5,52.2,UC HEALTH,UC HEALTH COMMERCIAL,113.535,87,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
OPTIVAC KIT DOUBLE MIX SYSTEM,2701650,CDM,,,,INPATIENT,,,189,75.6,UC HEALTH,UC HEALTH COMMERCIAL,164.43,87,,,OTHER,141.75,185.22,PERCENT OF TOTAL BILLED CHARGES
MIX EVAC II,2701660,CDM,,,,INPATIENT,,,398.25,159.3,UC HEALTH,UC HEALTH COMMERCIAL,346.4775,87,,,OTHER,298.69,390.29,PERCENT OF TOTAL BILLED CHARGES
KIT MULTIMED BDL LUMEN 7FR,2701670,CDM,,,,INPATIENT,,,264.75,105.9,UC HEALTH,UC HEALTH COMMERCIAL,230.3325,87,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
NASOGASTRIC LEVIN TUBE 18,2701710,CDM,,,,INPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
NEEDLE  BIOPSY 20MM DISP,2701720,CDM,,,,INPATIENT,,,258.75,103.5,UC HEALTH,UC HEALTH COMMERCIAL,225.1125,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
NOSE PROBE,2701750,CDM,,,,INPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGEAL STETH 18FR,2701760,CDM,,,,INPATIENT,,,613.5,245.4,UC HEALTH,UC HEALTH COMMERCIAL,533.745,87,,,OTHER,460.13,601.23,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGEAL STETH 12FR,2701770,CDM,,,,INPATIENT,,,1193.25,477.3,UC HEALTH,UC HEALTH COMMERCIAL,1038.1275,87,,,OTHER,894.94,1169.39,PERCENT OF TOTAL BILLED CHARGES
OPTHAMIC BURR,2701800,CDM,,,,INPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES LADIES LG,2701810,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES MEN LG,2701820,CDM,,,,INPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES LADIES MED,2701830,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
POST OP SHOES MEN MD,2701850,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
MICRODRIP NON VENT,2701860,CDM,,,,INPATIENT,,,22.75,9.1,UC HEALTH,UC HEALTH COMMERCIAL,19.7925,87,,,OTHER,17.06,22.3,PERCENT OF TOTAL BILLED CHARGES
MICRO CURVED SCISSOR,2701861,CDM,,,,INPATIENT,,,736.5,294.6,UC HEALTH,UC HEALTH COMMERCIAL,640.755,87,,,OTHER,552.38,721.77,PERCENT OF TOTAL BILLED CHARGES
CURVED SCISSOR,2701862,CDM,,,,INPATIENT,,,557.75,223.1,UC HEALTH,UC HEALTH COMMERCIAL,485.2425,87,,,OTHER,418.31,546.6,PERCENT OF TOTAL BILLED CHARGES
KIT PERITIONEAL LAVAGE,2701880,CDM,,,,INPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
TRAY PERCUTANEOUS,2701890,CDM,,,,INPATIENT,,,251.75,100.7,UC HEALTH,UC HEALTH COMMERCIAL,219.0225,87,,,OTHER,188.81,246.72,PERCENT OF TOTAL BILLED CHARGES
ATRIUM SINGLE CHEST DRAIN,2701900,CDM,,,,INPATIENT,,,236,94.4,UC HEALTH,UC HEALTH COMMERCIAL,205.32,87,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
SPLINT SAM,2701920,CDM,,,,INPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
STYLETE SHERI-SLIP 10FR,2701930,CDM,,,,INPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
SKIN TEMP SENSOR,2701940,CDM,,,,INPATIENT,,,20.75,8.3,UC HEALTH,UC HEALTH COMMERCIAL,18.0525,87,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
ORTHO SLING ARM ELEVATOR,2701950,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 2 X 10,2701960,CDM,271,RC,,INPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 3 X 35,2701970,CDM,,,,INPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 5 X 45,2701980,CDM,,,,INPATIENT,,,177.5,71,UC HEALTH,UC HEALTH COMMERCIAL,154.425,87,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 5 X 30,2701990,CDM,,,,INPATIENT,,,152.25,60.9,UC HEALTH,UC HEALTH COMMERCIAL,132.4575,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
SPLINT ONE STEP 4 X 15,2702000,CDM,271,RC,,INPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SPLINT WRIST XSM-XLG LT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
SPLINT WRIST XSM-XLG RT,L3908,HCPCS,271,RC,,INPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
STERI CATH CLOSED SUCTION,2702030,CDM,,,,INPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
SUCTION CANNISTER BLUE,2702090,CDM,,,,INPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.25,22.54,PERCENT OF TOTAL BILLED CHARGES
SUCTION DELEE INFANT 10FR,2702100,CDM,,,,INPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
SURGILAV PLUS HANDPIECE,2702110,CDM,,,,INPATIENT,,,362,144.8,UC HEALTH,UC HEALTH COMMERCIAL,314.94,87,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SURGIVAC EVACUATOR KIT,2702120,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
EXTENSTION T CONNECTOR,2702140,CDM,,,,INPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
COLOSTOMY WOUND KIT,2702150,CDM,,,,INPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
CROUP TENT CANOPY,2702280,CDM,,,,INPATIENT,,,103.25,41.3,UC HEALTH,UC HEALTH COMMERCIAL,89.8275,87,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
CATH TROCAR 20FR,2702290,CDM,,,,INPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
INFLOW CASSETTE TUBING,2702320,CDM,,,,INPATIENT,,,150.25,60.1,UC HEALTH,UC HEALTH COMMERCIAL,130.7175,87,,,OTHER,112.69,147.25,PERCENT OF TOTAL BILLED CHARGES
URI-METER DRAIN BAG,2702330,CDM,,,,INPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
FLEXIBLE WAF. 2-3/4,2702360,CDM,,,,INPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
TROCAR V2,2702370,CDM,,,,INPATIENT,,,727.5,291,UC HEALTH,UC HEALTH COMMERCIAL,632.925,87,,,OTHER,545.63,712.95,PERCENT OF TOTAL BILLED CHARGES
TROCAR 12MM W/REDUCER,2702380,CDM,,,,INPATIENT,,,637,254.8,UC HEALTH,UC HEALTH COMMERCIAL,554.19,87,,,OTHER,477.75,624.26,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSASTEP 12MM,2702390,CDM,,,,INPATIENT,,,514.25,205.7,UC HEALTH,UC HEALTH COMMERCIAL,447.3975,87,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
PROBE GUIDE LATERAL,2704000,CDM,,,,INPATIENT,,,53.5,21.4,UC HEALTH,UC HEALTH COMMERCIAL,46.545,87,,,OTHER,40.13,52.43,PERCENT OF TOTAL BILLED CHARGES
VACUUM SET,2704001,CDM,,,,INPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SITE IDENTIFIER 11G2,2704002,CDM,,,,INPATIENT,,,388.5,155.4,UC HEALTH,UC HEALTH COMMERCIAL,337.995,87,,,OTHER,291.38,380.73,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC PROBE,2704003,CDM,,,,INPATIENT,,,854.25,341.7,UC HEALTH,UC HEALTH COMMERCIAL,743.1975,87,,,OTHER,640.69,837.17,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SITE IDENTIFIER 11G,2704004,CDM,,,,INPATIENT,,,369.5,147.8,UC HEALTH,UC HEALTH COMMERCIAL,321.465,87,,,OTHER,277.13,362.11,PERCENT OF TOTAL BILLED CHARGES
PROBE GUIDE FRONTAL,2704005,CDM,,,,INPATIENT,,,49.5,19.8,UC HEALTH,UC HEALTH COMMERCIAL,43.065,87,,,OTHER,37.13,48.51,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
SHAVER BLADE TOMCAT 4.0MM,2704030,CDM,,,,INPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
SHAVER BLADE TOMCAT 5.5MM,2704031,CDM,,,,INPATIENT,,,201.75,80.7,UC HEALTH,UC HEALTH COMMERCIAL,175.5225,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
ENDOPATH TROCAR 12X100,2704032,CDM,,,,INPATIENT,,,166.25,66.5,UC HEALTH,UC HEALTH COMMERCIAL,144.6375,87,,,OTHER,124.69,162.93,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT TWIST 2.0,2704033,CDM,,,,INPATIENT,,,456.75,182.7,UC HEALTH,UC HEALTH COMMERCIAL,397.3725,87,,,OTHER,342.56,447.62,PERCENT OF TOTAL BILLED CHARGES
MULTI CLIP APPLIER SM 9 3/8,2704034,CDM,,,,INPATIENT,,,235.75,94.3,UC HEALTH,UC HEALTH COMMERCIAL,205.1025,87,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
MULTIPLE CLIP APPLIER 9 3/8,2704035,CDM,,,,INPATIENT,,,237.25,94.9,UC HEALTH,UC HEALTH COMMERCIAL,206.4075,87,,,OTHER,177.94,232.51,PERCENT OF TOTAL BILLED CHARGES
TROCAR VERSAPORT,2705000,CDM,,,,INPATIENT,,,356.5,142.6,UC HEALTH,UC HEALTH COMMERCIAL,310.155,87,,,OTHER,267.38,349.37,PERCENT OF TOTAL BILLED CHARGES
BLADELESS TROCAR XCEL 5MM,2705001,CDM,,,,INPATIENT,,,180.5,72.2,UC HEALTH,UC HEALTH COMMERCIAL,157.035,87,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
TROCAR CANNULA W/SLEEVE,2705002,CDM,,,,INPATIENT,,,102.25,40.9,UC HEALTH,UC HEALTH COMMERCIAL,88.9575,87,,,OTHER,76.69,100.21,PERCENT OF TOTAL BILLED CHARGES
SCISSORS CURVED W/UNIPOLAR,2705003,CDM,,,,INPATIENT,,,272.25,108.9,UC HEALTH,UC HEALTH COMMERCIAL,236.8575,87,,,OTHER,204.19,266.81,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT XS,2705004,CDM,,,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER SHORT XL,2705005,CDM,,,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE XS,2705006,CDM,,,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE SM,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE MED,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE LG,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
WALKER STD SIZE XL,L4361,HCPCS,270,RC,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
TROCAR BLUNT TIP 12MM,2705011,CDM,,,,INPATIENT,,,278.75,111.5,UC HEALTH,UC HEALTH COMMERCIAL,242.5125,87,,,OTHER,209.06,273.18,PERCENT OF TOTAL BILLED CHARGES
HARMONIC FOCUS CURVED SHEARS,2705012,CDM,,,,INPATIENT,,,1772.75,709.1,UC HEALTH,UC HEALTH COMMERCIAL,1542.2925,87,,,OTHER,1329.56,1737.3,PERCENT OF TOTAL BILLED CHARGES
CANNULA UNIVERSAL SET 5.5MM,2705013,CDM,,,,INPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
BUR ROUND 8 FLUTES 5.5MM,2705014,CDM,,,,INPATIENT,,,203.75,81.5,UC HEALTH,UC HEALTH COMMERCIAL,177.2625,87,,,OTHER,152.81,199.68,PERCENT OF TOTAL BILLED CHARGES
OSCILLATING SAW BLADE,2705015,CDM,,,,INPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
SAW BLADE OSCILLATING,2705016,CDM,,,,INPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
SHAVER BUR TAN 5.5MM,2705017,CDM,,,,INPATIENT,,,235,94,UC HEALTH,UC HEALTH COMMERCIAL,204.45,87,,,OTHER,176.25,230.3,PERCENT OF TOTAL BILLED CHARGES
RASP LG TEARCROSS CUT 7X14,2705018,CDM,,,,INPATIENT,,,355.25,142.1,UC HEALTH,UC HEALTH COMMERCIAL,309.0675,87,,,OTHER,266.44,348.15,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT COUPLING 3.2X145,2705019,CDM,,,,INPATIENT,,,279.5,111.8,UC HEALTH,UC HEALTH COMMERCIAL,243.165,87,,,OTHER,209.63,273.91,PERCENT OF TOTAL BILLED CHARGES
TAP FOR 3.5MM CORTEX SCREW,2705020,CDM,,,,INPATIENT,,,360.75,144.3,UC HEALTH,UC HEALTH COMMERCIAL,313.8525,87,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
LIGASURE IMPACT TISSUE FUSION,2705021,CDM,,,,INPATIENT,,,1893.75,757.5,UC HEALTH,UC HEALTH COMMERCIAL,1647.5625,87,,,OTHER,1420.31,1855.88,PERCENT OF TOTAL BILLED CHARGES
MULTICLIP APPLIER 11 1/2 LNGTH,2705022,CDM,,,,INPATIENT,,,237.25,94.9,UC HEALTH,UC HEALTH COMMERCIAL,206.4075,87,,,OTHER,177.94,232.51,PERCENT OF TOTAL BILLED CHARGES
HARMONIC ACE PISTOL GRIP TORQ,2705023,CDM,,,,INPATIENT,,,1432.75,573.1,UC HEALTH,UC HEALTH COMMERCIAL,1246.4925,87,,,OTHER,1074.56,1404.1,PERCENT OF TOTAL BILLED CHARGES
MULTI CLIP APPLIER SM,2705024,CDM,,,,INPATIENT,,,235.75,94.3,UC HEALTH,UC HEALTH COMMERCIAL,205.1025,87,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,282.75,113.1,UC HEALTH,UC HEALTH COMMERCIAL,245.9925,87,,,OTHER,212.06,277.1,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,293.75,117.5,UC HEALTH,UC HEALTH COMMERCIAL,255.5625,87,,,OTHER,220.31,287.88,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT CANNULATED,2705027,CDM,,,,INPATIENT,,,1392.25,556.9,UC HEALTH,UC HEALTH COMMERCIAL,1211.2575,87,,,OTHER,1044.19,1364.41,PERCENT OF TOTAL BILLED CHARGES
DRILL BIT QUICK COUPLING,2705025,CDM,,,,INPATIENT,,,452.75,181.1,UC HEALTH,UC HEALTH COMMERCIAL,393.8925,87,,,OTHER,339.56,443.7,PERCENT OF TOTAL BILLED CHARGES
SAGITTAL SAW BLADE,2705029,CDM,,,,INPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
TRU-CLOSE SUCTION DRAIN,2705032,CDM,,,,INPATIENT,,,109.25,43.7,UC HEALTH,UC HEALTH COMMERCIAL,95.0475,87,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
REFROBACIN CEMENT,2705034,CDM,,,,INPATIENT,,,529.2,211.68,UC HEALTH,UC HEALTH COMMERCIAL,460.404,87,,,OTHER,396.9,518.62,PERCENT OF TOTAL BILLED CHARGES
CPAP MASK,2710010,CDM,,,,INPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CPAP VALVE,2710020,CDM,,,,INPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
OXYHOOD DAILY (NSY),2710025,CDM,,,,INPATIENT,,,204.5,81.8,UC HEALTH,UC HEALTH COMMERCIAL,177.915,87,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
OXYHOOD DAILY,2710050,CDM,,,,INPATIENT,,,204.5,81.8,UC HEALTH,UC HEALTH COMMERCIAL,177.915,87,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
CLIP APPLIER LIGACLIP 10X28.9,2720010,CDM,,,,INPATIENT,,,210.5,84.2,UC HEALTH,UC HEALTH COMMERCIAL,183.135,87,,,OTHER,157.88,206.29,PERCENT OF TOTAL BILLED CHARGES
SHLDR ORTHOTIC SHLDR CAP DESN,L3671,HCPCS,274,RC,,INPATIENT,,,1089,435.6,UC HEALTH,UC HEALTH COMMERCIAL,947.43,87,,,OTHER,816.75,1067.22,PERCENT OF TOTAL BILLED CHARGES
ELBOW ORTHOTIC W/O JOINTS CUST,L3702,HCPCS,274,RC,,INPATIENT,,,694,277.6,UC HEALTH,UC HEALTH COMMERCIAL,603.78,87,,,OTHER,280.5,366.52,PERCENT OF TOTAL BILLED CHARGES
ELB ORTH W/ADJ LOCK JNT PRFAB,L3760,HCPCS,274,RC,,INPATIENT,,,691.75,276.7,UC HEALTH,UC HEALTH COMMERCIAL,601.8225,87,,,OTHER,518.81,677.92,PERCENT OF TOTAL BILLED CHARGES
EWHO RIGID W/O JNTS CF,L3763,HCPCS,274,RC,,INPATIENT,,,1562,624.8,UC HEALTH,UC HEALTH COMMERCIAL,1358.94,87,,,OTHER,1171.5,1530.8,PERCENT OF TOTAL BILLED CHARGES
EWHFO RIGID W/O JOINTS CUSTOM,L3765,HCPCS,274,RC,,INPATIENT,,,1616.25,646.5,UC HEALTH,UC HEALTH COMMERCIAL,1406.1375,87,,,OTHER,1212.19,1583.93,PERCENT OF TOTAL BILLED CHARGES
WHFO CUSTOM FABRICATED INCL,L3806,HCPCS,274,RC,,INPATIENT,,,1165.68,466.272,UC HEALTH,UC HEALTH COMMERCIAL,1014.1416,87,,,OTHER,422.81,552.48,PERCENT OF TOTAL BILLED CHARGES
"WHFO, RIGID W/O JOINTS",L3808,HCPCS,274,RC,,INPATIENT,,,850,340,UC HEALTH,UC HEALTH COMMERCIAL,739.5,87,,,OTHER,637.5,833,PERCENT OF TOTAL BILLED CHARGES
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,INPATIENT,,,485.38,194.152,UC HEALTH,UC HEALTH COMMERCIAL,422.2806,87,,,OTHER,364,475.7,PERCENT OF TOTAL BILLED CHARGES
WHFO DYN FLEXOR HINGE WRST/FIN,L3900,HCPCS,274,RC,,INPATIENT,,,1831,732.4,UC HEALTH,UC HEALTH COMMERCIAL,1592.97,87,,,OTHER,1373.25,1794.38,PERCENT OF TOTAL BILLED CHARGES
WHO INCL 1/MORE NONTORSION JOI,L3905,HCPCS,274,RC,,INPATIENT,,,1267.5,507,UC HEALTH,UC HEALTH COMMERCIAL,1102.725,87,,,OTHER,950.63,1242.15,PERCENT OF TOTAL BILLED CHARGES
WHO W/O JOINTS CF,L3906,HCPCS,274,RC,,INPATIENT,,,998,399.2,UC HEALTH,UC HEALTH COMMERCIAL,868.26,87,,,OTHER,748.5,978,PERCENT OF TOTAL BILLED CHARGES
HFO W/O JOINTS CF,L3913,HCPCS,274,RC,,INPATIENT,,,684,273.6,UC HEALTH,UC HEALTH COMMERCIAL,595.08,87,,,OTHER,513,670.3,PERCENT OF TOTAL BILLED CHARGES
HFO INCL 1/MORE NONTORSION JOI,L3921,HCPCS,274,RC,,INPATIENT,,,366,146.4,UC HEALTH,UC HEALTH COMMERCIAL,318.42,87,,,OTHER,274.5,358.68,PERCENT OF TOTAL BILLED CHARGES
HFO WITHOUT JOINTS PRE CST,L3923,HCPCS,274,RC,,INPATIENT,,,276.78,110.712,UC HEALTH,UC HEALTH COMMERCIAL,240.7986,87,,,OTHER,207.6,271.2,PERCENT OF TOTAL BILLED CHARGES
FO W/O JOINTS CF,L3933,HCPCS,274,RC,,INPATIENT,,,490,196,UC HEALTH,UC HEALTH COMMERCIAL,426.3,87,,,OTHER,367.5,480.2,PERCENT OF TOTAL BILLED CHARGES
FINGER ORTHOTIC NONTORSION JOI,L3935,HCPCS,274,RC,,INPATIENT,,,267.75,107.1,UC HEALTH,UC HEALTH COMMERCIAL,232.9425,87,,,OTHER,200.81,262.4,PERCENT OF TOTAL BILLED CHARGES
SEWHO ABDJUCTION POSITIONING,L3967,HCPCS,274,RC,,INPATIENT,,,668,267.2,UC HEALTH,UC HEALTH COMMERCIAL,581.16,87,,,OTHER,501,654.64,PERCENT OF TOTAL BILLED CHARGES
TISSUE LOCALIZATION-EXCISION,C1819,HCPCS,278,RC,,INPATIENT,,,720,288,UC HEALTH,UC HEALTH COMMERCIAL,626.4,87,,,OTHER,540,705.6,PERCENT OF TOTAL BILLED CHARGES
BULKAMID URETHRAL BULKING SYST,L8603,HCPCS,278,RC,,INPATIENT,,,1871.1,748.44,UC HEALTH,UC HEALTH COMMERCIAL,1627.857,87,,,OTHER,1403.3,1833.7,PERCENT OF TOTAL BILLED CHARGES
MATTRESS V-CUE HILL-ROM,2790024,CDM,,,,INPATIENT,,,118.5,47.4,UC HEALTH,UC HEALTH COMMERCIAL,103.095,87,,,OTHER,88.88,116.13,PERCENT OF TOTAL BILLED CHARGES
VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
CHROMOGRANIN A,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UC HEALTH,UC HEALTH COMMERCIAL,162.9075,87,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
ANA REFLEX TITER,86039,CPT,300,RC,,OUTPATIENT,,,90.75,36.3,UC HEALTH,UC HEALTH COMMERCIAL,78.9525,87,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION REFLEX SERUM,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UC HEALTH,UC HEALTH COMMERCIAL,189.225,87,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
HEMOCHROMATOSIS HFE GENE,81256,CPT,300,RC,,OUTPATIENT,,,545.75,218.3,UC HEALTH,UC HEALTH COMMERCIAL,474.8025,87,,,OTHER,409.31,534.84,PERCENT OF TOTAL BILLED CHARGES
IMMUNDFIXATION REFLEX URINE,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,UC HEALTH,UC HEALTH COMMERCIAL,195.0975,87,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
WARFARIN RESPONSE GENOTYPE,0030U,HCPCS,300,RC,,INPATIENT,,,821.83,328.732,UC HEALTH,UC HEALTH COMMERCIAL,714.9921,87,,,OTHER,616.4,805.4,PERCENT OF TOTAL BILLED CHARGES
MEDPRO C (STUDENTS),3000015,CDM,,,,INPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
VENOUS PH ONLY,82800,CPT,300,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
ALUMINUM SERUM,82108,CPT,300,RC,,OUTPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR PSA SCREENING,3000020,CDM,,,,INPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR FSH,3000021,CDM,,,,INPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR A1C,3000022,CDM,,,,INPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR CBC,3000023,CDM,,,,INPATIENT,,,25,10,UC HEALTH,UC HEALTH COMMERCIAL,21.75,87,,,OTHER,18.75,24.5,PERCENT OF TOTAL BILLED CHARGES
DMEA ABO,3000024,CDM,,,,INPATIENT,,,13.5,5.4,UC HEALTH,UC HEALTH COMMERCIAL,11.745,87,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
DMEA RH,3000025,CDM,,,,INPATIENT,,,13.5,5.4,UC HEALTH,UC HEALTH COMMERCIAL,11.745,87,,,OTHER,10.13,13.23,PERCENT OF TOTAL BILLED CHARGES
DES-GAMMA CARBOXY PROTHROMBIN,83951,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,UC HEALTH,UC HEALTH COMMERCIAL,262.9575,87,,,OTHER,226.69,296.21,PERCENT OF TOTAL BILLED CHARGES
MSHG GENE FULL ANALYSIS,81298,CPT,300,RC,,OUTPATIENT,,,1499.5,599.8,UC HEALTH,UC HEALTH COMMERCIAL,1304.565,87,,,OTHER,1124.63,1469.51,PERCENT OF TOTAL BILLED CHARGES
SPECIMEN COLLECTION CAPILLARY,36416,CPT,300,RC,,OUTPATIENT,,,6.25,2.5,UC HEALTH,UC HEALTH COMMERCIAL,5.4375,87,,,OTHER,4.69,6.13,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANSFER RBC,82657,CPT,300,RC,,OUTPATIENT,,,479.75,191.9,UC HEALTH,UC HEALTH COMMERCIAL,417.3825,87,,,OTHER,359.81,470.16,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY  RBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY WBC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L WBC,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATE&ID BY HIGH RESOLTN,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L WBC,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,83909,CPT,300,RC,,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,UC HEALTH,UC HEALTH COMMERCIAL,23.925,87,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z SEP ID BY HIGH RESOLUTION,8390959,CPT,300,RC,59,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
DRUGS OF ABUSE SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,293.5,117.4,UC HEALTH,UC HEALTH COMMERCIAL,255.345,87,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 1,80301,CPT,301,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 2,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 3,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 4,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 5,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 6,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 7,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z DRUG ABUSE SURVEY  URINE 8,G047959,HCPCS,300,RC,59,BOTH,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,138.5,55.4,UC HEALTH,UC HEALTH COMMERCIAL,120.495,87,,,OTHER,103.88,135.73,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,UC HEALTH,UC HEALTH COMMERCIAL,106.3314,87,,,OTHER,91.7,119.8,PERCENT OF TOTAL BILLED CHARGES
ZCELIAC ASSOC HL DQ 1,81376,CPT,300,RC,,OUTPATIENT,,,122.22,48.888,UC HEALTH,UC HEALTH COMMERCIAL,106.3314,87,,,OTHER,91.7,119.8,PERCENT OF TOTAL BILLED CHARGES
VASO INTESTINAL POLYPETIDE,84586,CPT,300,RC,,OUTPATIENT,,,245,98,UC HEALTH,UC HEALTH COMMERCIAL,213.15,87,,,OTHER,183.75,240.1,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE BY PCR,87476,CPT,300,RC,,OUTPATIENT,,,509,203.6,UC HEALTH,UC HEALTH COMMERCIAL,442.83,87,,,OTHER,381.75,498.82,PERCENT OF TOTAL BILLED CHARGES
INSITU HYBRIDIZATION AUTO,88367,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
TUMOR IMMUNOHISTOCHEM,88361,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C RESISTANCE V  PLASMA,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UC HEALTH,UC HEALTH COMMERCIAL,174.435,87,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
PROTEIN S ACTIVITY,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,UC HEALTH,UC HEALTH COMMERCIAL,205.1025,87,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
CHROM ANALY CT 5 CELLS 1 KARY,88261,CPT,300,RC,,OUTPATIENT,,,1072.75,429.1,UC HEALTH,UC HEALTH COMMERCIAL,933.2925,87,,,OTHER,804.56,1051.3,PERCENT OF TOTAL BILLED CHARGES
GONADOTROPIN RELEASING HORMONE,83727,CPT,300,RC,,OUTPATIENT,,,529.75,211.9,UC HEALTH,UC HEALTH COMMERCIAL,460.8825,87,,,OTHER,397.31,519.16,PERCENT OF TOTAL BILLED CHARGES
MYH GENETIC MOLECUALR ANALYSIS,81401,CPT,300,RC,,OUTPATIENT,,,398,159.2,UC HEALTH,UC HEALTH COMMERCIAL,346.26,87,,,OTHER,298.5,390.04,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN LIKE IMMUNOREACTIVITY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
TRYPSIN FECAL,84488,CPT,300,RC,,OUTPATIENT,,,157.25,62.9,UC HEALTH,UC HEALTH COMMERCIAL,136.8075,87,,,OTHER,117.94,154.11,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE ISOLATE NUCLEIC,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,88386,CPT,310,RC,,OUTPATIENT,,,735,294,UC HEALTH,UC HEALTH COMMERCIAL,639.45,87,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UC HEALTH,UC HEALTH COMMERCIAL,639.45,87,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UC HEALTH,UC HEALTH COMMERCIAL,639.45,87,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z ARRAY BASED EVAL MULT PROBES,8838691,CPT,310,RC,91,OUTPATIENT,,,735,294,UC HEALTH,UC HEALTH COMMERCIAL,639.45,87,,,OTHER,551.25,720.3,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR CYTOGENETICS DNA,8827159,CPT,,,59,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
5-HIAA ASSAY,83497,CPT,300,RC,,OUTPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,OUTPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
CARBOHYDRATE DEF TRANSFERRIN,82373,CPT,300,RC,,OUTPATIENT,,,101.25,40.5,UC HEALTH,UC HEALTH COMMERCIAL,88.0875,87,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
AUTOIMMUNE INNER EAR 68KD,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,UC HEALTH,UC HEALTH COMMERCIAL,248.385,87,,,OTHER,214.13,279.79,PERCENT OF TOTAL BILLED CHARGES
COLLAPSIN RESPONSE MP 5 IGG,84182,CPT,300,RC,,OUTPATIENT,,,285.5,114.2,UC HEALTH,UC HEALTH COMMERCIAL,248.385,87,,,OTHER,214.13,279.79,PERCENT OF TOTAL BILLED CHARGES
ACH R GANGLIONIC NEURONAL ANTI,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
PROTOPORPHYRINS FRAC ERYTHRO,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PHENOBARBITAL,80184,CPT,300,RC,,OUTPATIENT,,,52.5,21,UC HEALTH,UC HEALTH COMMERCIAL,45.675,87,,,OTHER,39.4,51.5,PERCENT OF TOTAL BILLED CHARGES
P GALACTOSE 1 PHOSPHATE,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UC HEALTH,UC HEALTH COMMERCIAL,30.0498,87,,,OTHER,12.56,16.42,PERCENT OF TOTAL BILLED CHARGES
P CF IMMUNOASSAY,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UC HEALTH,UC HEALTH COMMERCIAL,30.0498,87,,,OTHER,25.5,33.32,PERCENT OF TOTAL BILLED CHARGES
ZINC PROTOPORPHYRINS,84202,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
P MS-MS EXPANDED SCREEN,83788,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,83788,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
Z MASS SPECTOMETRY,8378859,CPT,300,RC,59,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
NUCLEOTIDASE-5,83915,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
UPD GLUCURONOSYLTRANSFERASE,81350,CPT,300,RC,,OUTPATIENT,,,1251.25,500.5,UC HEALTH,UC HEALTH COMMERCIAL,1088.5875,87,,,OTHER,938.44,1226.23,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS  FRACTIONATED,82542,CPT,301,RC,,OUTPATIENT,,,136,54.4,UC HEALTH,UC HEALTH COMMERCIAL,118.32,87,,,OTHER,102,133.28,PERCENT OF TOTAL BILLED CHARGES
ZIPRASIDONE,G0480,HCPCS,300,RC,,BOTH,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS  TOTAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
COENZYME Q10,82542,CPT,301,RC,,OUTPATIENT,,,289.5,115.8,UC HEALTH,UC HEALTH COMMERCIAL,251.865,87,,,OTHER,217.13,283.71,PERCENT OF TOTAL BILLED CHARGES
ESCITALOPRAM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
ANTI-HMGCR AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,256,102.4,UC HEALTH,UC HEALTH COMMERCIAL,222.72,87,,,OTHER,192,250.88,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
BRCA1/BRACA2 FULL GENE ANALYSI,81162,CPT,300,RC,,OUTPATIENT,,,3649.76,1459.904,UC HEALTH,UC HEALTH COMMERCIAL,3175.2912,87,,,OTHER,1546.31,2020.52,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
INHIBIN B,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
17-HYDROXYCORTICOSTEROIDS,83491,CPT,301,RC,,OUTPATIENT,,,166,66.4,UC HEALTH,UC HEALTH COMMERCIAL,144.42,87,,,OTHER,124.5,162.68,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
ZIKAVIRUS IGM,86790,CPT,300,RC,,OUTPATIENT,,,220.5,88.2,UC HEALTH,UC HEALTH COMMERCIAL,191.835,87,,,OTHER,165.38,216.09,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,87300,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z LEGIONELLA SMEAR,8730091,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
MICROSATELLITE INSTABILITY,81301,CPT,312,RC,,OUTPATIENT,,,697.12,278.848,UC HEALTH,UC HEALTH COMMERCIAL,606.4944,87,,,OTHER,304.13,397.39,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
HLA A HIGH RES BY DNA,81380,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,UC HEALTH,UC HEALTH COMMERCIAL,654.8925,87,,,OTHER,564.56,737.7,PERCENT OF TOTAL BILLED CHARGES
CALCULUS (STONE),82365,CPT,300,RC,,OUTPATIENT,,,82.25,32.9,UC HEALTH,UC HEALTH COMMERCIAL,71.5575,87,,,OTHER,61.69,80.61,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 100-300,88275,CPT,300,RC,,OUTPATIENT,,,106.33,42.532,UC HEALTH,UC HEALTH COMMERCIAL,92.5071,87,,,OTHER,79.7,104.2,PERCENT OF TOTAL BILLED CHARGES
HEREDITARY SPHEROCYTOSIS EVAL,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UC HEALTH,UC HEALTH COMMERCIAL,159.8625,87,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,UC HEALTH,UC HEALTH COMMERCIAL,82.65,87,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
Z STACLOT LUPUS ANTICOAGULANT,85598,CPT,300,RC,,OUTPATIENT,,,241.25,96.5,UC HEALTH,UC HEALTH COMMERCIAL,209.8875,87,,,OTHER,180.94,236.43,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,95,38,UC HEALTH,UC HEALTH COMMERCIAL,82.65,87,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN ANTIGEN,85385,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,UC HEALTH,UC HEALTH COMMERCIAL,188.355,87,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
HYDROXYPROGESTERONE - 17,83498,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,UC HEALTH,UC HEALTH COMMERCIAL,157.6875,87,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
"CRYSTINURIA PROFILE,QUANT",82136,CPT,301,RC,,OUTPATIENT,,,235,94,UC HEALTH,UC HEALTH COMMERCIAL,204.45,87,,,OTHER,176.25,230.3,PERCENT OF TOTAL BILLED CHARGES
P HYDROXYPROGESTERONE 17-ALPHA,83498,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,UC HEALTH,UC HEALTH COMMERCIAL,57.6375,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
GAMMA HYDROXYBUTYRIC ACID URIN,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UC HEALTH,UC HEALTH COMMERCIAL,61.0566,87,,,OTHER,41.44,54.15,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B GENOTYPE,87912,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,UC HEALTH,UC HEALTH COMMERCIAL,447.963,87,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES FRAC FREE URINE,82384,CPT,300,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID AMP PROBE,87150,CPT,300,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
Z MICRODILUTION MLC EACH PLATE,87187,CPT,300,RC,,OUTPATIENT,,,91,36.4,UC HEALTH,UC HEALTH COMMERCIAL,79.17,87,,,OTHER,68.25,89.18,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,87188,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
ID BY NUCLEIC ACID DIRECT PRBE,87149,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
MYCOBACT IDENT BY SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,UC HEALTH,UC HEALTH COMMERCIAL,200.7264,87,,,OTHER,164.25,214.62,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA PLATE,8718891,CPT,300,RC,91,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
D-DIMER,85378,CPT,305,RC,,OUTPATIENT,,,209.25,83.7,UC HEALTH,UC HEALTH COMMERCIAL,182.0475,87,,,OTHER,156.94,205.07,PERCENT OF TOTAL BILLED CHARGES
OXALATE PLASMA,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UC HEALTH,UC HEALTH COMMERCIAL,93.7425,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
Z MACROBROTH DILUTION EA AGENT,8718859,CPT,300,RC,59,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
MUCOR IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,33.33,13.332,UC HEALTH,UC HEALTH COMMERCIAL,28.9971,87,,,OTHER,25,32.7,PERCENT OF TOTAL BILLED CHARGES
JAK2 V617F MUTATION DETECTION,81270,CPT,300,RC,,OUTPATIENT,,,613.25,245.3,UC HEALTH,UC HEALTH COMMERCIAL,533.5275,87,,,OTHER,459.94,600.99,PERCENT OF TOTAL BILLED CHARGES
ISO PURIFIED NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,UC HEALTH,UC HEALTH COMMERCIAL,391.065,87,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE 1ST,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,856.5,342.6,UC HEALTH,UC HEALTH COMMERCIAL,745.155,87,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETAION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN,80307,CPT,301,RC,,OUTPATIENT,,,124.28,49.712,UC HEALTH,UC HEALTH COMMERCIAL,108.1236,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
Z B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UC HEALTH,UC HEALTH COMMERCIAL,65.6502,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z N K CELLS TOTAL COUNT,86357,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UC HEALTH,UC HEALTH COMMERCIAL,65.6502,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UC HEALTH,UC HEALTH COMMERCIAL,65.6502,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
Z T CELL ABSOLUTE COUNT RATIO,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UC HEALTH,UC HEALTH COMMERCIAL,93.7425,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
PARALDEHYDE PLASMA,82000,CPT,300,RC,,OUTPATIENT,,,169.75,67.9,UC HEALTH,UC HEALTH COMMERCIAL,147.6825,87,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE EA ADD'L,8389691,CPT,300,RC,91,OUTPATIENT,,,393.25,157.3,UC HEALTH,UC HEALTH COMMERCIAL,342.1275,87,,,OTHER,294.94,385.39,PERCENT OF TOTAL BILLED CHARGES
T CELL ANTIGEN RECEPTOR GAMMA,81342,CPT,312,RC,,OUTPATIENT,,,870.75,348.3,UC HEALTH,UC HEALTH COMMERCIAL,757.5525,87,,,OTHER,653.06,853.34,PERCENT OF TOTAL BILLED CHARGES
ACETONE SERUM QUAL,82009,CPT,301,RC,,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
RBC ENZYMES,83915,CPT,301,RC,,OUTPATIENT,,,797.25,318.9,UC HEALTH,UC HEALTH COMMERCIAL,693.6075,87,,,OTHER,597.94,781.31,PERCENT OF TOTAL BILLED CHARGES
FRUCTOSAMINE,82985,CPT,300,RC,,OUTPATIENT,,,82,32.8,UC HEALTH,UC HEALTH COMMERCIAL,71.34,87,,,OTHER,61.5,80.36,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 4,81403,CPT,300,RC,,OUTPATIENT,,,1365,546,UC HEALTH,UC HEALTH COMMERCIAL,1187.55,87,,,OTHER,1023.75,1337.7,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
Z PARTICLE AGGLTNTN SCREEN EA,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
C-NEURONAL (V-G) K+ CHANNEL AB,83519,CPT,300,RC,,OUTPATIENT,,,219.5,87.8,UC HEALTH,UC HEALTH COMMERCIAL,190.965,87,,,OTHER,164.63,215.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCHOLINE RECEPTOR AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z SLIDE REVIEW MOLECULAR GENE,88387,CPT,310,RC,,OUTPATIENT,,,195,78,UC HEALTH,UC HEALTH COMMERCIAL,169.65,87,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
TSH RECEPTOR ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
MELATONIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
MELANTONIN 24 HR URINE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z ACH RECEPTOR BINDING AB,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z ACH RECEPTOR BINDING AB,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
HYDROXYLASE 21 ANTIBODIES,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTOR MUSCLE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
DESMOGLEIN 1&3 SERUM,83516,CPT,300,RC,,OUTPATIENT,,,174.6,69.84,UC HEALTH,UC HEALTH COMMERCIAL,151.902,87,,,OTHER,130.95,171.11,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE RIA,83519,CPT,300,RC,,OUTPATIENT,,,1491.5,596.6,UC HEALTH,UC HEALTH COMMERCIAL,1297.605,87,,,OTHER,1118.63,1461.67,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY FOR ANALYTE MULT,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
ACID PHOS TOTAL,84060,CPT,300,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,397,158.8,UC HEALTH,UC HEALTH COMMERCIAL,345.39,87,,,OTHER,297.75,389.06,PERCENT OF TOTAL BILLED CHARGES
INFECT AGT NUCLEIC ACID QUANT,87799,CPT,300,RC,,OUTPATIENT,,,228,91.2,UC HEALTH,UC HEALTH COMMERCIAL,198.36,87,,,OTHER,171,223.44,PERCENT OF TOTAL BILLED CHARGES
Z ANTI HBC TOTAL,86704,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HBS AB QUAL QUANT,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.53,87,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
Z HEP A TOTAL ANTIBODIES,86708,CPT,300,RC,,OUTPATIENT,,,32.25,12.9,UC HEALTH,UC HEALTH COMMERCIAL,28.0575,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
Z HCV,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
Z HBS ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ACTH LEVEL,82024,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
Z ESTRADIOL ENHANCED,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UC HEALTH,UC HEALTH COMMERCIAL,179.655,87,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
Z ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
GALECTIN-3,82777,CPT,300,RC,,OUTPATIENT,,,195,78,UC HEALTH,UC HEALTH COMMERCIAL,169.65,87,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
EXTENDEND CORD BLOOD TYPING,86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
REPTILASE TIME,85635,CPT,300,RC,,OUTPATIENT,,,113,45.2,UC HEALTH,UC HEALTH COMMERCIAL,98.31,87,,,OTHER,84.75,110.74,PERCENT OF TOTAL BILLED CHARGES
EVAL FINE NEEDLE ASP ADDL SPEC,88177,CPT,300,RC,,OUTPATIENT,,,66.25,26.5,UC HEALTH,UC HEALTH COMMERCIAL,57.6375,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGM, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,UC HEALTH,UC HEALTH COMMERCIAL,170.085,87,,,OTHER,146.63,191.59,PERCENT OF TOTAL BILLED CHARGES
"CHIKUNGUNYA IGG, AB, S",86790,CPT,300,RC,,OUTPATIENT,,,195.5,78.2,UC HEALTH,UC HEALTH COMMERCIAL,170.085,87,,,OTHER,146.63,191.59,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN  SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN BODY FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UC HEALTH,UC HEALTH COMMERCIAL,58.9425,87,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
NMO IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,383.25,153.3,UC HEALTH,UC HEALTH COMMERCIAL,333.4275,87,,,OTHER,287.44,375.59,PERCENT OF TOTAL BILLED CHARGES
GRANULOCYTE ANTIBODIES,86021,CPT,300,RC,,OUTPATIENT,,,232.5,93,UC HEALTH,UC HEALTH COMMERCIAL,202.275,87,,,OTHER,174.38,227.85,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS TPMT GENETICS,81401,CPT,300,RC,,OUTPATIENT,,,372.25,148.9,UC HEALTH,UC HEALTH COMMERCIAL,323.8575,87,,,OTHER,279.19,364.81,PERCENT OF TOTAL BILLED CHARGES
TPMT GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,716.75,286.7,UC HEALTH,UC HEALTH COMMERCIAL,623.5725,87,,,OTHER,537.56,702.42,PERCENT OF TOTAL BILLED CHARGES
CHROMOTOGRAPHY QUANT SINGLE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,UC HEALTH,UC HEALTH COMMERCIAL,111.1425,87,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
"17 KETOSTEROID, 24 HR",83582,CPT,301,RC,,OUTPATIENT,,,291,116.4,UC HEALTH,UC HEALTH COMMERCIAL,253.17,87,,,OTHER,218.25,285.18,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GALOP AUTOANTIBODIES,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATHOLOGY PROC,81401,CPT,300,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PATH PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,957.75,383.1,UC HEALTH,UC HEALTH COMMERCIAL,833.2425,87,,,OTHER,718.31,938.6,PERCENT OF TOTAL BILLED CHARGES
DEHYDROCHOLESTEROL 7-/8,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
SYNTHETIC CANNABINOIDS,82541,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY VIRUS PCR,87631,CPT,300,RC,,OUTPATIENT,,,557.5,223,UC HEALTH,UC HEALTH COMMERCIAL,485.025,87,,,OTHER,418.13,546.35,PERCENT OF TOTAL BILLED CHARGES
RESPIRATORY PANEL PCR,87633,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,UC HEALTH,UC HEALTH COMMERCIAL,725.1972,87,,,OTHER,496.13,648.27,PERCENT OF TOTAL BILLED CHARGES
MPL EXON 10 MUTATION DETECT,81403,CPT,300,RC,,OUTPATIENT,,,797.75,319.1,UC HEALTH,UC HEALTH COMMERCIAL,694.0425,87,,,OTHER,598.31,781.8,PERCENT OF TOTAL BILLED CHARGES
CALR MUTATION ANALYSIS MPN,81219,CPT,300,RC,,OUTPATIENT,,,864,345.6,UC HEALTH,UC HEALTH COMMERCIAL,751.68,87,,,OTHER,648,846.72,PERCENT OF TOTAL BILLED CHARGES
MITOTANE,G0480,HCPCS,300,RC,,BOTH,,,165.5,66.2,UC HEALTH,UC HEALTH COMMERCIAL,143.985,87,,,OTHER,124.13,162.19,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389659,CPT,300,RC,59,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
FBNA GENE KM,81403,CPT,300,RC,,OUTPATIENT,,,938.75,375.5,UC HEALTH,UC HEALTH COMMERCIAL,816.7125,87,,,OTHER,704.06,919.98,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA NUCLEIC,8390991,CPT,300,RC,91,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN TREE PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN EPITHELIA PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL I,86003 91,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL II,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN GRASS PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN HOUSE DUST PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE,82542,CPT,301,RC,,OUTPATIENT,,,260.75,104.3,UC HEALTH,UC HEALTH COMMERCIAL,226.8525,87,,,OTHER,195.56,255.54,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL I,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALDOLASE,82085,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN WEED PANEL III,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CLOBAZAM,80339,CPT,301,RC,,OUTPATIENT,,,158,63.2,UC HEALTH,UC HEALTH COMMERCIAL,137.46,87,,,OTHER,118.5,154.84,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 9,81408,CPT,300,RC,,OUTPATIENT,,,4000,1600,UC HEALTH,UC HEALTH COMMERCIAL,3480,87,,,OTHER,2155.69,2816.77,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAGNOS ENZ DIGEST,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR EA NUCLEIC SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG SEP AND IDENT,8390991,CPT,300,RC,91,OUTPATIENT,,,2146.5,858.6,UC HEALTH,UC HEALTH COMMERCIAL,1867.455,87,,,OTHER,1609.88,2103.57,PERCENT OF TOTAL BILLED CHARGES
LYSOZYME SERUM,85549,CPT,300,RC,,OUTPATIENT,,,160,64,UC HEALTH,UC HEALTH COMMERCIAL,139.2,87,,,OTHER,120,156.8,PERCENT OF TOTAL BILLED CHARGES
ALDOSTERONE SERUM,82088,CPT,300,RC,,OUTPATIENT,,,255,102,UC HEALTH,UC HEALTH COMMERCIAL,221.85,87,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
Z EH MUMPS (IMMUNITY),86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UC HEALTH,UC HEALTH COMMERCIAL,105.705,87,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z EH MEASLES,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
Z EH VARICELLA ZOSTER IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UC HEALTH,UC HEALTH COMMERCIAL,116.58,87,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
Z EH RUBELLA,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.53,87,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
Z EH HIV,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z EH HEPATITIS C VIRUS,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
Z EH HEP B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
EH HIV NEEDLESTICK F/U,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HCV NEEDLESTICK F/U,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
EH STREP A ANTIGEN,3000455,CDM,,,,INPATIENT,,,32.25,12.9,UC HEALTH,UC HEALTH COMMERCIAL,28.0575,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
EH STREP CULTURE,3000456,CDM,300,RC,,INPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
HEMOLYSINS/AGGLUTININS,86941,CPT,300,RC,,OUTPATIENT,,,187,74.8,UC HEALTH,UC HEALTH COMMERCIAL,162.69,87,,,OTHER,140.25,183.26,PERCENT OF TOTAL BILLED CHARGES
ITRACONAZOLE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FTA ABS IGG BY IFA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UC HEALTH,UC HEALTH COMMERCIAL,92.655,87,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
TBNK QN,86355,CPT,300,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO,86357,CPT,300,RC,,OUTPATIENT,,,214.75,85.9,UC HEALTH,UC HEALTH COMMERCIAL,186.8325,87,,,OTHER,161.06,210.46,PERCENT OF TOTAL BILLED CHARGES
BAL,86359,CPT,300,RC,,OUTPATIENT,,,240,96,UC HEALTH,UC HEALTH COMMERCIAL,208.8,87,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR FUNCT,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,UC HEALTH,UC HEALTH COMMERCIAL,42.195,87,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
HEMOLYSINS/AGGLUTININS AUTO,86940,CPT,300,RC,,OUTPATIENT,,,169,67.6,UC HEALTH,UC HEALTH COMMERCIAL,147.03,87,,,OTHER,126.75,165.62,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE ISO,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UC HEALTH,UC HEALTH COMMERCIAL,144.855,87,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
ALKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,48.5,19.4,UC HEALTH,UC HEALTH COMMERCIAL,42.195,87,,,OTHER,36.38,47.53,PERCENT OF TOTAL BILLED CHARGES
FECAL FATS QUANT 24 48 72 HR,82710,CPT,301,RC,,OUTPATIENT,,,159,63.6,UC HEALTH,UC HEALTH COMMERCIAL,138.33,87,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
HEROIN METOBOLITC,80356,CPT,300,RC,,OUTPATIENT,,,285,114,UC HEALTH,UC HEALTH COMMERCIAL,247.95,87,,,OTHER,213.75,279.3,PERCENT OF TOTAL BILLED CHARGES
BONE ALKALINE PHOSPHATASE,84080,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UC HEALTH,UC HEALTH COMMERCIAL,144.855,87,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
ALLERGENS-SINGLE ASSAY,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN HAZELNUT TEST,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1 ANTITRYPSIN GENOTYPING,81332,CPT,300,RC,,OUTPATIENT,,,435.25,174.1,UC HEALTH,UC HEALTH COMMERCIAL,378.6675,87,,,OTHER,326.44,426.55,PERCENT OF TOTAL BILLED CHARGES
ALPHA-1-ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
"FENTANYL WITH METABOLITE,URINE",G0480,HCPCS,300,RC,,BOTH,,,369,147.6,UC HEALTH,UC HEALTH COMMERCIAL,321.03,87,,,OTHER,276.75,361.62,PERCENT OF TOTAL BILLED CHARGES
Z ALPHA 1 ANTITRYPSIN,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
A1A PHENOTYPE,82104,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UC HEALTH,UC HEALTH COMMERCIAL,38.4975,87,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
A1A,82103,CPT,301,RC,,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
ALPHA SUBUNIT PITUITARY TM,83520,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
PROSTAGLANDIN,84150,CPT,300,RC,,OUTPATIENT,,,142,56.8,UC HEALTH,UC HEALTH COMMERCIAL,123.54,87,,,OTHER,106.5,139.16,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,580,232,UC HEALTH,UC HEALTH COMMERCIAL,504.6,87,,,OTHER,435,568.4,PERCENT OF TOTAL BILLED CHARGES
HYDROXYPROLINE  TOTAL URINE,83505,CPT,301,RC,,OUTPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
ALPHA FETO PROTEIN BODY FLUIDS,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UC HEALTH,UC HEALTH COMMERCIAL,162.9075,87,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
ALPHA FETO PROTEIN,82105,CPT,300,RC,,OUTPATIENT,,,166.5,66.6,UC HEALTH,UC HEALTH COMMERCIAL,144.855,87,,,OTHER,124.88,163.17,PERCENT OF TOTAL BILLED CHARGES
CA 72 4,86316,CPT,300,RC,,OUTPATIENT,,,187.25,74.9,UC HEALTH,UC HEALTH COMMERCIAL,162.9075,87,,,OTHER,140.44,183.51,PERCENT OF TOTAL BILLED CHARGES
AFP,82106,CPT,300,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ACETYLOCHOLINESTERASE ASSAY,82013,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
AMNIOTIC FLUID SCAN,82143,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ELECTROPHORECTIC TEST,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z ELECTROPHORECTIC TEST,8266491,CPT,301,RC,91,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
ETHYLENE GLYCOL LEVEL,82693,CPT,300,RC,,OUTPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
INSULIN ANTIBODY  SERUM,86337,CPT,302,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
APTT MIX 1:1,85732,CPT,300,RC,,OUTPATIENT,,,163.5,65.4,UC HEALTH,UC HEALTH COMMERCIAL,142.245,87,,,OTHER,122.63,160.23,PERCENT OF TOTAL BILLED CHARGES
EUGLOBULIN LYSIS TIME,85360,CPT,300,RC,,OUTPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
LATEX IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,UC HEALTH,UC HEALTH COMMERCIAL,129.4125,87,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
Z HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UC HEALTH,UC HEALTH COMMERCIAL,138.5475,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
P HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION PANEL B,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,UC HEALTH,UC HEALTH COMMERCIAL,134.1975,87,,,OTHER,115.69,151.17,PERCENT OF TOTAL BILLED CHARGES
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION PANEL A,87107,CPT,300,RC,,OUTPATIENT,,,154.25,61.7,UC HEALTH,UC HEALTH COMMERCIAL,134.1975,87,,,OTHER,115.69,151.17,PERCENT OF TOTAL BILLED CHARGES
FUNGAL D2 SEQUENCING ID,87153,CPT,300,RC,,OUTPATIENT,,,230.72,92.288,UC HEALTH,UC HEALTH COMMERCIAL,200.7264,87,,,OTHER,164.25,214.62,PERCENT OF TOTAL BILLED CHARGES
AMEBIASIS ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UC HEALTH,UC HEALTH COMMERCIAL,107.445,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
THYROTROPIN RELEASING HORMONE,83519,CPT,300,RC,,OUTPATIENT,,,373.75,149.5,UC HEALTH,UC HEALTH COMMERCIAL,325.1625,87,,,OTHER,280.31,366.28,PERCENT OF TOTAL BILLED CHARGES
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN - TROUGH,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS,80197,CPT,300,RC,,OUTPATIENT,,,433.75,173.5,UC HEALTH,UC HEALTH COMMERCIAL,377.3625,87,,,OTHER,325.31,425.08,PERCENT OF TOTAL BILLED CHARGES
AMIKACIN PEAK,80150,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
KRAS ADDITIONAL VARIANT,81276,CPT,300,RC,,OUTPATIENT,,,386.5,154.6,UC HEALTH,UC HEALTH COMMERCIAL,336.255,87,,,OTHER,230.25,300.86,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRACTION NUCLIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,65.25,26.1,UC HEALTH,UC HEALTH COMMERCIAL,56.7675,87,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,8389191,CPT,300,RC,91,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ISO/EXTRATION NUCLEIC ACID,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,8389491,CPT,300,RC,91,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYMATIC DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z IODINE,83789,CPT,300,RC,,OUTPATIENT,,,300,120,UC HEALTH,UC HEALTH COMMERCIAL,261,87,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION AND REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,306,122.4,UC HEALTH,UC HEALTH COMMERCIAL,266.22,87,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
Z AMMONIA,82140,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,83904,CPT,300,RC,,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID BY SEQ EA SEGMT,8390491,CPT,300,RC,91,OUTPATIENT,,,2677.25,1070.9,UC HEALTH,UC HEALTH COMMERCIAL,2329.2075,87,,,OTHER,2007.94,2623.71,PERCENT OF TOTAL BILLED CHARGES
Z CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,68.85,27.54,UC HEALTH,UC HEALTH COMMERCIAL,59.8995,87,,,OTHER,51.6,67.5,PERCENT OF TOTAL BILLED CHARGES
GENOMIC SEQ HEMATOLYMPHOID DNA,81450,CPT,310,RC,,OUTPATIENT,,,1519.06,607.624,UC HEALTH,UC HEALTH COMMERCIAL,1321.5822,87,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HLA I&II TYPING LR,81370,CPT,300,RC,,OUTPATIENT,,,1000,400,UC HEALTH,UC HEALTH COMMERCIAL,870,87,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ANTIDEPRESSANTS CLASS 3-5,80333,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UC HEALTH,UC HEALTH COMMERCIAL,88.5225,87,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UC HEALTH,UC HEALTH COMMERCIAL,88.5225,87,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,300,RC,,OUTPATIENT,,,110.25,44.1,UC HEALTH,UC HEALTH COMMERCIAL,95.9175,87,,,OTHER,82.69,108.05,PERCENT OF TOTAL BILLED CHARGES
DRVVT DILUTED,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE  RBC,82482,CPT,301,RC,,OUTPATIENT,,,177.5,71,UC HEALTH,UC HEALTH COMMERCIAL,154.425,87,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGG,86651,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGG CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
EAST EQUINE ENCEP IGM CSF,86652,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE ENCEP IGG CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
WEST EQUINE EHCEP IGM CSF,86654,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
CALIF VIRUS LAC AB IGM,86651,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
AMYLASE (SO),82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
17 HYROXYPREGNEN,84143,CPT,300,RC,,OUTPATIENT,,,211,84.4,UC HEALTH,UC HEALTH COMMERCIAL,183.57,87,,,OTHER,158.25,206.78,PERCENT OF TOTAL BILLED CHARGES
SPINOCEREBELLAR ATAXIA TYPE 1,81178,CPT,300,RC,,OUTPATIENT,,,716,286.4,UC HEALTH,UC HEALTH COMMERCIAL,622.92,87,,,OTHER,537,701.68,PERCENT OF TOTAL BILLED CHARGES
DPYD GENE ANALYSIS,81232,CPT,300,RC,,OUTPATIENT,,,1123,449.2,UC HEALTH,UC HEALTH COMMERCIAL,977.01,87,,,OTHER,842.25,1100.54,PERCENT OF TOTAL BILLED CHARGES
GI PATHOGEN 6-11 TARGETS,87506,CPT,300,RC,,OUTPATIENT,,,525.98,210.392,UC HEALTH,UC HEALTH COMMERCIAL,457.6026,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
PARIETAL CELL ANTIBODIES  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR BASEMENT MEM AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
ACH RECEPTORS,8351991,CPT,300,RC,91,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY ANALYTE-QUANT,8625691,CPT,300,RC,91,OUTPATIENT,,,138.5,55.4,UC HEALTH,UC HEALTH COMMERCIAL,120.495,87,,,OTHER,103.88,135.73,PERCENT OF TOTAL BILLED CHARGES
ANTI KU,83516,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
MULTIPLEX PROBE STAIN EA,88374,CPT,300,RC,,OUTPATIENT,,,426,170.4,UC HEALTH,UC HEALTH COMMERCIAL,370.62,87,,,OTHER,319.5,417.48,PERCENT OF TOTAL BILLED CHARGES
URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UC HEALTH,UC HEALTH COMMERCIAL,93.7425,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
Z URINE OXALATE  24 HR,83945,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NON ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
"HUMAN EPIDIDYMIS PROTEIN 4,SER",86305,CPT,302,RC,,OUTPATIENT,,,277,110.8,UC HEALTH,UC HEALTH COMMERCIAL,240.99,87,,,OTHER,207.75,271.46,PERCENT OF TOTAL BILLED CHARGES
UR FENTANYL CON,80299,CPT,300,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
GLYCOMARK,84378,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,UC HEALTH,UC HEALTH COMMERCIAL,175.5225,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,U0003,HCPCS,300,RC,,BOTH,,,180,72,UC HEALTH,UC HEALTH COMMERCIAL,156.6,87,,,OTHER,135,176.4,PERCENT OF TOTAL BILLED CHARGES
COVID-19 IGG,U0002,HCPCS,302,RC,,BOTH,,,86,34.4,UC HEALTH,UC HEALTH COMMERCIAL,74.82,87,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
COVID-19 PCR TEST,U0003,HCPCS,300,RC,,INPATIENT,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
INFEC AGEN DETEC AMPLI PROBE,U0005,HCPCS,300,RC,,INPATIENT,,,24,9.6,UC HEALTH,UC HEALTH COMMERCIAL,20.88,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C GENOTYPE,87902,CPT,300,RC,,OUTPATIENT,,,678.75,271.5,UC HEALTH,UC HEALTH COMMERCIAL,590.5125,87,,,OTHER,509.06,665.18,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C AMPLIFIED PROBE,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UC HEALTH,UC HEALTH COMMERCIAL,283.8375,87,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
HEPARIN ANTI-XA,85520,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,UC HEALTH,UC HEALTH COMMERCIAL,211.845,87,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C MEDICARE SCREEN,G0472,HCPCS,300,RC,,INPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
TISSUE TRANSGLUTAMINASE AB IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR (GBM) ELISHA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
ANDROSTENEDIONE,82157,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C RNA AMP PROBE,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,UC HEALTH,UC HEALTH COMMERCIAL,403.68,87,,,OTHER,348,454.72,PERCENT OF TOTAL BILLED CHARGES
MYELOPEROXIDASE,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
PROTEINASE 3 ANTIBODY,8351659,CPT,,,59,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE,82542,CPT,301,RC,,OUTPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z TISS TRANSGLUTAMINASE IGG,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
F ACTIN,83516,CPT,300,RC,,OUTPATIENT,,,220,88,UC HEALTH,UC HEALTH COMMERCIAL,191.4,87,,,OTHER,165,215.6,PERCENT OF TOTAL BILLED CHARGES
PRADER-WILLI/ANGELMAN SYN,81331,CPT,300,RC,,OUTPATIENT,,,500.5,200.2,UC HEALTH,UC HEALTH COMMERCIAL,435.435,87,,,OTHER,375.38,490.49,PERCENT OF TOTAL BILLED CHARGES
METHDIOXYAMPH,G0480,HCPCS,300,RC,,BOTH,,,56.25,22.5,UC HEALTH,UC HEALTH COMMERCIAL,48.9375,87,,,OTHER,42.19,55.13,PERCENT OF TOTAL BILLED CHARGES
ANGIOTENSIN CONVERTING ENZYME,82164,CPT,300,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
NICOTINE/COTININE META URINE,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,UC HEALTH,UC HEALTH COMMERCIAL,161.385,87,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
CYCLIC CITRULLINATED  PEP AB,86200,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,UC HEALTH,UC HEALTH COMMERCIAL,97.2225,87,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
CYCLIC AMP URINARY EXCRETAION,82030,CPT,300,RC,,OUTPATIENT,,,213.5,85.4,UC HEALTH,UC HEALTH COMMERCIAL,185.745,87,,,OTHER,160.13,209.23,PERCENT OF TOTAL BILLED CHARGES
CSF P1433 PROTEIN SPINAL FLUID,82528,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UC HEALTH,UC HEALTH COMMERCIAL,133.7625,87,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
CATECHOLAMINES PLASMA,82384,CPT,300,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY TITER (COOMBS TEST),86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
ANTIMITOCHONDRIAL M2 AB  IGG,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGG  IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN ANTIBODY IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN ANTIBODIES IGM,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGG (MAYO),86147,CPT,300,RC,,OUTPATIENT,,,50.9,20.36,UC HEALTH,UC HEALTH COMMERCIAL,44.283,87,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
Z CARDIOLIPIN AB IGM (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,50.9,20.36,UC HEALTH,UC HEALTH COMMERCIAL,44.283,87,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGG (MAYO),8614791,CPT,300,RC,91,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
ANTI MULLERIAN HORMONE,83520,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
QUANTIFERON-TB GOLD BLOOD,86481,CPT,300,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,147.56,192.82,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83516,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
HUMAN ANTI - MOUSE AB ELISA,83520,CPT,300,RC,,OUTPATIENT,,,304.25,121.7,UC HEALTH,UC HEALTH COMMERCIAL,264.6975,87,,,OTHER,228.19,298.17,PERCENT OF TOTAL BILLED CHARGES
ANTI DNA AB SINGLE STRAND,86226,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CULTURE STREP (THROAT),87081,CPT,306,RC,,OUTPATIENT,,,29.25,11.7,UC HEALTH,UC HEALTH COMMERCIAL,25.4475,87,,,OTHER,21.94,28.67,PERCENT OF TOTAL BILLED CHARGES
ASSAY CELLULAR FUNCTION,86352,CPT,300,RC,,OUTPATIENT,,,323.75,129.5,UC HEALTH,UC HEALTH COMMERCIAL,281.6625,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
E. COLI 0157,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
COVID-19 POC RAPID,87635,CPT,300,RC,,OUTPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH AG DFA,87270,CPT,300,RC,,OUTPATIENT,,,107.25,42.9,UC HEALTH,UC HEALTH COMMERCIAL,93.3075,87,,,OTHER,80.44,105.11,PERCENT OF TOTAL BILLED CHARGES
CHOLINESTERASE SERUM ASSAY,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH BY DNA PROBE,87490,CPT,300,RC,,OUTPATIENT,,,96.25,38.5,UC HEALTH,UC HEALTH COMMERCIAL,83.7375,87,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
NEISSERIA GONORRHEA DNA PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UC HEALTH,UC HEALTH COMMERCIAL,79.605,87,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA TRACH DNA AMP PROBE,87491,CPT,306,RC,,OUTPATIENT,,,96.25,38.5,UC HEALTH,UC HEALTH COMMERCIAL,83.7375,87,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
GONORRHEA DNA AMP PROBE,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UC HEALTH,UC HEALTH COMMERCIAL,79.605,87,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
N GONORHEA ANTIBODY SERUM,86609,CPT,300,RC,,OUTPATIENT,,,192,76.8,UC HEALTH,UC HEALTH COMMERCIAL,167.04,87,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
GLUTERIC ACIDS,82544,CPT,300,RC,,OUTPATIENT,,,379.25,151.7,UC HEALTH,UC HEALTH COMMERCIAL,329.9475,87,,,OTHER,284.44,371.67,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR PANEL,3001000,CDM,,,,INPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR HSCRP,3001002,CDM,,,,INPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
HEALTH FAIR VITAMIN D,3001004,CDM,,,,INPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
PBG DEAMINASE WB,82657,CPT,300,RC,,OUTPATIENT,,,190.25,76.1,UC HEALTH,UC HEALTH COMMERCIAL,165.5175,87,,,OTHER,142.69,186.45,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME PERIPHERAL BLOOD,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,UC HEALTH,UC HEALTH COMMERCIAL,838.68,87,,,OTHER,723,944.72,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOMONAL IN SITU HYBRID,88272,CPT,310,RC,,OUTPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
HIV-1 P24 ANTIGEN,87390,CPT,306,RC,,OUTPATIENT,,,153.25,61.3,UC HEALTH,UC HEALTH COMMERCIAL,133.3275,87,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
CITRATES ASSAY,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,UC HEALTH,UC HEALTH COMMERCIAL,148.77,87,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
ZONISAMIDE,80203,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
CLOSTRIDIUM DIFFICLE TOXIN PCR,87493,CPT,300,RC,,OUTPATIENT,,,266,106.4,UC HEALTH,UC HEALTH COMMERCIAL,231.42,87,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
URINE CITRATE  24 HR,82507,CPT,301,RC,,OUTPATIENT,,,171,68.4,UC HEALTH,UC HEALTH COMMERCIAL,148.77,87,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLETHANOL,G0480,HCPCS,300,RC,,BOTH,,,153.25,61.3,UC HEALTH,UC HEALTH COMMERCIAL,133.3275,87,,,OTHER,114.94,150.19,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS,88269,CPT,311,RC,,OUTPATIENT,,,894.75,357.9,UC HEALTH,UC HEALTH COMMERCIAL,778.4325,87,,,OTHER,671.06,876.86,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,UC HEALTH,UC HEALTH COMMERCIAL,468.495,87,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
ANALYZE 20-25 CELLS,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,UC HEALTH,UC HEALTH COMMERCIAL,812.145,87,,,OTHER,700.13,914.83,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULTURE NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,616.75,246.7,UC HEALTH,UC HEALTH COMMERCIAL,536.5725,87,,,OTHER,462.56,604.42,PERCENT OF TOTAL BILLED CHARGES
TISSUE PROCESSING FOR CULTURE,87176,CPT,300,RC,,OUTPATIENT,,,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME 15-20  CELLS,88262,CPT,310,RC,,OUTPATIENT,,,1042,416.8,UC HEALTH,UC HEALTH COMMERCIAL,906.54,87,,,OTHER,781.5,1021.16,PERCENT OF TOTAL BILLED CHARGES
"CHROMOSOMAL MICROARRAY,CONGEN",81229,CPT,300,RC,,OUTPATIENT,,,3083,1233.2,UC HEALTH,UC HEALTH COMMERCIAL,2682.21,87,,,OTHER,2312.25,3021.34,PERCENT OF TOTAL BILLED CHARGES
CULTURE GROUP B STREP,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
PYRUVATE KINASE ERYTHROCYTES,84220,CPT,300,RC,,OUTPATIENT,,,145.75,58.3,UC HEALTH,UC HEALTH COMMERCIAL,126.8025,87,,,OTHER,109.31,142.84,PERCENT OF TOTAL BILLED CHARGES
ANA,86038,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CEREVISIAE IGA,83520,CPT,300,RC,,OUTPATIENT,,,90,36,UC HEALTH,UC HEALTH COMMERCIAL,78.3,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY RIA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CEREVISIAE IGG,83520,CPT,300,RC,,OUTPATIENT,,,90,36,UC HEALTH,UC HEALTH COMMERCIAL,78.3,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREENING,86255,CPT,300,RC,,OUTPATIENT,,,90,36,UC HEALTH,UC HEALTH COMMERCIAL,78.3,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
Z CUTANEOUS IMMUNOFLUOR AB IGG,8625591,CPT,300,RC,91,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
TRANSFORMING GRWTH FACTOR BETA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
SCLERODERMA ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLOUR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
Z DIRECT IMMUNOFLUOR STAINING,8834691,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,44.63,58.31,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
PROMETHEUS INFLIXAMAB HACA,8352059,CPT,301,RC,59,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
RNA POLYMERASE III AB IGG,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS,83520,CPT,300,RC,,OUTPATIENT,,,289.75,115.9,UC HEALTH,UC HEALTH COMMERCIAL,252.0825,87,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
CANNABINOIDS CONFIRM,G0480,HCPCS,300,RC,,BOTH,,,100,40,UC HEALTH,UC HEALTH COMMERCIAL,87,87,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
URINE PROTEIN,84156,CPT,301,RC,,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
KIT GENE ANALYS D816 VARIANT,81273,CPT,300,RC,,OUTPATIENT,,,1125.75,450.3,UC HEALTH,UC HEALTH COMMERCIAL,979.4025,87,,,OTHER,844.31,1103.24,PERCENT OF TOTAL BILLED CHARGES
TGFBR1 GENE KNOWN MUTATION,81403,CPT,300,RC,,OUTPATIENT,,,1361.75,544.7,UC HEALTH,UC HEALTH COMMERCIAL,1184.7225,87,,,OTHER,1021.31,1334.52,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,449.5,179.8,UC HEALTH,UC HEALTH COMMERCIAL,391.065,87,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAGNOSTICS,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC AMPLI EACH,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
GENETIC EXAMINATION,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE,83909,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
NUCLEIC ACID HIGH RESOLUTE ADD,8390959,CPT,300,RC,59,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC ADD'L,8381959,CPT,300,RC,59,OUTPATIENT,,,449.5,179.8,UC HEALTH,UC HEALTH COMMERCIAL,391.065,87,,,OTHER,337.13,440.51,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC TRANSFER,83897,CPT,300,RC,,OUTPATIENT,,,148.75,59.5,UC HEALTH,UC HEALTH COMMERCIAL,129.4125,87,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGE,8600391,CPT,300,RC,91,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
CMV IGG ANTIBODY,86644,CPT,302,RC,,OUTPATIENT,,,119.75,47.9,UC HEALTH,UC HEALTH COMMERCIAL,104.1825,87,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
VENLAFAXINE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,129.75,51.9,UC HEALTH,UC HEALTH COMMERCIAL,112.8825,87,,,OTHER,97.31,127.16,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,1524.5,609.8,UC HEALTH,UC HEALTH COMMERCIAL,1326.315,87,,,OTHER,1143.38,1494.01,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,86382,CPT,300,RC,,OUTPATIENT,,,132.5,53,UC HEALTH,UC HEALTH COMMERCIAL,115.275,87,,,OTHER,99.38,129.85,PERCENT OF TOTAL BILLED CHARGES
NEUTRALIZATION TEST VIRAL,8638291,CPT,300,RC,91,OUTPATIENT,,,132.5,53,UC HEALTH,UC HEALTH COMMERCIAL,115.275,87,,,OTHER,99.38,129.85,PERCENT OF TOTAL BILLED CHARGES
ADH (VASOPRESSIN),84588,CPT,300,RC,,OUTPATIENT,,,372,148.8,UC HEALTH,UC HEALTH COMMERCIAL,323.64,87,,,OTHER,279,364.56,PERCENT OF TOTAL BILLED CHARGES
Z LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,UC HEALTH,UC HEALTH COMMERCIAL,120.06,87,,,OTHER,103.5,135.24,PERCENT OF TOTAL BILLED CHARGES
Z APOLIPOROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z LP(A) CHOLESTEROL ELECTROPHO,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
CMV CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UC HEALTH,UC HEALTH COMMERCIAL,200.7525,87,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
CMV DNA QUANTITATIVE BY PCR,87497,CPT,300,RC,,OUTPATIENT,,,408.5,163.4,UC HEALTH,UC HEALTH COMMERCIAL,355.395,87,,,OTHER,306.38,400.33,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE W/ID IMM STAIN,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
VIRAL SMEAR SHELL VIAL,87254,CPT,306,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z ANTISTREPTOLYSIN O,86060,CPT,300,RC,,OUTPATIENT,,,19.75,7.9,UC HEALTH,UC HEALTH COMMERCIAL,17.1825,87,,,OTHER,14.81,19.36,PERCENT OF TOTAL BILLED CHARGES
Z TISSUE CULUTRE  LYMPHOCYTE,88230,CPT,310,RC,,OUTPATIENT,,,553,221.2,UC HEALTH,UC HEALTH COMMERCIAL,481.11,87,,,OTHER,199.31,260.44,PERCENT OF TOTAL BILLED CHARGES
Z CHROMOSOME ANALYSIS 15-20,88262,CPT,310,RC,,OUTPATIENT,,,964,385.6,UC HEALTH,UC HEALTH COMMERCIAL,838.68,87,,,OTHER,723,944.72,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,158,63.2,UC HEALTH,UC HEALTH COMMERCIAL,137.46,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
AFP L3% TOTAL AFP,82107,CPT,300,RC,,OUTPATIENT,,,422.75,169.1,UC HEALTH,UC HEALTH COMMERCIAL,367.7925,87,,,OTHER,317.06,414.3,PERCENT OF TOTAL BILLED CHARGES
STREP GRP A AMP PROBE TECH,87651,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UC HEALTH,UC HEALTH COMMERCIAL,61.0566,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A/B PCR,87502,CPT,306,RC,,OUTPATIENT,,,191.6,76.64,UC HEALTH,UC HEALTH COMMERCIAL,166.692,87,,,OTHER,91.5,119.56,PERCENT OF TOTAL BILLED CHARGES
RSV AMPLIFIED PROBE TECHNIQUE,87634,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UC HEALTH,UC HEALTH COMMERCIAL,122.148,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN ANTIGEN,85301,CPT,305,RC,,OUTPATIENT,,,186.5,74.6,UC HEALTH,UC HEALTH COMMERCIAL,162.255,87,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS FUMIGATUS,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FUNGUS ANTIBODY,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS ANTIGEN,87305,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UC HEALTH,UC HEALTH COMMERCIAL,120.7125,87,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
ASPERGILLUS IGM ANTIBODIES,86606,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FUNGAL IDENTIFICATION(MAYO),87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
YEAST ID PANEL,87106,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,91.5,36.6,UC HEALTH,UC HEALTH COMMERCIAL,79.605,87,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN URINE,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,UC HEALTH,UC HEALTH COMMERCIAL,216.63,87,,,OTHER,186.75,244.02,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS BLOOD,86890,CPT,300,RC,,OUTPATIENT,,,563.5,225.4,UC HEALTH,UC HEALTH COMMERCIAL,490.245,87,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
HISTOPLASMA ANTIGEN SERUM,87385,CPT,300,RC,,OUTPATIENT,,,249,99.6,UC HEALTH,UC HEALTH COMMERCIAL,216.63,87,,,OTHER,186.75,244.02,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTEIN 1 AB IGA,86146,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGG,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
Z BETA-2 GLYCOPROTIEN 1 AB IGM,86146,CPT,300,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
BETA-2-MICROGLOBULIN,82232,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
BETA-2 TRANSFERRIN BODY FLUID,86335,CPT,300,RC,,OUTPATIENT,,,224.25,89.7,UC HEALTH,UC HEALTH COMMERCIAL,195.0975,87,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
RISPERIDONE,G0480,HCPCS,300,RC,,BOTH,,,185.25,74.1,UC HEALTH,UC HEALTH COMMERCIAL,161.1675,87,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
EA ADD'L SINGLE PROBE STAIN,88364,CPT,300,RC,,OUTPATIENT,,,547.5,219,UC HEALTH,UC HEALTH COMMERCIAL,476.325,87,,,OTHER,410.63,536.55,PERCENT OF TOTAL BILLED CHARGES
MULTIPLER PROBE STAIN PROC,88377,CPT,300,RC,,OUTPATIENT,,,622.75,249.1,UC HEALTH,UC HEALTH COMMERCIAL,541.7925,87,,,OTHER,467.06,610.3,PERCENT OF TOTAL BILLED CHARGES
HCG QUANTATATIVE,84702,CPT,301,RC,,OUTPATIENT,,,194.25,77.7,UC HEALTH,UC HEALTH COMMERCIAL,168.9975,87,,,OTHER,145.69,190.37,PERCENT OF TOTAL BILLED CHARGES
B TYPE NATRIURECTIC PEPTIDE,83880,CPT,301,RC,,OUTPATIENT,,,475.5,190.2,UC HEALTH,UC HEALTH COMMERCIAL,413.685,87,,,OTHER,356.63,465.99,PERCENT OF TOTAL BILLED CHARGES
BETA-HYDROXYBUTYRIC ACID,82010,CPT,300,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
BETA-GLOBIN GENE SEQUENCING B,81364,CPT,300,RC,,OUTPATIENT,,,797,318.8,UC HEALTH,UC HEALTH COMMERCIAL,693.39,87,,,OTHER,597.75,781.06,PERCENT OF TOTAL BILLED CHARGES
COCAINE & METABOLITES DETECT,G0480,HCPCS,300,RC,,BOTH,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
DIRECT COOMBS,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
Z PRE DAT,86880,CPT,300,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
Z POST DAT,8688091,CPT,300,RC,91,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
DNA ANTIBODY IGG,86225,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN DIRECT,82248,CPT,301,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR PROCEDURE,81479,CPT,300,RC,,OUTPATIENT,,,786.75,314.7,UC HEALTH,UC HEALTH COMMERCIAL,684.4725,87,,,OTHER,590.06,771.02,PERCENT OF TOTAL BILLED CHARGES
CRMP S IGG WESTERN BLOT,84182,CPT,300,RC,,OUTPATIENT,,,192,76.8,UC HEALTH,UC HEALTH COMMERCIAL,167.04,87,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
Z URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE SULFATE,84392,CPT,300,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
MERCURY  URINE,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,UC HEALTH,UC HEALTH COMMERCIAL,97.005,87,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BILIRUBIN  NEONATAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BIOTINIDASE SERUM,82261,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
P BIOTINIDASE,82261,CPT,300,RC,,OUTPATIENT,,,33.74,13.496,UC HEALTH,UC HEALTH COMMERCIAL,29.3538,87,,,OTHER,6.94,9.07,PERCENT OF TOTAL BILLED CHARGES
BLEEDING TIME,85002,CPT,305,RC,,OUTPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
FUNGUS ANTIBODY ADD'L,8667191,CPT,300,RC,91,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
MEASLES RUBEOLA AB IGM,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
MEASLES RUBEOLA AB IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB  CF,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,UC HEALTH,UC HEALTH COMMERCIAL,70.035,87,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
CLOMIPRAMINE & METABOLITE,82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB,86612,CPT,300,RC,,OUTPATIENT,,,80.5,32.2,UC HEALTH,UC HEALTH COMMERCIAL,70.035,87,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
PREALBUMIN,84134,CPT,301,RC,,OUTPATIENT,,,66.25,26.5,UC HEALTH,UC HEALTH COMMERCIAL,57.6375,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
BLASTOMYCES AB,8661291,CPT,300,RC,91,OUTPATIENT,,,80.5,32.2,UC HEALTH,UC HEALTH COMMERCIAL,70.035,87,,,OTHER,60.38,78.89,PERCENT OF TOTAL BILLED CHARGES
ACYLCARNITINE QUANTITATIVE,82017,CPT,301,RC,,OUTPATIENT,,,176.5,70.6,UC HEALTH,UC HEALTH COMMERCIAL,153.555,87,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
BORDETELLA PERTUSSIS AB IGG,86615,CPT,300,RC,,OUTPATIENT,,,178.5,71.4,UC HEALTH,UC HEALTH COMMERCIAL,155.295,87,,,OTHER,133.88,174.93,PERCENT OF TOTAL BILLED CHARGES
BORDETELLA PERTUSSIS AB IGA,86615,CPT,300,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CADMIUM BLOOD,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,UC HEALTH,UC HEALTH COMMERCIAL,53.7225,87,,,OTHER,46.31,60.52,PERCENT OF TOTAL BILLED CHARGES
INFECTIOUS AGENT DETECTION APT,87801,CPT,300,RC,,OUTPATIENT,,,231,92.4,UC HEALTH,UC HEALTH COMMERCIAL,200.97,87,,,OTHER,173.25,226.38,PERCENT OF TOTAL BILLED CHARGES
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGG BY CF,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGG BY IMMUN,8663591,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z COCCIDIOIDES AB IGM BY IMMUN,86635,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN (BUN),84520,CPT,301,RC,,OUTPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
BILE ACIDS FRACTIONATE TOTAL,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
IODINE URINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
MANGANESE SERUM,83785,CPT,300,RC,,OUTPATIENT,,,184.75,73.9,UC HEALTH,UC HEALTH COMMERCIAL,160.7325,87,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
IODINE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANSFERESE,83789,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
CALPROTECTIN FECAL,83993,CPT,300,RC,,OUTPATIENT,,,435,174,UC HEALTH,UC HEALTH COMMERCIAL,378.45,87,,,OTHER,326.25,426.3,PERCENT OF TOTAL BILLED CHARGES
MALARIA ANTIBODY SCREEN,86750,CPT,300,RC,,OUTPATIENT,,,344.25,137.7,UC HEALTH,UC HEALTH COMMERCIAL,299.4975,87,,,OTHER,258.19,337.37,PERCENT OF TOTAL BILLED CHARGES
STREP B DNA AMP PROBE,87653,CPT,300,RC,,OUTPATIENT,,,252.75,101.1,UC HEALTH,UC HEALTH COMMERCIAL,219.8925,87,,,OTHER,189.56,247.7,PERCENT OF TOTAL BILLED CHARGES
CULTURE SCREEN,87081,CPT,306,RC,,OUTPATIENT,,,14.25,5.7,UC HEALTH,UC HEALTH COMMERCIAL,12.3975,87,,,OTHER,10.69,13.97,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
HEPARIN CO FACTOR II,85130,CPT,300,RC,,OUTPATIENT,,,338.5,135.4,UC HEALTH,UC HEALTH COMMERCIAL,294.495,87,,,OTHER,253.88,331.73,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE GEL ELECTROPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS A ANTIBODY IGM,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,UC HEALTH,UC HEALTH COMMERCIAL,110.2725,87,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
C-PEPTIDE,84681,CPT,301,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGG,86628,CPT,300,RC,,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGM,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
Z CANDIDA ANTIBODY IGA,8662891,CPT,300,RC,91,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
CANDIDA ALBICANS ANTIGEN DETEC,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
C-REACTIVE PROTEIN,86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
C-REACTIVE PROTEIN (BABY),86140,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
OPIATES DRUG AND METABOLITES,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
SHIGA TOXIN 1,87427,CPT,300,RC,,OUTPATIENT,,,41.5,16.6,UC HEALTH,UC HEALTH COMMERCIAL,36.105,87,,,OTHER,31.13,40.67,PERCENT OF TOTAL BILLED CHARGES
OPIATE CONFIRM MECONIUM,80361,CPT,300,RC,,OUTPATIENT,,,219.75,87.9,UC HEALTH,UC HEALTH COMMERCIAL,191.1825,87,,,OTHER,164.81,215.36,PERCENT OF TOTAL BILLED CHARGES
SHIGA TOXIN 2,8742759,CPT,300,RC,59,OUTPATIENT,,,41.5,16.6,UC HEALTH,UC HEALTH COMMERCIAL,36.105,87,,,OTHER,31.13,40.67,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOCOCCUS AG SCREEN,SERUM",87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,UC HEALTH,UC HEALTH COMMERCIAL,122.67,87,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
C5 COMPLEMENT ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CA 125,86304,CPT,300,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
C2 COMPLEMENT FUNCTIONAL,86161,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
CA 15-3,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
CA 27.29,86300,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
CA19-9 (GI),86301,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
C4ADES,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
C3A LEVEL,86160,CPT,300,RC,,OUTPATIENT,,,208.5,83.4,UC HEALTH,UC HEALTH COMMERCIAL,181.395,87,,,OTHER,156.38,204.33,PERCENT OF TOTAL BILLED CHARGES
LIVER CYTOSOL AUTOANTIBODIES,86376,CPT,300,RC,,OUTPATIENT,,,269,107.6,UC HEALTH,UC HEALTH COMMERCIAL,234.03,87,,,OTHER,201.75,263.62,PERCENT OF TOTAL BILLED CHARGES
CORTISOL-FREE,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
CORTISOL SALIVA,82530,CPT,301,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
PANTOTHENIC ACID (VIT B5),84591,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,UC HEALTH,UC HEALTH COMMERCIAL,158.9925,87,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
CALCITONIN,82308,CPT,300,RC,,OUTPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
CORD BLOOD ARTERIAL,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CORD BLOOD VENOUS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
BLOOD GAS,82803,CPT,300,RC,,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
CORD DRUG SCREEN,80301,CPT,301,RC,,OUTPATIENT,,,379.75,151.9,UC HEALTH,UC HEALTH COMMERCIAL,330.3825,87,,,OTHER,284.81,372.16,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREEN SINGLE DRUG CLASS,80302,CPT,301,RC,,OUTPATIENT,,,109.5,43.8,UC HEALTH,UC HEALTH COMMERCIAL,95.265,87,,,OTHER,82.13,107.31,PERCENT OF TOTAL BILLED CHARGES
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UC HEALTH,UC HEALTH COMMERCIAL,85.695,87,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
METHEMOGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN A2 AND F,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UC HEALTH,UC HEALTH COMMERCIAL,138.5475,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
CALCIUM TOTAL,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UC HEALTH,UC HEALTH COMMERCIAL,36.975,87,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
Z CALCIUM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UC HEALTH,UC HEALTH COMMERCIAL,36.975,87,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
NON DRUG ANALYTE MASS SPEC,82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
PREGABALIN (LYRICA),80366,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE CALCIUM 24 HR,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,UC HEALTH,UC HEALTH COMMERCIAL,66.555,87,,,OTHER,57.38,74.97,PERCENT OF TOTAL BILLED CHARGES
URINE QUANTITATIVE TIMED SPEC,82340,CPT,300,RC,,OUTPATIENT,,,76.5,30.6,UC HEALTH,UC HEALTH COMMERCIAL,66.555,87,,,OTHER,57.38,74.97,PERCENT OF TOTAL BILLED CHARGES
VOLUME MEASUREMENT TIMED COLL,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
BENZODIAZEPINE CONFIRM URINE,G0483,HCPCS,301,RC,,BOTH,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
CYP2C9 GENE COM VARIANTS,81227,CPT,300,RC,,OUTPATIENT,,,1059.5,423.8,UC HEALTH,UC HEALTH COMMERCIAL,921.765,87,,,OTHER,794.63,1038.31,PERCENT OF TOTAL BILLED CHARGES
VKORC1 GENE,81355,CPT,300,RC,,OUTPATIENT,,,176.4,70.56,UC HEALTH,UC HEALTH COMMERCIAL,153.468,87,,,OTHER,1.31,1.72,PERCENT OF TOTAL BILLED CHARGES
TRICHOMONAS VAGINALIS AMP RNA,87661,CPT,300,RC,,OUTPATIENT,,,243.5,97.4,UC HEALTH,UC HEALTH COMMERCIAL,211.845,87,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
CARBON DIOXIDE (CO2),82374,CPT,301,RC,,OUTPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
URINE CALCIUM  RANDOM,82310,CPT,300,RC,,OUTPATIENT,,,42.5,17,UC HEALTH,UC HEALTH COMMERCIAL,36.975,87,,,OTHER,31.88,41.65,PERCENT OF TOTAL BILLED CHARGES
CARBOXYHEMOGLOBIN,82375,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UC HEALTH,UC HEALTH COMMERCIAL,85.695,87,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CAROTENE,82380,CPT,301,RC,,OUTPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
Z DNA,86225,CPT,300,RC,,OUTPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
Z ENA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SSA,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SSB,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SM,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z RNP,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z SC/70,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z JO1,8623591,CPT,300,RC,91,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ANA 2,86038,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID NON URINE/OR,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID NON URI/PERITONEAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CEA,82378,CPT,301,RC,,OUTPATIENT,,,423.71,169.484,UC HEALTH,UC HEALTH COMMERCIAL,368.6277,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
CSF CELL CT W/DIFF,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
VDRL CSF,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UC HEALTH,UC HEALTH COMMERCIAL,58.29,87,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
CELL CT/DIFF BODY FLUID,89051,CPT,309,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
CYANIDE ASSAY,82600,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
PROCALCITONIN SERUM,84145,CPT,300,RC,,OUTPATIENT,,,212.5,85,UC HEALTH,UC HEALTH COMMERCIAL,184.875,87,,,OTHER,159.38,208.25,PERCENT OF TOTAL BILLED CHARGES
SOMATIC HYPERMUTATION IN BCLL,81263,CPT,300,RC,,OUTPATIENT,,,948,379.2,UC HEALTH,UC HEALTH COMMERCIAL,824.76,87,,,OTHER,711,929.04,PERCENT OF TOTAL BILLED CHARGES
CYLERT (PEMOLINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
PYRUVIC ACID B,84210,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UC HEALTH,UC HEALTH COMMERCIAL,159.8625,87,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
OLIGOCLONAL BAND SERUM,83916,CPT,301,RC,,OUTPATIENT,,,83.5,33.4,UC HEALTH,UC HEALTH COMMERCIAL,72.645,87,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
Z IGG SERUM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
SEROQUEL (QUETIAPINE),82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z IGG CSF,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z OLIGOCLONAL BAND CSF,8391691,CPT,300,RC,91,OUTPATIENT,,,83.5,33.4,UC HEALTH,UC HEALTH COMMERCIAL,72.645,87,,,OTHER,62.63,81.83,PERCENT OF TOTAL BILLED CHARGES
Z ALBUMIN SERUM,82040,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z ALBUMIN SPINAL FLUID,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UC HEALTH,UC HEALTH COMMERCIAL,58.9425,87,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
CYSTICERCUS ANTIBODY CFS,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
BRAF GENE ANALYSIS,81210,CPT,300,RC,,OUTPATIENT,,,661.5,264.6,UC HEALTH,UC HEALTH COMMERCIAL,575.505,87,,,OTHER,496.13,648.27,PERCENT OF TOTAL BILLED CHARGES
CERULOPLASMIN,82390,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS QUAL BY PCR,87496,CPT,300,RC,,OUTPATIENT,,,204.5,81.8,UC HEALTH,UC HEALTH COMMERCIAL,177.915,87,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS ANTIBODY IGM,86645,CPT,300,RC,,OUTPATIENT,,,159.25,63.7,UC HEALTH,UC HEALTH COMMERCIAL,138.5475,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
Z HERPES SIMPLEX NON SPEC TYPE,86694,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,UC HEALTH,UC HEALTH COMMERCIAL,31.9725,87,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
Z RUBELLA IGM,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
Z CMV IGM,86645,CPT,300,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
LEPTIN LEVEL,83520,CPT,300,RC,,OUTPATIENT,,,263.75,105.5,UC HEALTH,UC HEALTH COMMERCIAL,229.4625,87,,,OTHER,197.81,258.48,PERCENT OF TOTAL BILLED CHARGES
CYTOLOGY SPUTUM/FLUIDS,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
POSACONAZOLE,80187,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,UC HEALTH,UC HEALTH COMMERCIAL,277.095,87,,,OTHER,238.88,312.13,PERCENT OF TOTAL BILLED CHARGES
CYTOLOGY URINE,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
HLA B5701 GENOTY PHARMACOGENOM,81381,CPT,300,RC,,OUTPATIENT,,,405,162,UC HEALTH,UC HEALTH COMMERCIAL,352.35,87,,,OTHER,303.75,396.9,PERCENT OF TOTAL BILLED CHARGES
CD20 TOTAL COUNT,86356,CPT,300,RC,,OUTPATIENT,,,272.25,108.9,UC HEALTH,UC HEALTH COMMERCIAL,236.8575,87,,,OTHER,204.19,266.81,PERCENT OF TOTAL BILLED CHARGES
ABSOLUTE CD4 & CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UC HEALTH,UC HEALTH COMMERCIAL,93.7425,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
LYSE CELLS FOR NUCLEIC EXTRACT,83907,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UC HEALTH,UC HEALTH COMMERCIAL,120.7125,87,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
Z T CELLS  TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,75.46,30.184,UC HEALTH,UC HEALTH COMMERCIAL,65.6502,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
Z CD4 & CD8 ABSOLUTE COUNT,86360,CPT,300,RC,,OUTPATIENT,,,107.75,43.1,UC HEALTH,UC HEALTH COMMERCIAL,93.7425,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
PROPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
NORPOXYPHENE DARVON,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
DEXTROSTIX,82948,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE PCX REAGENT STRIP,82962,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
CHLORIDE,82435,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNODIFFUSION OUCHTERLONY,8633191,CPT,300,RC,91,OUTPATIENT,,,30,12,UC HEALTH,UC HEALTH COMMERCIAL,26.1,87,,,OTHER,22.5,29.4,PERCENT OF TOTAL BILLED CHARGES
CSF CHLORIDE,82438,CPT,300,RC,,OUTPATIENT,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METABOLITES,82542,CPT,301,RC,,OUTPATIENT,,,465.75,186.3,UC HEALTH,UC HEALTH COMMERCIAL,405.2025,87,,,OTHER,349.31,456.44,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z THIOPURINE METABOLITES,8249191,CPT,300,RC,91,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
DIHYDROTESTOSTRONE ASSEY,G0480,HCPCS,300,RC,,BOTH,,,258.75,103.5,UC HEALTH,UC HEALTH COMMERCIAL,225.1125,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
DIHYDROPYRIMIDINE DEHYDROGENAS,81400,CPT,300,RC,,OUTPATIENT,,,557.5,223,UC HEALTH,UC HEALTH COMMERCIAL,485.025,87,,,OTHER,418.13,546.35,PERCENT OF TOTAL BILLED CHARGES
INSULIN-LIKE GROWTH FACTOR-2,83519,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UC HEALTH,UC HEALTH COMMERCIAL,182.265,87,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE SERUM,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
DIPTHERIA ANTIBODY,86648,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
DIPTHERIA TOXOID IGG AB,86317,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
PHENOTHIAZINE,82542,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UC HEALTH,UC HEALTH COMMERCIAL,59.8125,87,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
CHOLESTEROL,82465,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METABOLITES,80299,CPT,300,RC,,OUTPATIENT,,,417,166.8,UC HEALTH,UC HEALTH COMMERCIAL,362.79,87,,,OTHER,312.75,408.66,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEINS  BLOOD,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
PROTEIN ELECTROPHORESIS BDY FL,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UC HEALTH,UC HEALTH COMMERCIAL,133.7625,87,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN ELECTROPHORESIS,84165,CPT,300,RC,,OUTPATIENT,,,20,8,UC HEALTH,UC HEALTH COMMERCIAL,17.4,87,,,OTHER,30.38,39.69,PERCENT OF TOTAL BILLED CHARGES
IG PARAPROTEIN QUAL BLD/UR,0077U,HCPCS,300,RC,,INPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.8,51.9,PERCENT OF TOTAL BILLED CHARGES
ENCAINIDE,82542,CPT,301,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS PANEL ACUTE,80074,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,UC HEALTH,UC HEALTH COMMERCIAL,168.5625,87,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
ESTRIOL SERUM,82677,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
ESTRONE,82679,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
ETHOSUXIMIDE (ZARONTIN),80168,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR IX,85250,CPT,305,RC,,OUTPATIENT,,,371.75,148.7,UC HEALTH,UC HEALTH COMMERCIAL,323.4225,87,,,OTHER,278.81,364.32,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR V,85220,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
FACTOR V LEIDEN,81241,CPT,300,RC,,OUTPATIENT,,,201.75,80.7,UC HEALTH,UC HEALTH COMMERCIAL,175.5225,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
FACTOR VIII INHIBITOR,85335,CPT,300,RC,,OUTPATIENT,,,287.25,114.9,UC HEALTH,UC HEALTH COMMERCIAL,249.9075,87,,,OTHER,215.44,281.51,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR VII,85230,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR VIII,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,UC HEALTH,UC HEALTH COMMERCIAL,241.425,87,,,OTHER,208.13,271.95,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR II ACTIVITY,85210,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
HAGEMAN COAGULATION FACTOR XII,85280,CPT,305,RC,,OUTPATIENT,,,200.25,80.1,UC HEALTH,UC HEALTH COMMERCIAL,174.2175,87,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
COLD AGGLUTININ TITER,86156,CPT,302,RC,,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
C1 ESTERASE INHIBITOR,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C3,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C1Q,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C2 ANTIGEN,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT C4,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT FACTOR B,86160,CPT,300,RC,,OUTPATIENT,,,131.75,52.7,UC HEALTH,UC HEALTH COMMERCIAL,114.6225,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
COMPLEMENT TOTAL (CH5O),86162,CPT,300,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CHLAMYDIA ANTIBODY IGG,86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),86631,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGG (PANEL TEST),8663191,CPT,300,RC,91,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
COPPER LEVEL,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
COPPER URINE 24 HR,82525,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CORTISOL,82533,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
CPK TOTAL ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UC HEALTH,UC HEALTH COMMERCIAL,85.695,87,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CPK MB FRACTION,82553,CPT,301,RC,,OUTPATIENT,,,281,112.4,UC HEALTH,UC HEALTH COMMERCIAL,244.47,87,,,OTHER,210.75,275.38,PERCENT OF TOTAL BILLED CHARGES
Z CPK ISO,82552,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
Z CK ASSAY,82550,CPT,301,RC,,OUTPATIENT,,,98.5,39.4,UC HEALTH,UC HEALTH COMMERCIAL,85.695,87,,,OTHER,73.88,96.53,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),86632,CPT,300,RC,,OUTPATIENT,,,35.75,14.3,UC HEALTH,UC HEALTH COMMERCIAL,31.1025,87,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,UC HEALTH,UC HEALTH COMMERCIAL,31.1025,87,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CHLAM IGM (PANEL TEST),8663291,CPT,300,RC,91,OUTPATIENT,,,35.75,14.3,UC HEALTH,UC HEALTH COMMERCIAL,31.1025,87,,,OTHER,26.81,35.04,PERCENT OF TOTAL BILLED CHARGES
CREATININE ASSAY,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,OUTPATIENT,,,239,95.6,UC HEALTH,UC HEALTH COMMERCIAL,207.93,87,,,OTHER,179.25,234.22,PERCENT OF TOTAL BILLED CHARGES
CRP HIGH SENSITIVITY,86141,CPT,302,RC,,OUTPATIENT,,,125.75,50.3,UC HEALTH,UC HEALTH COMMERCIAL,109.4025,87,,,OTHER,94.31,123.24,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSA,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SSB,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SM,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA RNP,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA SCL 70,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
Z ENA JO1,86235XU,CPT,,,XU,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,UC HEALTH,UC HEALTH COMMERCIAL,56.7675,87,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
Z URINE CREATININE,82570,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE KETONES,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE COCAINE CONFIRMATORY,80353,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
CRYOFIBRINOGEN,82585,CPT,300,RC,,OUTPATIENT,,,36.75,14.7,UC HEALTH,UC HEALTH COMMERCIAL,31.9725,87,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
CRYOGLOBULIN,82595,CPT,300,RC,,OUTPATIENT,,,32,12.8,UC HEALTH,UC HEALTH COMMERCIAL,27.84,87,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
FATS URINE STAIN,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UC HEALTH,UC HEALTH COMMERCIAL,59.3775,87,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
FATS URINE QUALITATIVE,89125,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UC HEALTH,UC HEALTH COMMERCIAL,59.3775,87,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
NMR LIPOPROTEIN PROFILE,83704,CPT,301,RC,,OUTPATIENT,,,100,40,UC HEALTH,UC HEALTH COMMERCIAL,87,87,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
FELBATOL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
SIROLIMUS,8019559,CPT,,,59,OUTPATIENT,,,402.25,160.9,UC HEALTH,UC HEALTH COMMERCIAL,349.9575,87,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,8718191,CPT,306,RC,91,OUTPATIENT,,,101.75,40.7,UC HEALTH,UC HEALTH COMMERCIAL,88.5225,87,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
Z ANAEROBIC SENSITIVITY,87181,CPT,306,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
DNA RNA SEQUENCING,87153,CPT,300,RC,,OUTPATIENT,,,361,144.4,UC HEALTH,UC HEALTH COMMERCIAL,314.07,87,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
ANAEROBIC ISOLATE  ID,87076,CPT,306,RC,,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTES STOOL,83630,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CLOZAPINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
CULTURE SPECIMEN BACTERIA,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CLOTEST,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
"MYCOBACTERIAL CULTURE, BLOOD",87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
TB TEST,3003032,CDM,,,,INPATIENT,,,36.75,14.7,UC HEALTH,UC HEALTH COMMERCIAL,31.9725,87,,,OTHER,27.56,36.02,PERCENT OF TOTAL BILLED CHARGES
VECTRA,3003033,CDM,,,,OUTPATIENT,,,29.25,11.7,UC HEALTH,UC HEALTH COMMERCIAL,25.4475,87,,,OTHER,21.94,28.67,PERCENT OF TOTAL BILLED CHARGES
CULTURE SMEAR GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UC HEALTH,UC HEALTH COMMERCIAL,200.7525,87,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
VIRUS ISO/TISS CUL/OBSV/ID(SO),87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UC HEALTH,UC HEALTH COMMERCIAL,200.7525,87,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
VIRUS EA ISO ID  TISS CUL  SO,87253,CPT,300,RC,,OUTPATIENT,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HANTA VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
HANTA VIRUS IGM,8679091,CPT,300,RC,91,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
JC VIRUS,87799,CPT,300,RC,,OUTPATIENT,,,543,217.2,UC HEALTH,UC HEALTH COMMERCIAL,472.41,87,,,OTHER,407.25,532.14,PERCENT OF TOTAL BILLED CHARGES
ST LOUIS ENCEPHALITIS IGG,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
ST LOUIS ENCEPHALITIS IGM,86653,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC (X28),8600391,CPT,300,RC,91,OUTPATIENT,,,994.25,397.7,UC HEALTH,UC HEALTH COMMERCIAL,864.9975,87,,,OTHER,745.69,974.37,PERCENT OF TOTAL BILLED CHARGES
Z VIRUS IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z VIRUS IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
FLUID CRYSTALS EXAM,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,UC HEALTH,UC HEALTH COMMERCIAL,74.82,87,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
B PERTUSSIS SMEAR BY DFA,87265,CPT,306,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
SMEAR BLOOD-PARASITES,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UC HEALTH,UC HEALTH COMMERCIAL,93.525,87,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
CULTURE AFB,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
SMEAR INTER ONLY  W/WO CELL CT,85097,CPT,310,RC,,OUTPATIENT,,,1307.81,523.124,UC HEALTH,UC HEALTH COMMERCIAL,1137.7947,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
CYCLOSPORA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UC HEALTH,UC HEALTH COMMERCIAL,93.525,87,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
MICROSPORIDIA CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAIN,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UC HEALTH,UC HEALTH COMMERCIAL,93.525,87,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
SMITH (ENA) ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
JO 1 ANTIBODY   IGG,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
SEPARTN BY GEL ELECTROPHORESIS,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
ENTROVIRUS PANEL II,86658,CPT,300,RC,,OUTPATIENT,,,1295.25,518.1,UC HEALTH,UC HEALTH COMMERCIAL,1126.8675,87,,,OTHER,971.44,1269.35,PERCENT OF TOTAL BILLED CHARGES
FIBRINOLYSINS/COAG SCR REPORT,85390,CPT,300,RC,,OUTPATIENT,,,57,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.59,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
CULTURE AEROBIC,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS TOTAL AB,0064U,CPT,300,RC,,OUTPATIENT,,,120,48,UC HEALTH,UC HEALTH COMMERCIAL,104.4,87,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
AFB CULTURE,87116,CPT,300,RC,,OUTPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
CULTURE ANAEROBIC,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,UC HEALTH,UC HEALTH COMMERCIAL,160.515,87,,,OTHER,138.38,180.81,PERCENT OF TOTAL BILLED CHARGES
CULTURE AFB W/DEFINITIVE ID,87118,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,UC HEALTH,UC HEALTH COMMERCIAL,153.555,87,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
CULTURE BLOOD,8704091,CPT,306,RC,91,OUTPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE IGG,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE IGM,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,UC HEALTH,UC HEALTH COMMERCIAL,98.0925,87,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
CULTURE BLOOD MULTIPLE SITES,8704059,CPT,306,RC,59,OUTPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
ENTEROVIRUS DETECTION RT-PCR,87498,CPT,306,RC,,OUTPATIENT,,,176.5,70.6,UC HEALTH,UC HEALTH COMMERCIAL,153.555,87,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE VIRUS AB IGM CSF,86788,CPT,300,RC,,OUTPATIENT,,,112.75,45.1,UC HEALTH,UC HEALTH COMMERCIAL,98.0925,87,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
Z WEST NILE VIRUS AB IGG CSF,86789,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
ENTEROVIRUS RNA QUAL RT PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN-BARR VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
WEST NILE VIRUS  RNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,395,158,UC HEALTH,UC HEALTH COMMERCIAL,343.65,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
PHEUMOCYSTIS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
CREATININE BODY FLUID,82570,CPT,301,RC,,OUTPATIENT,,,102.5,41,UC HEALTH,UC HEALTH COMMERCIAL,89.175,87,,,OTHER,76.88,100.45,PERCENT OF TOTAL BILLED CHARGES
BK VIRUS DNA BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
CREATININE OTHER SOURCE,82570,CPT,301,RC,,OUTPATIENT,,,65.25,26.1,UC HEALTH,UC HEALTH COMMERCIAL,56.7675,87,,,OTHER,48.94,63.95,PERCENT OF TOTAL BILLED CHARGES
BK VIRUS PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
MALARIA MODLECULAR DETECT PCR,87798,CPT,306,RC,,OUTPATIENT,,,255.75,102.3,UC HEALTH,UC HEALTH COMMERCIAL,222.5025,87,,,OTHER,191.81,250.64,PERCENT OF TOTAL BILLED CHARGES
AFB SMEAR,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
AFB SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
SIGNAL RECOGNITION PROTEIN,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,UC HEALTH,UC HEALTH COMMERCIAL,271.005,87,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS ANALYSIS,8827591,CPT,310,RC,91,OUTPATIENT,,,311.5,124.6,UC HEALTH,UC HEALTH COMMERCIAL,271.005,87,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS FRAGILE X,88248,CPT,310,RC,,OUTPATIENT,,,1778.75,711.5,UC HEALTH,UC HEALTH COMMERCIAL,1547.5125,87,,,OTHER,1334.06,1743.18,PERCENT OF TOTAL BILLED CHARGES
CULTURE BODY FLUID,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CHROM & DNA ANAL FRAGILE-X,81243,CPT,310,RC,,OUTPATIENT,,,375,150,UC HEALTH,UC HEALTH COMMERCIAL,326.25,87,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS - DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS ANALY 100-300,88275,CPT,300,RC,,OUTPATIENT,,,311.5,124.6,UC HEALTH,UC HEALTH COMMERCIAL,271.005,87,,,OTHER,233.63,305.27,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETICS/MOLECULAR REPORT,88291,CPT,310,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CYTOGENECTICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,UC HEALTH,UC HEALTH COMMERCIAL,296.235,87,,,OTHER,255.38,333.69,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANLY TISSUE CULT,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,UC HEALTH,UC HEALTH COMMERCIAL,579.2025,87,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
G-6 PD,82955,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CYSTICERCOSIS IGG SERUM,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
QUANTITATION THERAPY DRUG,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW ANALYSIS,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
GLOMERULAR ANTIBODIES IGA&IGG,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
GLIAD ANTIBODY - IGA,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GLIADIN IGG ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GLIADIN IGA ANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 1,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 2,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 3,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 4,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 5,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z GANGLIOSIDE ANTIBODY PANEL 6,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z STRIATIONAL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INTERLEUKIN 8,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INTERLEUKIN 6,83520,CPT,300,RC,,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
STREP A ANTIGEN,87880,CPT,300,RC,,OUTPATIENT,,,38.75,15.5,UC HEALTH,UC HEALTH COMMERCIAL,33.7125,87,,,OTHER,29.06,37.98,PERCENT OF TOTAL BILLED CHARGES
CULTURE FUNGAL,87101,CPT,306,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
GROUP B STREP ANTIGEN - SERUM,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCUS ANTIGEN CSF,87327,CPT,300,RC,,OUTPATIENT,,,141,56.4,UC HEALTH,UC HEALTH COMMERCIAL,122.67,87,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE BLOOD FUNGUS,87103,CPT,300,RC,,OUTPATIENT,,,127,50.8,UC HEALTH,UC HEALTH COMMERCIAL,110.49,87,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
Z SPECIMEN CONCENTRATION,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCUS ANTIGEN LTX AGGLU,86403,CPT,300,RC,,OUTPATIENT,,,155.5,62.2,UC HEALTH,UC HEALTH COMMERCIAL,135.285,87,,,OTHER,116.63,152.39,PERCENT OF TOTAL BILLED CHARGES
CULTURE GC,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CULTURE GENITAL,87070,CPT,306,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
Z CADMIUM,82300,CPT,301,RC,,OUTPATIENT,,,61.75,24.7,UC HEALTH,UC HEALTH COMMERCIAL,53.7225,87,,,OTHER,46.31,60.52,PERCENT OF TOTAL BILLED CHARGES
Z ARSENIC,82175,CPT,301,RC,,OUTPATIENT,,,54.75,21.9,UC HEALTH,UC HEALTH COMMERCIAL,47.6325,87,,,OTHER,41.06,53.66,PERCENT OF TOTAL BILLED CHARGES
Z MERCURY  QUANTITATIVE,83825,CPT,301,RC,,OUTPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
Z LEAD,83655,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI (DCMH),86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,UC HEALTH,UC HEALTH COMMERCIAL,97.2225,87,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI ANTIGEN,87338,CPT,306,RC,,OUTPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI IGM,86677,CPT,302,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CADASIL,81406,CPT,300,RC,,OUTPATIENT,,,3619,1447.6,UC HEALTH,UC HEALTH COMMERCIAL,3148.53,87,,,OTHER,2714.25,3546.62,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR DIAG ISO/EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGG,86677,CPT,302,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGA,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
Z HELICOBACTER PYLORI IGM,8667791,CPT,300,RC,91,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
HEMAGLOBIN PLASMA,83051,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN BARR VIRUS IGG ERLY AG,86663,CPT,300,RC,,OUTPATIENT,,,111.75,44.7,UC HEALTH,UC HEALTH COMMERCIAL,97.2225,87,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
SMEAR EXAM W/MANUAL DIFF,85007,CPT,305,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN-BARR VIRUS PANEL 2,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
HEMOGRAM,85027,CPT,305,RC,,OUTPATIENT,,,58.75,23.5,UC HEALTH,UC HEALTH COMMERCIAL,51.1125,87,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
EPSTEIN BARR VIRUS AB VIRAL,86665,CPT,300,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
PLATELET  AUTO,85049,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
PLATELET NEUTRALIZATION,85597,CPT,300,RC,,OUTPATIENT,,,178,71.2,UC HEALTH,UC HEALTH COMMERCIAL,154.86,87,,,OTHER,133.5,174.44,PERCENT OF TOTAL BILLED CHARGES
PLATELET ANTIBODIES SERUM,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,UC HEALTH,UC HEALTH COMMERCIAL,290.145,87,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
HIV 1-2 AG AB EVAL,G0475,HCPCS,300,RC,,BOTH,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
HIV 1 ANTIBODY RAPID SCREEN,86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
HIV 1 ANTIBODY DIFFERENTIATION,86701,CPT,300,RC,,OUTPATIENT,,,174.5,69.8,UC HEALTH,UC HEALTH COMMERCIAL,151.815,87,,,OTHER,130.88,171.01,PERCENT OF TOTAL BILLED CHARGES
MONO SCREEN,86318,CPT,302,RC,,OUTPATIENT,,,111.75,44.7,UC HEALTH,UC HEALTH COMMERCIAL,97.2225,87,,,OTHER,83.81,109.52,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS BY PCR,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UC HEALTH,UC HEALTH COMMERCIAL,91.35,87,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS TYPE 2,86696,CPT,300,RC,,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX VIRUS TYPE 1,86695,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
HERPES SIMPLEX AMPLIFIED PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UC HEALTH,UC HEALTH COMMERCIAL,91.35,87,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
HSV AB IGM BY IFA,86694,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
AMPLIFIED PROBE TECHE EA ORGNS,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
HISTONE ANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,86698,CPT,300,RC,,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
Z HISTOPLASMA ANTIBODY,8669891,CPT,300,RC,91,OUTPATIENT,,,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.535,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
TYSABRI IMMUNOGENICITY,83516,CPT,300,RC,,OUTPATIENT,,,547,218.8,UC HEALTH,UC HEALTH COMMERCIAL,475.89,87,,,OTHER,410.25,536.06,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION DIAGNOS,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.9,151.4,PERCENT OF TOTAL BILLED CHARGES
HIV 1/2 AB. EVALUATION,G0432,HCPCS,300,RC,,BOTH,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HIV-1 GENOTYPE REFLEX TO PHENO,87901,CPT,300,RC,,OUTPATIENT,,,1378.75,551.5,UC HEALTH,UC HEALTH COMMERCIAL,1199.5125,87,,,OTHER,1034.06,1351.18,PERCENT OF TOTAL BILLED CHARGES
HIV-1 PHENOTYPIC RESIST PRE,87900,CPT,300,RC,,OUTPATIENT,,,673.5,269.4,UC HEALTH,UC HEALTH COMMERCIAL,585.945,87,,,OTHER,505.13,660.03,PERCENT OF TOTAL BILLED CHARGES
HIV-1,86703,CPT,300,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
HIV ANTIBODY TYPE 2 SCREEN,86702,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE HEALTH HIV (SOURCE),86701,CPT,300,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1/2 CONFIRMATORY EVAL,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,UC HEALTH,UC HEALTH COMMERCIAL,161.1675,87,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE SGPT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
HIV TYPE 1 CONFIRMATION BY IFA,86689,CPT,300,RC,,OUTPATIENT,,,185.25,74.1,UC HEALTH,UC HEALTH COMMERCIAL,161.1675,87,,,OTHER,138.94,181.55,PERCENT OF TOTAL BILLED CHARGES
CULTURE STOOL,87045,CPT,306,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
HIV RNA QUANT BY PCR,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,UC HEALTH,UC HEALTH COMMERCIAL,389.9775,87,,,OTHER,336.19,439.29,PERCENT OF TOTAL BILLED CHARGES
MOLECU DIAG ISOLATION/EXTRACTI,83890,CPT,301,RC,,OUTPATIENT,,,1153,461.2,UC HEALTH,UC HEALTH COMMERCIAL,1003.11,87,,,OTHER,864.75,1129.94,PERCENT OF TOTAL BILLED CHARGES
HIV ULTRA SENSITIVE RNA QNT,87536,CPT,306,RC,,OUTPATIENT,,,448.25,179.3,UC HEALTH,UC HEALTH COMMERCIAL,389.9775,87,,,OTHER,336.19,439.29,PERCENT OF TOTAL BILLED CHARGES
CULTURE ID BACTERIA,87077,CPT,306,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
HLA-A&B PHENOTYPE,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,UC HEALTH,UC HEALTH COMMERCIAL,561.8025,87,,,OTHER,484.31,632.84,PERCENT OF TOTAL BILLED CHARGES
CULTURE URINE,87088,CPT,306,RC,,OUTPATIENT,,,130.5,52.2,UC HEALTH,UC HEALTH COMMERCIAL,113.535,87,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
HLA B 5701,81381,CPT,300,RC,,OUTPATIENT,,,755.25,302.1,UC HEALTH,UC HEALTH COMMERCIAL,657.0675,87,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
CULTURE VIRUS NON RESPIRATORY,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UC HEALTH,UC HEALTH COMMERCIAL,200.7525,87,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
HLA TYPING  DR/DQ,86817,CPT,300,RC,,OUTPATIENT,,,485.25,194.1,UC HEALTH,UC HEALTH COMMERCIAL,422.1675,87,,,OTHER,363.94,475.55,PERCENT OF TOTAL BILLED CHARGES
HOMOCYSTINE TOTAL,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UC HEALTH,UC HEALTH COMMERCIAL,163.125,87,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
HOMOVANILLIC ACID URINE,83150,CPT,300,RC,,OUTPATIENT,,,167.25,66.9,UC HEALTH,UC HEALTH COMMERCIAL,145.5075,87,,,OTHER,125.44,163.91,PERCENT OF TOTAL BILLED CHARGES
BENZENE BLOOD,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
HYPOGLYCEMIC AGENT SCREEN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PM SCL ANTIBODY ID,86331,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
CYCLOSPORINE ASSAY,80158,CPT,300,RC,,OUTPATIENT,,,330,132,UC HEALTH,UC HEALTH COMMERCIAL,287.1,87,,,OTHER,247.5,323.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNOELECTRO-SERUM (IFE),86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UC HEALTH,UC HEALTH COMMERCIAL,189.225,87,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
INHIBIN A TUMOR MARKER,86336,CPT,300,RC,,OUTPATIENT,,,117,46.8,UC HEALTH,UC HEALTH COMMERCIAL,101.79,87,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UC HEALTH,UC HEALTH COMMERCIAL,189.225,87,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFIXATION CRYOGLOBULIN,86334,CPT,300,RC,,OUTPATIENT,,,217.5,87,UC HEALTH,UC HEALTH COMMERCIAL,189.225,87,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
IGA,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DHEA-S,82627,CPT,301,RC,,OUTPATIENT,,,216.5,86.6,UC HEALTH,UC HEALTH COMMERCIAL,188.355,87,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
IGD,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DHEA,82626,CPT,300,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
DESIPRAMINE (NORPRAMINE),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM,80177,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
ANCA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
MUMPS VIRUS CULTURE,87252,CPT,306,RC,,OUTPATIENT,,,230.75,92.3,UC HEALTH,UC HEALTH COMMERCIAL,200.7525,87,,,OTHER,173.06,226.14,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM (VALIUM),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IGG,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,UC HEALTH,UC HEALTH COMMERCIAL,48.5025,87,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z SPOTTED FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,UC HEALTH,UC HEALTH COMMERCIAL,48.5025,87,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
DIGITOXIN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
IGM,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
ALPRAZOLAM (XANAX),80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IBUPROFEN,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
LORAZAPAM SERUM,80346,CPT,300,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
DULOXETINE (CYMBALTA),G0480,HCPCS,300,RC,,BOTH,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGA),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGG),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
Z GAMMA GLOBULIN ASSAY (IGM),82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN,80162,CPT,301,RC,,OUTPATIENT,,,150.75,60.3,UC HEALTH,UC HEALTH COMMERCIAL,131.1525,87,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
Z ANTITHROMBIN III ACTIVITY,85300,CPT,300,RC,,OUTPATIENT,,,88.75,35.5,UC HEALTH,UC HEALTH COMMERCIAL,77.2125,87,,,OTHER,66.56,86.98,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,159.75,63.9,UC HEALTH,UC HEALTH COMMERCIAL,138.9825,87,,,OTHER,119.81,156.56,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S ANTIGEN  FREE,85306,CPT,300,RC,,OUTPATIENT,,,235.75,94.3,UC HEALTH,UC HEALTH COMMERCIAL,205.1025,87,,,OTHER,176.81,231.04,PERCENT OF TOTAL BILLED CHARGES
Z D DIMER,85379,CPT,300,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
Z PLASMINOGEN ACTIVITY,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
Z PT (PROTIME),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
Z DRVVT MIX,85613,CPT,305,RC,,OUTPATIENT,,,70.75,28.3,UC HEALTH,UC HEALTH COMMERCIAL,61.5525,87,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
Z THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,UC HEALTH,UC HEALTH COMMERCIAL,96.7875,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
Z APTT,85730,CPT,300,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389291,CPT,300,RC,91,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,8390391,CPT,300,RC,91,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,8391291,CPT,300,RC,91,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
Z INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
HAEMOPHILUS INFLUENZA B IGG,86684,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,UC HEALTH,UC HEALTH COMMERCIAL,95.0475,87,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A&B VIRUS ANTIBODIES,86710,CPT,302,RC,,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
NORPACE (DISOPRYAMIDE),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
QUANTITATION THERAPEUTIC DRUG,80299,CPT,300,RC,,OUTPATIENT,,,382.25,152.9,UC HEALTH,UC HEALTH COMMERCIAL,332.5575,87,,,OTHER,286.69,374.61,PERCENT OF TOTAL BILLED CHARGES
INSULIN GROWTH BINDING,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
INSULIN GROWTH FACTOR I,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UC HEALTH,UC HEALTH COMMERCIAL,170.955,87,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
DOXEPINE SERUM,80166,CPT,300,RC,,OUTPATIENT,,,216.5,86.6,UC HEALTH,UC HEALTH COMMERCIAL,188.355,87,,,OTHER,162.38,212.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN  TOTAL,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
INSULIN  FREE,83527,CPT,301,RC,,OUTPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
CALCIUM IONIZED,82330,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ISLET CELL ANITBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
DNASE-B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
Z DNASE B ANTIBODY,86215,CPT,300,RC,,OUTPATIENT,,,39.5,15.8,UC HEALTH,UC HEALTH COMMERCIAL,34.365,87,,,OTHER,29.63,38.71,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIP/OTC GASTRIC,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIP/OTC PLASMA,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
L/S FETAL LUNG,83661,CPT,301,RC,,OUTPATIENT,,,101,40.4,UC HEALTH,UC HEALTH COMMERCIAL,87.87,87,,,OTHER,75.75,98.98,PERCENT OF TOTAL BILLED CHARGES
DRUG MISC MED TOX LABORATORIES,99999,CPT,300,RC,,OUTPATIENT,,,286,114.4,UC HEALTH,UC HEALTH COMMERCIAL,248.82,87,,,OTHER,214.5,280.28,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREEN URINE (MEDTOX),3003900,CDM,,,,INPATIENT,,,42,16.8,UC HEALTH,UC HEALTH COMMERCIAL,36.54,87,,,OTHER,31.5,41.16,PERCENT OF TOTAL BILLED CHARGES
DRUG SCR PRESCRIPTION/OTC URIN,80307,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREENING ETOH,80320,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
DRUG SCREENING BARBITURATES,80345,CPT,300,RC,,OUTPATIENT,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
DRAWING FEE-SPEC KIT,36415,CPT,300,RC,,OUTPATIENT,,,50.75,20.3,UC HEALTH,UC HEALTH COMMERCIAL,44.1525,87,,,OTHER,38.06,49.74,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B DNA QUALITATIVE,87516,CPT,306,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
LDH TOTAL DIRECT,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
EOSINOPHIL COUNT,85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
LIPID PANEL,80061,CPT,300,RC,,OUTPATIENT,,,138,55.2,UC HEALTH,UC HEALTH COMMERCIAL,120.06,87,,,OTHER,103.5,135.24,PERCENT OF TOTAL BILLED CHARGES
EOSINOPHILS URINE,87205,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN ELECTROPHORESIS,83700,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,UC HEALTH,UC HEALTH COMMERCIAL,318.855,87,,,OTHER,274.88,359.17,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN WITH LDL HDL PART,83704,CPT,301,RC,,OUTPATIENT,,,212.75,85.1,UC HEALTH,UC HEALTH COMMERCIAL,185.0925,87,,,OTHER,159.56,208.5,PERCENT OF TOTAL BILLED CHARGES
LOW DENSITY LIPOPROTEIN,83721,CPT,301,RC,,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
LH LUTEINIZING HORMONE,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,UC HEALTH,UC HEALTH COMMERCIAL,152.685,87,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
LUTEINIZING HORMONE BY ICMA,83002,CPT,301,RC,,OUTPATIENT,,,175.5,70.2,UC HEALTH,UC HEALTH COMMERCIAL,152.685,87,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
"HLA CLASS II TYPING, LOW RESOL",81376,CPT,300,RC,,OUTPATIENT,,,244.44,97.776,UC HEALTH,UC HEALTH COMMERCIAL,212.6628,87,,,OTHER,155.63,203.35,PERCENT OF TOTAL BILLED CHARGES
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,OUTPATIENT,,,521.25,208.5,UC HEALTH,UC HEALTH COMMERCIAL,453.4875,87,,,OTHER,390.94,510.83,PERCENT OF TOTAL BILLED CHARGES
ASCORBIC ACID BLOOD,82180,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,UC HEALTH,UC HEALTH COMMERCIAL,122.0175,87,,,OTHER,105.19,137.45,PERCENT OF TOTAL BILLED CHARGES
METHYLENETETRAHYDROFOLATE REDC,81291,CPT,300,RC,,OUTPATIENT,,,571,228.4,UC HEALTH,UC HEALTH COMMERCIAL,496.77,87,,,OTHER,428.25,559.58,PERCENT OF TOTAL BILLED CHARGES
Z EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
Z DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBES,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCREEN,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
METHYLMALONIC ACID URINE,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,UC HEALTH,UC HEALTH COMMERCIAL,161.385,87,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
EBNA,86664,CPT,300,RC,,OUTPATIENT,,,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.455,87,,,OTHER,34.88,45.57,PERCENT OF TOTAL BILLED CHARGES
METHYLMALONIC ACID  SERUM,83921,CPT,301,RC,,OUTPATIENT,,,185.5,74.2,UC HEALTH,UC HEALTH COMMERCIAL,161.385,87,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
Z SIGNAL AMPLIFICATION,83908,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
Z SIGNAL AMPLIFICATION,8390891,CPT,300,RC,91,OUTPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
EBV IGG,86665,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UC HEALTH,UC HEALTH COMMERCIAL,38.4975,87,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
EBV IGM,8666591,CPT,300,RC,91,OUTPATIENT,,,44.25,17.7,UC HEALTH,UC HEALTH COMMERCIAL,38.4975,87,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
EBV DNA DETECTION BY PCR,87799,CPT,300,RC,,OUTPATIENT,,,270.25,108.1,UC HEALTH,UC HEALTH COMMERCIAL,235.1175,87,,,OTHER,202.69,264.85,PERCENT OF TOTAL BILLED CHARGES
EBV BY PCR QUALITATIVE,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
ERYTHROPOIETIN,82668,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
ESTRADIOL,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UC HEALTH,UC HEALTH COMMERCIAL,179.655,87,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
HER-2/NEU QUANTITATIVE,83950,CPT,300,RC,,OUTPATIENT,,,482.75,193.1,UC HEALTH,UC HEALTH COMMERCIAL,419.9925,87,,,OTHER,362.06,473.1,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEN ASSOC PHOSPLIPSE A2,83698,CPT,300,RC,,OUTPATIENT,,,280.5,112.2,UC HEALTH,UC HEALTH COMMERCIAL,244.035,87,,,OTHER,210.38,274.89,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL ETHANOL,80307,CPT,301,RC,,OUTPATIENT,,,182.75,73.1,UC HEALTH,UC HEALTH COMMERCIAL,158.9925,87,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
SEDATIVE HYPNOTIC PANEL URINE,80301,CPT,301,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
MERCURY QUANTITATIVE BLOOD,83825,CPT,301,RC,,OUTPATIENT,,,111.5,44.6,UC HEALTH,UC HEALTH COMMERCIAL,97.005,87,,,OTHER,83.63,109.27,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC ELASTASE,82656,CPT,300,RC,,OUTPATIENT,,,342.75,137.1,UC HEALTH,UC HEALTH COMMERCIAL,298.1925,87,,,OTHER,257.06,335.9,PERCENT OF TOTAL BILLED CHARGES
FECAL FATS QUAL,82705,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB SCREEN CONFIRM,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,UC HEALTH,UC HEALTH COMMERCIAL,63.7275,87,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB,8662259,CPT,302,RC,59,OUTPATIENT,,,73.25,29.3,UC HEALTH,UC HEALTH COMMERCIAL,63.7275,87,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BRUCELLA AB,86622,CPT,300,RC,,OUTPATIENT,,,73.25,29.3,UC HEALTH,UC HEALTH COMMERCIAL,63.7275,87,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
FERN TEST,89060,CPT,300,RC,,OUTPATIENT,,,86,34.4,UC HEALTH,UC HEALTH COMMERCIAL,74.82,87,,,OTHER,64.5,84.28,PERCENT OF TOTAL BILLED CHARGES
FERRITIN,82728,CPT,300,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
METHADONE ASSAY,80358,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
HEAVY METAL-QUANTITATIVE,83018,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
NICKEL SERUM,83885,CPT,300,RC,,OUTPATIENT,,,221.5,88.6,UC HEALTH,UC HEALTH COMMERCIAL,192.705,87,,,OTHER,166.13,217.07,PERCENT OF TOTAL BILLED CHARGES
TITANIUM SERUM,83018,CPT,300,RC,,OUTPATIENT,,,258.75,103.5,UC HEALTH,UC HEALTH COMMERCIAL,225.1125,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
CHROMIUM SERUM,82495,CPT,300,RC,,OUTPATIENT,,,181.25,72.5,UC HEALTH,UC HEALTH COMMERCIAL,157.6875,87,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
METHANOL LEVEL,84600,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
METHEMAGLOBIN,83050,CPT,301,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
CYTOCHROME P450 2D6,81226,CPT,300,RC,,OUTPATIENT,,,942.25,376.9,UC HEALTH,UC HEALTH COMMERCIAL,819.7575,87,,,OTHER,706.69,923.41,PERCENT OF TOTAL BILLED CHARGES
CTTICGRINE P450 3A4V GENOTYPE,81230,CPT,300,RC,,OUTPATIENT,,,787.5,315,UC HEALTH,UC HEALTH COMMERCIAL,685.125,87,,,OTHER,590.63,771.75,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
R FIBRINOGEN ACTIVITY,85384,CPT,300,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
FETAL FIBRONECTIN,82731,CPT,300,RC,,OUTPATIENT,,,427.5,171,UC HEALTH,UC HEALTH COMMERCIAL,371.925,87,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
FETOMATERNAL BLEED FLOW CYTO,88184,CPT,300,RC,,OUTPATIENT,,,851.25,340.5,UC HEALTH,UC HEALTH COMMERCIAL,740.5875,87,,,OTHER,638.44,834.23,PERCENT OF TOTAL BILLED CHARGES
METHYLPHENIDATE (RITALIN),82542,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FETAL HEMOGLOBIN APT,83033,CPT,300,RC,,OUTPATIENT,,,23.25,9.3,UC HEALTH,UC HEALTH COMMERCIAL,20.2275,87,,,OTHER,17.44,22.79,PERCENT OF TOTAL BILLED CHARGES
FLECAINIDE (TAMBOCOR),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FLUOXETINE (PROZAC),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
FLUNITRAZEPAM (ROHYPNOL),82542,CPT,301,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
SERTRALINE ZOLOFT,82542,CPT,301,RC,,OUTPATIENT,,,181.75,72.7,UC HEALTH,UC HEALTH COMMERCIAL,158.1225,87,,,OTHER,136.31,178.12,PERCENT OF TOTAL BILLED CHARGES
ASYMMETRIC DIMETHYL ARGININE,82542,CPT,301,RC,,OUTPATIENT,,,230.5,92.2,UC HEALTH,UC HEALTH COMMERCIAL,200.535,87,,,OTHER,172.88,225.89,PERCENT OF TOTAL BILLED CHARGES
FLUPHENAZINE,84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UC HEALTH,UC HEALTH COMMERCIAL,59.8125,87,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
FOLATE,82746,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
FOLATE RBC,82747,CPT,301,RC,,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
METHYLENE BLUE,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
FREE T3,84481,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
T3 REVERSE,84482,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CARNITINE FREE  TOTAL QUANT,82379,CPT,301,RC,,OUTPATIENT,,,382,152.8,UC HEALTH,UC HEALTH COMMERCIAL,332.34,87,,,OTHER,286.5,374.36,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN-URINE-QUANT,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,UC HEALTH,UC HEALTH COMMERCIAL,78.9525,87,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
MICROSCOPIC EXAM URINE,81015,CPT,307,RC,,OUTPATIENT,,,38.5,15.4,UC HEALTH,UC HEALTH COMMERCIAL,33.495,87,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
MICROALBUMINURIA 24HR,82043,CPT,301,RC,,OUTPATIENT,,,90.75,36.3,UC HEALTH,UC HEALTH COMMERCIAL,78.9525,87,,,OTHER,68.06,88.94,PERCENT OF TOTAL BILLED CHARGES
COXSACKIE B VIRUS ANTIBODIES,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,UC HEALTH,UC HEALTH COMMERCIAL,60.2475,87,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
Z Q FEVER AB IGG,86638,CPT,300,RC,,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
Z Q FEVER AB IGM,8663891,CPT,300,RC,91,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
Q FEVER PCR,87798,CPT,306,RC,,OUTPATIENT,,,603.75,241.5,UC HEALTH,UC HEALTH COMMERCIAL,525.2625,87,,,OTHER,452.81,591.68,PERCENT OF TOTAL BILLED CHARGES
FSH FOLLICLE STIMULATING HARMO,83001,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
CARBAPENEMASE TEST,87185,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,UC HEALTH,UC HEALTH COMMERCIAL,233.8125,87,,,OTHER,201.56,263.38,PERCENT OF TOTAL BILLED CHARGES
GGT GLUTAMYLTRANSFERASE ASSAY,82977,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
GASTRIN,82941,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
GASTROCULT,82271,CPT,300,RC,,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
GASTROINTESTINAL PATHOGENS,87507,CPT,300,RC,,OUTPATIENT,,,833.56,333.424,UC HEALTH,UC HEALTH COMMERCIAL,725.1972,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST (GTT) 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UC HEALTH,UC HEALTH COMMERCIAL,118.755,87,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
MRSA NASAL SURVEILLANCE CULT,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
GENTAMYCIN PEAK,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN TROUGH,80170,CPT,300,RC,,OUTPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE SCREENING 1 HOUR,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TOLERANCE 2 HOUR,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UC HEALTH,UC HEALTH COMMERCIAL,118.755,87,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADD BEYOND 3 SPECIMEN,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON,82943,CPT,301,RC,,OUTPATIENT,,,181.25,72.5,UC HEALTH,UC HEALTH COMMERCIAL,157.6875,87,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE 2HR POST/GLUCOSE,82950,CPT,301,RC,,OUTPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (2),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z GTT EACH ADDITIONAL,8295291,CPT,300,RC,91,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (3),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (4),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
BFL AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
BFL GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
BFL LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
BFL TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
CSF LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
GTT EACH ADDITIONAL (5),82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TEST ADD SAMPLE,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST 3 SPEC,82951,CPT,301,RC,,OUTPATIENT,,,136.5,54.6,UC HEALTH,UC HEALTH COMMERCIAL,118.755,87,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
Z TOLERANCE TEST EA ADD'L SPEC,82952,CPT,301,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
CSF GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE RANDOM,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE FASTING,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE - INSULIN RATIO,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
MUCOPOLYSACCHARIDES  QUAL,83866,CPT,301,RC,,OUTPATIENT,,,236,94.4,UC HEALTH,UC HEALTH COMMERCIAL,205.32,87,,,OTHER,177,231.28,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE 2HR POST/MEAL,82947,CPT,300,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
NEUROMYELITIS OPTICA EVAL,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
NEURONAL CELL ANTIBODIES,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
NEURON SPECIFIC ENOLASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
TUMOR NECROSIS FACTOR - ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
PLASMINOGEN ACTIVATOR INH ANTI,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
VASCULAR ENDOTHELIAL GROWTH,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
TRYPTASE,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE,80299,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
Z SULFATIDE AUTOANTIBODY,83520,CPT,300,RC,,OUTPATIENT,,,443,177.2,UC HEALTH,UC HEALTH COMMERCIAL,385.41,87,,,OTHER,332.25,434.14,PERCENT OF TOTAL BILLED CHARGES
Z SULFATIDE AUTOANTIBODY,8352091,CPT,300,RC,91,OUTPATIENT,,,443,177.2,UC HEALTH,UC HEALTH COMMERCIAL,385.41,87,,,OTHER,332.25,434.14,PERCENT OF TOTAL BILLED CHARGES
NEUTROPHIL CYTOLOGY ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CARDIOLIPIN AB IGA,86147,CPT,300,RC,,OUTPATIENT,,,156.25,62.5,UC HEALTH,UC HEALTH COMMERCIAL,135.9375,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
NORTRIPTYLINE LEVEL,G0480,HCPCS,300,RC,,BOTH,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE (ZYPREXA),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
ORGANIC ACIDS  PLASMA,83918,CPT,301,RC,,OUTPATIENT,,,527.75,211.1,UC HEALTH,UC HEALTH COMMERCIAL,459.1425,87,,,OTHER,395.81,517.2,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC POLYPEPTIDE,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
SECRETIN,83519,CPT,300,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE METABOLIC PANEL,80053,CPT,301,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE ANTIBODY ASSMNT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
COMPREHENSIVE DIGESTIVE STOOL,87075,CPT,306,RC,,OUTPATIENT,,,184.5,73.8,UC HEALTH,UC HEALTH COMMERCIAL,160.515,87,,,OTHER,138.38,180.81,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
PRENATAL PANEL,80055,CPT,300,RC,,OUTPATIENT,,,484.25,193.7,UC HEALTH,UC HEALTH COMMERCIAL,421.2975,87,,,OTHER,363.19,474.57,PERCENT OF TOTAL BILLED CHARGES
Z HGB UNSTABLE SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,25.75,10.3,UC HEALTH,UC HEALTH COMMERCIAL,22.4025,87,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
HCG URINE QUALATATIVE,81025,CPT,300,RC,,OUTPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.75,44.1,PERCENT OF TOTAL BILLED CHARGES
BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,96.25,38.5,UC HEALTH,UC HEALTH COMMERCIAL,83.7375,87,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
FRANCISELLA TULARENSIS DFA,87299,CPT,306,RC,,OUTPATIENT,,,273.75,109.5,UC HEALTH,UC HEALTH COMMERCIAL,238.1625,87,,,OTHER,205.31,268.28,PERCENT OF TOTAL BILLED CHARGES
GRAM STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
HALDOL (HALOPERIDOL),80173,CPT,300,RC,,OUTPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
CRYPTOCOCCAL AG,87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
COAGULATION FACTOR X,85260,CPT,305,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
COAG FACTOR X1 ACTIVITY,85270,CPT,300,RC,,OUTPATIENT,,,170.5,68.2,UC HEALTH,UC HEALTH COMMERCIAL,148.335,87,,,OTHER,127.88,167.09,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE DEAMINASE FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE DEAMINASE BLOOD,82657,CPT,300,RC,,OUTPATIENT,,,127.75,51.1,UC HEALTH,UC HEALTH COMMERCIAL,111.1425,87,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
CHYMOTRYSIN FECAL,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
CHOLESTEROL BODY FLUID,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
HAPTOGLOBIN,83010,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
ELECTROLYTE PANEL,80051,CPT,301,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B19 AG IGG,8674791,CPT,300,RC,91,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B19 AB IGM,86747,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
PARVOVIRUS B-19 PCR PLASMA,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN LATEX,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
LATEX TYPING FOR SALMONELLA,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PECAN-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DOG DANDER IGG,86001,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN COCONUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FOOD & GRAIN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HCG SERUM-QUAL,84703,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PERITONEAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ALPHA GALACTOSIDASE,82657,CPT,300,RC,,OUTPATIENT,,,255.75,102.3,UC HEALTH,UC HEALTH COMMERCIAL,222.5025,87,,,OTHER,191.81,250.64,PERCENT OF TOTAL BILLED CHARGES
PERITONEAL FLUID  LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
ALPHA-GLOBIN GENE ANALYSIS,81269,CPT,300,RC,,OUTPATIENT,,,502,200.8,UC HEALTH,UC HEALTH COMMERCIAL,436.74,87,,,OTHER,376.5,491.96,PERCENT OF TOTAL BILLED CHARGES
PERITONEAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PANCREATIC,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN WALNUT-FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC X20,8600391,CPT,300,RC,91,OUTPATIENT,,,710,284,UC HEALTH,UC HEALTH COMMERCIAL,617.7,87,,,OTHER,532.5,695.8,PERCENT OF TOTAL BILLED CHARGES
HDL CHOLESTEROL,83718,CPT,301,RC,,OUTPATIENT,,,130.5,52.2,UC HEALTH,UC HEALTH COMMERCIAL,113.535,87,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
NASAL EOSINOPHIL SMEAR,89190,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DAIRY & GRAIN PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN DAIRY & GRAIN,8600391,CPT,300,RC,91,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
R LEUKEMIA IMMUNOTYPING,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE HISTAMINE RELEASE,86343,CPT,300,RC,,OUTPATIENT,,,240,96,UC HEALTH,UC HEALTH COMMERCIAL,208.8,87,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO CELL SURF 1ST MRK,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTO EA ADD'L MARKER,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,563.75,225.5,UC HEALTH,UC HEALTH COMMERCIAL,490.4625,87,,,OTHER,422.81,552.48,PERCENT OF TOTAL BILLED CHARGES
FIBRIN SPLIT PRODUCTS,85362,CPT,300,RC,,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTO EA ADD'L MARKER,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
C FLOW CYTOMETRY EA ADD'L,8818559,CPT,310,RC,59,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L,88185,CPT,310,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,UC HEALTH,UC HEALTH COMMERCIAL,46.3275,87,,,OTHER,39.94,52.19,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SPECIFIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,53.25,21.3,UC HEALTH,UC HEALTH COMMERCIAL,46.3275,87,,,OTHER,39.94,52.19,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,130.75,52.3,UC HEALTH,UC HEALTH COMMERCIAL,113.7525,87,,,OTHER,98.06,128.14,PERCENT OF TOTAL BILLED CHARGES
FATTY ACID PROFILE ESSENTIAL,82542,CPT,301,RC,,OUTPATIENT,,,233.25,93.3,UC HEALTH,UC HEALTH COMMERCIAL,202.9275,87,,,OTHER,174.94,228.59,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FOOD MEAT PANEL,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PEANUT,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN FLAXSEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN PISTACHIO,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SESAME SEED,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
ALLERGEN SOYBEAN,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
HEMOSIDERIN,83070,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PHENCYCLIDINE LEVEL,83992,CPT,301,RC,,OUTPATIENT,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
PHENYLALANINE,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
HAAB IGM ANTIBODY,86709,CPT,302,RC,,OUTPATIENT,,,126.75,50.7,UC HEALTH,UC HEALTH COMMERCIAL,110.2725,87,,,OTHER,95.06,124.22,PERCENT OF TOTAL BILLED CHARGES
PHLEBOTOMY  THERAPEUTIC,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,UC HEALTH,UC HEALTH COMMERCIAL,231.42,87,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B SURFACE AB,86706,CPT,300,RC,,OUTPATIENT,,,119,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.53,87,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,57,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.59,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
Z PHOSPHORUS,84100,CPT,301,RC,,OUTPATIENT,,,14.25,5.7,UC HEALTH,UC HEALTH COMMERCIAL,12.3975,87,,,OTHER,10.69,13.97,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB A,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UC HEALTH,UC HEALTH COMMERCIAL,124.845,87,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB G,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UC HEALTH,UC HEALTH COMMERCIAL,124.845,87,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
FETAL LUNG MATURITY,83663,CPT,300,RC,,OUTPATIENT,,,293.5,117.4,UC HEALTH,UC HEALTH COMMERCIAL,255.345,87,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
Z PHOSPHATIDYLGLYCEROL,84081,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLSERINE AB M,86148,CPT,300,RC,,OUTPATIENT,,,143.5,57.4,UC HEALTH,UC HEALTH COMMERCIAL,124.845,87,,,OTHER,107.63,140.63,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B SURFACE ANTIGEN,87340,CPT,300,RC,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
HEPITITIS B ANTIGEN CONFIRMATN,87341,CPT,300,RC,,OUTPATIENT,,,102.5,41,UC HEALTH,UC HEALTH COMMERCIAL,89.175,87,,,OTHER,76.88,100.45,PERCENT OF TOTAL BILLED CHARGES
FILARIA IGG 4 ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT METHOD CULT TYPING,87158,CPT,300,RC,,OUTPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS BE ANTIGEN,87350,CPT,306,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
BAND 3 FLUORESCENCE STAIN RBC,88184,CPT,300,RC,,OUTPATIENT,,,837.25,334.9,UC HEALTH,UC HEALTH COMMERCIAL,728.4075,87,,,OTHER,627.94,820.51,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B VIRAL DNA  QUANT,87517,CPT,300,RC,,OUTPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS BE ANTIBODY,86707,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B CORE ANTIBODY,86704,CPT,300,RC,,OUTPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B CORE AB IGM,86705,CPT,300,RC,,OUTPATIENT,,,180.5,72.2,UC HEALTH,UC HEALTH COMMERCIAL,157.035,87,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS AB,86803,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS RNA QUANT,87522,CPT,300,RC,,OUTPATIENT,,,464,185.6,UC HEALTH,UC HEALTH COMMERCIAL,403.68,87,,,OTHER,348,454.72,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C VIRUS RNA QUAL PCR,87521,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UC HEALTH,UC HEALTH COMMERCIAL,283.8375,87,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D ANTIGEN,87380,CPT,300,RC,,OUTPATIENT,,,321.75,128.7,UC HEALTH,UC HEALTH COMMERCIAL,279.9225,87,,,OTHER,241.31,315.32,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D TOTAL AB,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS D VIRUS AB IGM,86692,CPT,300,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS E ANTIBODY IGM,86790,CPT,300,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS E ANTIBODY IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
AMYLASE PLEURAL FLUID,82150,CPT,301,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
SYNOVIAL FLUID T.P.,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SYNOVIAL FLUID GLUCOSE,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
PORPHOBILINGEN QUANT,84110,CPT,301,RC,,OUTPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS C FIBRO,81596,CPT,300,RC,,OUTPATIENT,,,390,156,UC HEALTH,UC HEALTH COMMERCIAL,339.3,87,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
HCV-RIBA SUPP,86804,CPT,300,RC,,OUTPATIENT,,,348.5,139.4,UC HEALTH,UC HEALTH COMMERCIAL,303.195,87,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
HEP C RNA NSC DRUG RESISTANCE,87902,CPT,300,RC,,OUTPATIENT,,,1007.25,402.9,UC HEALTH,UC HEALTH COMMERCIAL,876.3075,87,,,OTHER,755.44,987.11,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBLIN ELECTRO(EVALUATION,83021,CPT,301,RC,,OUTPATIENT,,,159.25,63.7,UC HEALTH,UC HEALTH COMMERCIAL,138.5475,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
HUNTINGTON DISEASE,81271,CPT,300,RC,,OUTPATIENT,,,592,236.8,UC HEALTH,UC HEALTH COMMERCIAL,515.04,87,,,OTHER,444,580.16,PERCENT OF TOTAL BILLED CHARGES
H PYLORI BREATH TEST,83013,CPT,300,RC,,OUTPATIENT,,,279.75,111.9,UC HEALTH,UC HEALTH COMMERCIAL,243.3825,87,,,OTHER,209.81,274.16,PERCENT OF TOTAL BILLED CHARGES
"HB VARIANT BY MASS SPEC, B",83789,CPT,300,RC,,OUTPATIENT,,,261.5,104.6,UC HEALTH,UC HEALTH COMMERCIAL,227.505,87,,,OTHER,196.13,256.27,PERCENT OF TOTAL BILLED CHARGES
HLA-B27,86812,CPT,300,RC,,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
HUMAN GROWTH HORMONE,83003,CPT,301,RC,,OUTPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
SEX HORMONE BINDING GLOBULIN,84270,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
HUMAN PAPILLOMAVIRUS HIGH RISK,87624,CPT,300,RC,,OUTPATIENT,,,256.5,102.6,UC HEALTH,UC HEALTH COMMERCIAL,223.155,87,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
IMIPRAMINE (TROFANIL),80335,CPT,300,RC,,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
NEPHELOMETRY EA ANALYTE,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,UC HEALTH,UC HEALTH COMMERCIAL,113.97,87,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
IGE,82785,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ANTI PLATELET DIRECT ASSAY,86023,CPT,300,RC,,OUTPATIENT,,,196,78.4,UC HEALTH,UC HEALTH COMMERCIAL,170.52,87,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,175,70,UC HEALTH,UC HEALTH COMMERCIAL,152.25,87,,,OTHER,131.25,171.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOBULIN G SUBCLASSES,82787,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOB LIGHT CHAINS,83883,CPT,301,RC,,OUTPATIENT,,,131,52.4,UC HEALTH,UC HEALTH COMMERCIAL,113.97,87,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOGLOB LIGHT CHAINS,8388391,CPT,300,RC,91,OUTPATIENT,,,131,52.4,UC HEALTH,UC HEALTH COMMERCIAL,113.97,87,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
INDIA INK,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSY ANALYTE QUANT RIA,8351959,CPT,300,RC,59,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
INDIRECT COOMBS,86885,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
INSULIN,83525,CPT,301,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
IRON BINDING CAPACITY  TOTAL,83550,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,UC HEALTH,UC HEALTH COMMERCIAL,51.1125,87,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
IRON,83540,CPT,300,RC,,OUTPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS QUANT 24 HR,84120,CPT,301,RC,,OUTPATIENT,,,188,75.2,UC HEALTH,UC HEALTH COMMERCIAL,163.56,87,,,OTHER,141,184.24,PERCENT OF TOTAL BILLED CHARGES
BROMIDE  BLOOD,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
KOH PREP,87220,CPT,306,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
HLA CLASS II MOLECULAR TYPING,81375,CPT,300,RC,,OUTPATIENT,,,483,193.2,UC HEALTH,UC HEALTH COMMERCIAL,420.21,87,,,OTHER,362.25,473.34,PERCENT OF TOTAL BILLED CHARGES
HLA CLASS I MOLECULAR TYPING,81372,CPT,300,RC,,OUTPATIENT,,,807.18,322.872,UC HEALTH,UC HEALTH COMMERCIAL,702.2466,87,,,OTHER,386.44,504.95,PERCENT OF TOTAL BILLED CHARGES
PROINSULIN ASSAY,84206,CPT,301,RC,,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
PROPAFENONE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
THC CONFIRMATION URINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
PSA-FREE   DIAGNOSTIC,84154,CPT,301,RC,,OUTPATIENT,,,158.25,63.3,UC HEALTH,UC HEALTH COMMERCIAL,137.6775,87,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
PSA SCREENING,G0103,HCPCS,301,RC,,INPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PSA COMPLEXED (DIRECT METHOD),84152,CPT,301,RC,,OUTPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
PSEUDOCHOLINESTERASE TOTAL,82480,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
PSEUDOCHOLINESTERASE  DIB INH,82638,CPT,300,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
LACTIC ACID,83605,CPT,301,RC,,OUTPATIENT,,,130,52,UC HEALTH,UC HEALTH COMMERCIAL,113.1,87,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
LACTIC ACID CSF,83605,CPT,301,RC,,OUTPATIENT,,,130,52,UC HEALTH,UC HEALTH COMMERCIAL,113.1,87,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
THC SCREEN AND CONFIRMATION,80349,CPT,300,RC,,OUTPATIENT,,,268.75,107.5,UC HEALTH,UC HEALTH COMMERCIAL,233.8125,87,,,OTHER,201.56,263.38,PERCENT OF TOTAL BILLED CHARGES
Z TOTAL PSA,84153,CPT,301,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
LAMOTRIGINE,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
LAMELLAR BODY COUNT,83664,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UC HEALTH,UC HEALTH COMMERCIAL,92.655,87,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
LDH ISOENZYMES,83625,CPT,301,RC,,OUTPATIENT,,,100.75,40.3,UC HEALTH,UC HEALTH COMMERCIAL,87.6525,87,,,OTHER,75.56,98.74,PERCENT OF TOTAL BILLED CHARGES
LACTATE ENZYME LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PURKINJE CELL ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PYRIDINIUM CROSSLINKS-TOTAL,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
PYRIDINIUM CROSSLINKS-T&DEOXY,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN  URINE QUANIT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,UC HEALTH,UC HEALTH COMMERCIAL,404.55,87,,,OTHER,348.75,455.7,PERCENT OF TOTAL BILLED CHARGES
SERUM CTX,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
R.P.R.,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UC HEALTH,UC HEALTH COMMERCIAL,58.29,87,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
CHORIONIC GONAD BETA SUBUNIT,84704,CPT,300,RC,,OUTPATIENT,,,70.75,28.3,UC HEALTH,UC HEALTH COMMERCIAL,61.5525,87,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
NICOTINE METABOLITES SERUM,G0480,HCPCS,300,RC,,BOTH,,,185.5,74.2,UC HEALTH,UC HEALTH COMMERCIAL,161.385,87,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
HLA-B TYPING LOW RESOLUTION,81373,CPT,300,RC,,OUTPATIENT,,,254.86,101.944,UC HEALTH,UC HEALTH COMMERCIAL,221.7282,87,,,OTHER,159.19,208.01,PERCENT OF TOTAL BILLED CHARGES
HLA TYPING A B C,86813,CPT,302,RC,,OUTPATIENT,,,645.75,258.3,UC HEALTH,UC HEALTH COMMERCIAL,561.8025,87,,,OTHER,484.31,632.84,PERCENT OF TOTAL BILLED CHARGES
ISOLATION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
PCR PRODUCTS # FOR DETECTION,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
PROBES (96),83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION (2),83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z AMP NUCLEIC ACID EA SEQ,8389891,CPT,301,RC,91,OUTPATIENT,,,3105.75,1242.3,UC HEALTH,UC HEALTH COMMERCIAL,2702.0025,87,,,OTHER,2329.31,3043.64,PERCENT OF TOTAL BILLED CHARGES
ROTAVIRUS,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,UC HEALTH,UC HEALTH COMMERCIAL,130.935,87,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
ROTAVIRUS AG  EIA,87425,CPT,306,RC,,OUTPATIENT,,,150.5,60.2,UC HEALTH,UC HEALTH COMMERCIAL,130.935,87,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
ADENOVIRUS AG EIA,87301,CPT,302,RC,,OUTPATIENT,,,130.5,52.2,UC HEALTH,UC HEALTH COMMERCIAL,113.535,87,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
ADENOVIRUS AB BY CF,86603,CPT,300,RC,,OUTPATIENT,,,496.25,198.5,UC HEALTH,UC HEALTH COMMERCIAL,431.7375,87,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
FUNGAL SENSITIVITY (MAYO),87186,CPT,306,RC,,OUTPATIENT,,,172,68.8,UC HEALTH,UC HEALTH COMMERCIAL,149.64,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
LEAD LEVEL BLOOD,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,UC HEALTH,UC HEALTH COMMERCIAL,80.04,87,,,OTHER,69,90.16,PERCENT OF TOTAL BILLED CHARGES
HF LEAD WITH DEMOGRAPHICS,83655,CPT,301,RC,,OUTPATIENT,,,38.75,15.5,UC HEALTH,UC HEALTH COMMERCIAL,33.7125,87,,,OTHER,29.06,37.98,PERCENT OF TOTAL BILLED CHARGES
LEAD URINE,83655,CPT,301,RC,,OUTPATIENT,,,92,36.8,UC HEALTH,UC HEALTH COMMERCIAL,80.04,87,,,OTHER,69,90.16,PERCENT OF TOTAL BILLED CHARGES
LEFLUNOMIDE METABOLITE S,80299,CPT,300,RC,,OUTPATIENT,,,318.75,127.5,UC HEALTH,UC HEALTH COMMERCIAL,277.3125,87,,,OTHER,239.06,312.38,PERCENT OF TOTAL BILLED CHARGES
NORWALK LIKE VIRUS (NOROVIRUS),87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UC HEALTH,UC HEALTH COMMERCIAL,120.7125,87,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA CULTURE,87081,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA PNEUMOPHILA,86713,CPT,302,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA SPECIES BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
LEGIONELLA PNEUMO AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,UC HEALTH,UC HEALTH COMMERCIAL,114.84,87,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,OUTPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
EHRLICHIA CHAFFEENSIS AB,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
ANAPLASMA PHAGOCYTOPHILIUM IGG,86666,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UC HEALTH,UC HEALTH COMMERCIAL,141.5925,87,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UC HEALTH,UC HEALTH COMMERCIAL,141.5925,87,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
YERSINIA ANTIBODY,86793,CPT,300,RC,,OUTPATIENT,,,162.75,65.1,UC HEALTH,UC HEALTH COMMERCIAL,141.5925,87,,,OTHER,122.06,159.5,PERCENT OF TOTAL BILLED CHARGES
ANTIBIOTIC SENSITIVITY  MIC,87186XU,CPT,306,RC,XU,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
CHROME ANALY CLT PROC FEE (AF),88235,CPT,311,RC,,OUTPATIENT,,,569.75,227.9,UC HEALTH,UC HEALTH COMMERCIAL,495.6825,87,,,OTHER,427.31,558.36,PERCENT OF TOTAL BILLED CHARGES
LEUKOCYTE ALK PHOS,85540,CPT,305,RC,,OUTPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
MYOGLOBIN SERUM,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE,80176,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UC HEALTH,UC HEALTH COMMERCIAL,92.655,87,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
LIPASE,83690,CPT,300,RC,,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
LITHIUM,80178,CPT,300,RC,,OUTPATIENT,,,101.75,40.7,UC HEALTH,UC HEALTH COMMERCIAL,88.5225,87,,,OTHER,76.31,99.72,PERCENT OF TOTAL BILLED CHARGES
LISTERIA AB,86609,CPT,300,RC,,OUTPATIENT,,,63.75,25.5,UC HEALTH,UC HEALTH COMMERCIAL,55.4625,87,,,OTHER,47.81,62.48,PERCENT OF TOTAL BILLED CHARGES
HEPATIC FUNCTION PANEL (LIVER),80076,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE SEROLOGY SERUM,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
LYME DISEASE ANTIBODY  CSF,86618,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
SACCHAROMYCES CERERISIAL PANEL,86671,CPT,300,RC,,OUTPATIENT,,,111,44.4,UC HEALTH,UC HEALTH COMMERCIAL,96.57,87,,,OTHER,83.25,108.78,PERCENT OF TOTAL BILLED CHARGES
PIGEON BREEDERS DISEASE,86671,CPT,300,RC,,OUTPATIENT,,,60,24,UC HEALTH,UC HEALTH COMMERCIAL,52.2,87,,,OTHER,45,58.8,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UC HEALTH,UC HEALTH COMMERCIAL,77.6475,87,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  CSF,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM URINE,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UC HEALTH,UC HEALTH COMMERCIAL,77.6475,87,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
Z URINE MAGNESIUM,83735,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM RBC'S,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UC HEALTH,UC HEALTH COMMERCIAL,77.6475,87,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
MALARIAL THICK/THIN SMEAR,87207,CPT,306,RC,,OUTPATIENT,,,107.5,43,UC HEALTH,UC HEALTH COMMERCIAL,93.525,87,,,OTHER,80.63,105.35,PERCENT OF TOTAL BILLED CHARGES
MAPROTILINE (LUDIOMIL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
HEXAGONAL PHASE CONFIRM,85597,CPT,300,RC,,OUTPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
DRVVT CONFIRM,8559759,CPT,300,RC,59,OUTPATIENT,,,206.75,82.7,UC HEALTH,UC HEALTH COMMERCIAL,179.8725,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
DRVVT 1:1 MIX,8561359,CPT,300,RC,59,OUTPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
SINEMET,82491,CPT,300,RC,,OUTPATIENT,,,402.5,161,UC HEALTH,UC HEALTH COMMERCIAL,350.175,87,,,OTHER,301.88,394.45,PERCENT OF TOTAL BILLED CHARGES
B-D GLUCAN,87449,CPT,300,RC,,OUTPATIENT,,,138.75,55.5,UC HEALTH,UC HEALTH COMMERCIAL,120.7125,87,,,OTHER,104.06,135.98,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES (TOTAL),83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UC HEALTH,UC HEALTH COMMERCIAL,182.265,87,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES PLASMA,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UC HEALTH,UC HEALTH COMMERCIAL,182.265,87,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
METANEPHRINES FRACT URINE RNDM,83835,CPT,300,RC,,OUTPATIENT,,,209.5,83.8,UC HEALTH,UC HEALTH COMMERCIAL,182.265,87,,,OTHER,157.13,205.31,PERCENT OF TOTAL BILLED CHARGES
SMOOTH MUSCLE ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
CELONTIN (METHSUXIMIDE),83858,CPT,301,RC,,OUTPATIENT,,,175.75,70.3,UC HEALTH,UC HEALTH COMMERCIAL,152.9025,87,,,OTHER,131.81,172.24,PERCENT OF TOTAL BILLED CHARGES
ARRAY COMP GENOMIC HYBRID,81228,CPT,300,RC,,OUTPATIENT,,,1800,720,UC HEALTH,UC HEALTH COMMERCIAL,1566,87,,,OTHER,884.06,1155.18,PERCENT OF TOTAL BILLED CHARGES
MEXILETINE,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
Z SYPHILIS AB IGG,86592,CPT,300,RC,,OUTPATIENT,,,67,26.8,UC HEALTH,UC HEALTH COMMERCIAL,58.29,87,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
Z SYPHILIS AB IGM,8659259,CPT,300,RC,59,OUTPATIENT,,,67,26.8,UC HEALTH,UC HEALTH COMMERCIAL,58.29,87,,,OTHER,50.25,65.66,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS ANTIBODY IGG,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UC HEALTH,UC HEALTH COMMERCIAL,92.655,87,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
SYPHILIS AB TP-PA,86780,CPT,300,RC,,OUTPATIENT,,,106.5,42.6,UC HEALTH,UC HEALTH COMMERCIAL,92.655,87,,,OTHER,79.88,104.37,PERCENT OF TOTAL BILLED CHARGES
AFB (TUBERCLE BAC) EA DRUG,87190,CPT,306,RC,,OUTPATIENT,,,264.75,105.9,UC HEALTH,UC HEALTH COMMERCIAL,230.3325,87,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
SOTALOL,82491,CPT,300,RC,,OUTPATIENT,,,176,70.4,UC HEALTH,UC HEALTH COMMERCIAL,153.12,87,,,OTHER,132,172.48,PERCENT OF TOTAL BILLED CHARGES
FECES PORPHYRINS ASSAY,84126,CPT,301,RC,,OUTPATIENT,,,333,133.2,UC HEALTH,UC HEALTH COMMERCIAL,289.71,87,,,OTHER,249.75,326.34,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE TRANSFERRIN RECEPTOR,84238,CPT,300,RC,,OUTPATIENT,,,200.25,80.1,UC HEALTH,UC HEALTH COMMERCIAL,174.2175,87,,,OTHER,150.19,196.25,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE LIVER ANTIGEN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
RPR TITER S,86593,CPT,300,RC,,OUTPATIENT,,,32,12.8,UC HEALTH,UC HEALTH COMMERCIAL,27.84,87,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
BARR BODIES (SEX CHROMATIN ID),88130,CPT,311,RC,,OUTPATIENT,,,155.75,62.3,UC HEALTH,UC HEALTH COMMERCIAL,135.5025,87,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
BLOOD BANK PROC DEVIATION,86079,CPT,302,RC,,OUTPATIENT,,,158.25,63.3,UC HEALTH,UC HEALTH COMMERCIAL,137.6775,87,,,OTHER,118.69,155.09,PERCENT OF TOTAL BILLED CHARGES
ENTAMOEBA HISTOLYTICA,87337,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
STOOL PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
MUMPS IGG  SCREEN,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UC HEALTH,UC HEALTH COMMERCIAL,105.705,87,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z MUMPS VIRUS AB  IGG,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UC HEALTH,UC HEALTH COMMERCIAL,105.705,87,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
Z MUMPS VIRUS AB IGM,86735,CPT,300,RC,,OUTPATIENT,,,121.5,48.6,UC HEALTH,UC HEALTH COMMERCIAL,105.705,87,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
HEP A TOTAL WITH REFLEX,86708,CPT,300,RC,,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PNEUMONIAE AB,86738,CPT,300,RC,,OUTPATIENT,,,98,39.2,UC HEALTH,UC HEALTH COMMERCIAL,85.26,87,,,OTHER,73.5,96.04,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PNEUMONIAE IGM,8673891,CPT,300,RC,91,OUTPATIENT,,,98,39.2,UC HEALTH,UC HEALTH COMMERCIAL,85.26,87,,,OTHER,73.5,96.04,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA PHEUMONIAC CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,UC HEALTH,UC HEALTH COMMERCIAL,193.575,87,,,OTHER,166.88,218.05,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA HOMINIS CULTURE,87109,CPT,300,RC,,OUTPATIENT,,,222.5,89,UC HEALTH,UC HEALTH COMMERCIAL,193.575,87,,,OTHER,166.88,218.05,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLIC ACID,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
MYOGLOBIN URINE,83874,CPT,301,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
MYELIN ASSOC GLYCOPROTEIN,83520,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MYELIN ASSOC GLYCOPROTEIN,8352091,CPT,300,RC,91,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
"MYELIN ASSOC GLYCOPROTEIN, IGM",84181,CPT,300,RC,,OUTPATIENT,,,255,102,UC HEALTH,UC HEALTH COMMERCIAL,221.85,87,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
N TELOPEPTIDE URINE,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
N TELOPEPTIDE  SERUM,82523,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
NAPA,80192,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME,86063,CPT,302,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME SCREEN,86403,CPT,300,RC,,OUTPATIENT,,,159,63.6,UC HEALTH,UC HEALTH COMMERCIAL,138.33,87,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
STREPTOZYME TITER,86406,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UC HEALTH,UC HEALTH COMMERCIAL,107.445,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
HELICOBACTER PYLORI CULT SENS,87081,CPT,306,RC,,OUTPATIENT,,,114,45.6,UC HEALTH,UC HEALTH COMMERCIAL,99.18,87,,,OTHER,85.5,111.72,PERCENT OF TOTAL BILLED CHARGES
TETANUS ANTIBODY,86317,CPT,300,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY  SERUM,83930,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY  URINE,83935,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
Z URINE OSMOLALITY,83935,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
PLASMINOGEN,85420,CPT,300,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
FFP THAWING EA UNIT,86927,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
EVEROLIMUS,80169,CPT,300,RC,,OUTPATIENT,,,433.25,173.3,UC HEALTH,UC HEALTH COMMERCIAL,376.9275,87,,,OTHER,324.94,424.59,PERCENT OF TOTAL BILLED CHARGES
VORICONAZOLE,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
VORICONAZOLE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,147.5,59,UC HEALTH,UC HEALTH COMMERCIAL,128.325,87,,,OTHER,110.63,144.55,PERCENT OF TOTAL BILLED CHARGES
PT MIX 1:1,85611,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
PTT (PARTIAL THROMBO TIME),85730,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID TRIGLYCERIDE,84478,CPT,300,RC,,OUTPATIENT,,,326.25,130.5,UC HEALTH,UC HEALTH COMMERCIAL,283.8375,87,,,OTHER,244.69,319.73,PERCENT OF TOTAL BILLED CHARGES
Z BILIRUBIN TOTAL,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
Z ELECTROPHORETIC TECHNIQUE,82664,CPT,301,RC,,OUTPATIENT,,,154.5,61.8,UC HEALTH,UC HEALTH COMMERCIAL,134.415,87,,,OTHER,115.88,151.41,PERCENT OF TOTAL BILLED CHARGES
Z SPECTROPHOTOMETRY ANALYTE,84311,CPT,300,RC,,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
Z SPECTROPHOTOMETRY ANALYTE,8431191,CPT,300,RC,91,OUTPATIENT,,,86.25,34.5,UC HEALTH,UC HEALTH COMMERCIAL,75.0375,87,,,OTHER,64.69,84.53,PERCENT OF TOTAL BILLED CHARGES
Z TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
MICROSOMAL ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
THYROID PEROXIDASE ANTIBODY,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
Z ANTITHYROID MICROSOMAL ANTBD,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
LIVER-KIDNEY MICROSOMAL ANTBDS,86376,CPT,300,RC,,OUTPATIENT,,,122.75,49.1,UC HEALTH,UC HEALTH COMMERCIAL,106.7925,87,,,OTHER,92.06,120.3,PERCENT OF TOTAL BILLED CHARGES
Z THYROGLOBULIN AB,86376,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID ALBUMIN,82042,CPT,300,RC,,OUTPATIENT,,,67.75,27.1,UC HEALTH,UC HEALTH COMMERCIAL,58.9425,87,,,OTHER,50.81,66.4,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID LDH,83615,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PLEURAL FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,38.5,15.4,UC HEALTH,UC HEALTH COMMERCIAL,33.495,87,,,OTHER,28.88,37.73,PERCENT OF TOTAL BILLED CHARGES
BODY FLUID BILIRUBIN,82247,CPT,301,RC,,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
PH  URINE,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITOL,80184,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
NEWBORN SCREENING 1,S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,UC HEALTH,UC HEALTH COMMERCIAL,122.4525,87,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
NEWBORN SCREENING 2 (PKU),S3620,HCPCS,300,RC,,INPATIENT,,,140.75,56.3,UC HEALTH,UC HEALTH COMMERCIAL,122.4525,87,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
P PHENYLALANINE (PKU),84030,CPT,300,RC,,OUTPATIENT,,,15,6,UC HEALTH,UC HEALTH COMMERCIAL,13.05,87,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
DILUTE RUSSELL VIPER VENOM,85613,CPT,305,RC,,OUTPATIENT,,,130.25,52.1,UC HEALTH,UC HEALTH COMMERCIAL,113.3175,87,,,OTHER,97.69,127.65,PERCENT OF TOTAL BILLED CHARGES
DILANTIN (PHENYTOIN),80185,CPT,301,RC,,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
DILANTIN FREE (PHENYTOIN),80186,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CARBAMAZEPINE (TEGRETOL),80156,CPT,301,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
PIN WORM EXAM,87172,CPT,306,RC,,OUTPATIENT,,,67.25,26.9,UC HEALTH,UC HEALTH COMMERCIAL,58.5075,87,,,OTHER,50.44,65.91,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN,85018,CPT,300,RC,,OUTPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
CBC WITH AUTO DIFF,85025,CPT,300,RC,,OUTPATIENT,,,68.25,27.3,UC HEALTH,UC HEALTH COMMERCIAL,59.3775,87,,,OTHER,51.19,66.89,PERCENT OF TOTAL BILLED CHARGES
AFB SPECIAL STAINS,87206,CPT,306,RC,,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
TOPIRIMATE,80201,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UC HEALTH,UC HEALTH COMMERCIAL,132.4575,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM (K) SERUM,84132,CPT,301,RC,,OUTPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM,84999,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UC HEALTH,UC HEALTH COMMERCIAL,59.8125,87,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
Z TOXOPLASMA  IGM,86778,CPT,300,RC,,OUTPATIENT,,,49.5,19.8,UC HEALTH,UC HEALTH COMMERCIAL,43.065,87,,,OTHER,37.13,48.51,PERCENT OF TOTAL BILLED CHARGES
TOXOCARA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
FASCIOLA HEPATICA ANTIBODY,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
ECHINOCOCCUS GRANULOSUS AB IGG,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGM,86778,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UC HEALTH,UC HEALTH COMMERCIAL,132.4575,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
PREGNENOLONE,84140,CPT,300,RC,,OUTPATIENT,,,264.75,105.9,UC HEALTH,UC HEALTH COMMERCIAL,230.3325,87,,,OTHER,198.56,259.46,PERCENT OF TOTAL BILLED CHARGES
Z PRIMIDONE (MYSOLINE),80188,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
Z PHENOBARB,80184,CPT,300,RC,,OUTPATIENT,,,54.75,21.9,UC HEALTH,UC HEALTH COMMERCIAL,47.6325,87,,,OTHER,41.06,53.66,PERCENT OF TOTAL BILLED CHARGES
PROCAINAMIDE ASSAY,80190,CPT,300,RC,,OUTPATIENT,,,130,52,UC HEALTH,UC HEALTH COMMERCIAL,113.1,87,,,OTHER,97.5,127.4,PERCENT OF TOTAL BILLED CHARGES
PROGESTERONE,84144,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
PROLACTIN,84146,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
TRICHOMONAS,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
PSA  TOTAL DIAGNOSTIC,84153,CPT,301,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
PROSTATIC ACID PHOSPHATASE,84066,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C ACTIVITY,85303,CPT,300,RC,,OUTPATIENT,,,258.25,103.3,UC HEALTH,UC HEALTH COMMERCIAL,224.6775,87,,,OTHER,193.69,253.09,PERCENT OF TOTAL BILLED CHARGES
PROTEIN C ANTIGEN,85302,CPT,300,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
PROTEIN S TOTAT  REFLEX,85305,CPT,300,RC,,OUTPATIENT,,,203.5,81.4,UC HEALTH,UC HEALTH COMMERCIAL,177.045,87,,,OTHER,152.63,199.43,PERCENT OF TOTAL BILLED CHARGES
"MACROPROLACTIN, S",84146,CPT,300,RC,,OUTPATIENT,,,133,53.2,UC HEALTH,UC HEALTH COMMERCIAL,115.71,87,,,OTHER,99.75,130.34,PERCENT OF TOTAL BILLED CHARGES
"URINE PROTEIN, TOTAL",84156,CPT,301,RC,,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
URINE ELECTROPHORESIS PROTEIN,84166,CPT,300,RC,,OUTPATIENT,,,153.75,61.5,UC HEALTH,UC HEALTH COMMERCIAL,133.7625,87,,,OTHER,115.31,150.68,PERCENT OF TOTAL BILLED CHARGES
TRICYCLIC ANTIDEPRESSANT,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S TOTAL,85305,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
Z PROTEIN S FREE,85306,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
I-STAT PT (INR),85610,CPT,300,RC,,OUTPATIENT,,,47.25,18.9,UC HEALTH,UC HEALTH COMMERCIAL,41.1075,87,,,OTHER,35.44,46.31,PERCENT OF TOTAL BILLED CHARGES
PROTROMBIN G20210A MUTATION B,81240,CPT,300,RC,,OUTPATIENT,,,246,98.4,UC HEALTH,UC HEALTH COMMERCIAL,214.02,87,,,OTHER,184.5,241.08,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULE ISOLATE NUCLEIC,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
TROPONIN QUANTATIVE,84484,CPT,301,RC,,OUTPATIENT,,,170.25,68.1,UC HEALTH,UC HEALTH COMMERCIAL,148.1175,87,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
HPGDE DNA EXTRACTION,83891,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR DIAG ISO EA EXTRACT,83890,CPT,301,RC,,OUTPATIENT,,,354,141.6,UC HEALTH,UC HEALTH COMMERCIAL,307.98,87,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULAR ISOLATION/EXTRACTN,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
PTH INTACT MOLECULE CALCIUM,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,UC HEALTH,UC HEALTH COMMERCIAL,264.48,87,,,OTHER,228,297.92,PERCENT OF TOTAL BILLED CHARGES
Z PARATHORMONE,83970,CPT,300,RC,,OUTPATIENT,,,109.25,43.7,UC HEALTH,UC HEALTH COMMERCIAL,95.0475,87,,,OTHER,81.94,107.07,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID HORMONE,83970,CPT,300,RC,,OUTPATIENT,,,304,121.6,UC HEALTH,UC HEALTH COMMERCIAL,264.48,87,,,OTHER,228,297.92,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID HORMONE RELATED PE,82397,CPT,301,RC,,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z CREATININE,82565,CPT,301,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
THYROID IMMUNOGLOBULINS TSI,84445,CPT,301,RC,,OUTPATIENT,,,526.25,210.5,UC HEALTH,UC HEALTH COMMERCIAL,457.8375,87,,,OTHER,394.69,515.73,PERCENT OF TOTAL BILLED CHARGES
LEISHMANIASIS AB,86717,CPT,300,RC,,OUTPATIENT,,,140.25,56.1,UC HEALTH,UC HEALTH COMMERCIAL,122.0175,87,,,OTHER,105.19,137.45,PERCENT OF TOTAL BILLED CHARGES
TULAREMIA ANTIBODY,86000,CPT,302,RC,,OUTPATIENT,,,159,63.6,UC HEALTH,UC HEALTH COMMERCIAL,138.33,87,,,OTHER,119.25,155.82,PERCENT OF TOTAL BILLED CHARGES
QUINIDINE,80194,CPT,300,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
TYROSINE ASSAY,82131,CPT,301,RC,,OUTPATIENT,,,149.75,59.9,UC HEALTH,UC HEALTH COMMERCIAL,130.2825,87,,,OTHER,112.31,146.76,PERCENT OF TOTAL BILLED CHARGES
SMEAR CYTOPATHOLOGY,88161,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
OSMOTIC FRAGILITY,85555,CPT,305,RC,,OUTPATIENT,,,292,116.8,UC HEALTH,UC HEALTH COMMERCIAL,254.04,87,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
OSMOTIC FRAGILITY RBC,85557,CPT,300,RC,,OUTPATIENT,,,183.75,73.5,UC HEALTH,UC HEALTH COMMERCIAL,159.8625,87,,,OTHER,137.81,180.08,PERCENT OF TOTAL BILLED CHARGES
RENIN ACTIVITY,84244,CPT,301,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
RESP SYNCYTIAL VIRUS ANTIBODY,86756,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
RETICULOCYTE COUNT,85045,CPT,305,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
RSV ANTIGEN,87807,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UC HEALTH,UC HEALTH COMMERCIAL,174.435,87,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
RETICULIN ANTIBODY  IGA,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
RHEUMATOID FACTOR,86431,CPT,300,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
RABIES ANTIBODY,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA HENSELAE IGG,86611,CPT,300,RC,,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA HENSELAE IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA QUINTANA IGG,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
Z BARTONELLA QUINTANA IGM,8661191,CPT,300,RC,91,OUTPATIENT,,,37.75,15.1,UC HEALTH,UC HEALTH COMMERCIAL,32.8425,87,,,OTHER,28.31,37,PERCENT OF TOTAL BILLED CHARGES
E. HISTOLYTICA ANTIBODY,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UC HEALTH,UC HEALTH COMMERCIAL,107.445,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
TRYPANOSOMA CRUZI AB IGG,86753,CPT,300,RC,,OUTPATIENT,,,123.5,49.4,UC HEALTH,UC HEALTH COMMERCIAL,107.445,87,,,OTHER,92.63,121.03,PERCENT OF TOTAL BILLED CHARGES
RUBELLA IGG ANTIBODY,86762,CPT,300,RC,,OUTPATIENT,,,100.5,40.2,UC HEALTH,UC HEALTH COMMERCIAL,87.435,87,,,OTHER,75.38,98.49,PERCENT OF TOTAL BILLED CHARGES
RUBEOLA IGG ANTIBODY,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
MEASLES  IGG,86765,CPT,300,RC,,OUTPATIENT,,,133.5,53.4,UC HEALTH,UC HEALTH COMMERCIAL,116.145,87,,,OTHER,100.13,130.83,PERCENT OF TOTAL BILLED CHARGES
SALICYLATE,80307,CPT,301,RC,,OUTPATIENT,,,290.75,116.3,UC HEALTH,UC HEALTH COMMERCIAL,252.9525,87,,,OTHER,218.06,284.94,PERCENT OF TOTAL BILLED CHARGES
CLINICAL CHEMISTRY TEST,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,UC HEALTH,UC HEALTH COMMERCIAL,92.4375,87,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
CANCER TYPE INDEX,84999,CPT,301,RC,,OUTPATIENT,,,6049,2419.6,UC HEALTH,UC HEALTH COMMERCIAL,5262.63,87,,,OTHER,4536.75,5928.02,PERCENT OF TOTAL BILLED CHARGES
ESR (AUTO),85652,CPT,305,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
SEMEN ANALYSIS COMPLETE,89320,CPT,309,RC,,OUTPATIENT,,,202.5,81,UC HEALTH,UC HEALTH COMMERCIAL,176.175,87,,,OTHER,151.88,198.45,PERCENT OF TOTAL BILLED CHARGES
SERUM KILLING LEVEL  PEAK,87197,CPT,300,RC,,OUTPATIENT,,,362,144.8,UC HEALTH,UC HEALTH COMMERCIAL,314.94,87,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SERUM KILLING LEVEL  TROUGH,87197,CPT,300,RC,,OUTPATIENT,,,240.5,96.2,UC HEALTH,UC HEALTH COMMERCIAL,209.235,87,,,OTHER,180.38,235.69,PERCENT OF TOTAL BILLED CHARGES
SEROTONIN,84260,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,UC HEALTH,UC HEALTH COMMERCIAL,124.1925,87,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
SELENIUM,84255,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
LIPOPROTEIN A,83695,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
SEMEN ANALYSIS  POST VAS,89321,CPT,300,RC,,OUTPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
SGPT EMPLOYEE,84460,CPT,300,RC,,OUTPATIENT,,,51.25,20.5,UC HEALTH,UC HEALTH COMMERCIAL,44.5875,87,,,OTHER,38.44,50.23,PERCENT OF TOTAL BILLED CHARGES
SICKLE CELL,85660,CPT,301,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
SS-A,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
SS-B,86235,CPT,300,RC,,OUTPATIENT,,,60.5,24.2,UC HEALTH,UC HEALTH COMMERCIAL,52.635,87,,,OTHER,45.38,59.29,PERCENT OF TOTAL BILLED CHARGES
ORGANIC ACID SCREEN URINE,83919,CPT,301,RC,,OUTPATIENT,,,217.25,86.9,UC HEALTH,UC HEALTH COMMERCIAL,189.0075,87,,,OTHER,162.94,212.91,PERCENT OF TOTAL BILLED CHARGES
SODIUM (NA) SERUM,84295,CPT,301,RC,,OUTPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
Z SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
SODIUM (NA) URINE (RANDOM),84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,UC HEALTH,UC HEALTH COMMERCIAL,63.51,87,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
URINE PHOSPHORUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,114.25,45.7,UC HEALTH,UC HEALTH COMMERCIAL,99.3975,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z URINE POTASSIUM,84133,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE SODIUM 24 HR,84300,CPT,301,RC,,OUTPATIENT,,,73,29.2,UC HEALTH,UC HEALTH COMMERCIAL,63.51,87,,,OTHER,54.75,71.54,PERCENT OF TOTAL BILLED CHARGES
Z URINE PH,83986,CPT,307,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,167.75,67.1,UC HEALTH,UC HEALTH COMMERCIAL,145.9425,87,,,OTHER,125.81,164.4,PERCENT OF TOTAL BILLED CHARGES
Z URINE TOXIC SCREEN,80305,CPT,300,RC,,OUTPATIENT,,,25.2,10.08,UC HEALTH,UC HEALTH COMMERCIAL,21.924,87,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
URINE TOXIC SCREEN,80306,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY EA DRUG CLASS,8030159,CPT,300,RC,59,OUTPATIENT,,,190.5,76.2,UC HEALTH,UC HEALTH COMMERCIAL,165.735,87,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
SOMATOSTATIN,84307,CPT,301,RC,,OUTPATIENT,,,442.75,177.1,UC HEALTH,UC HEALTH COMMERCIAL,385.1925,87,,,OTHER,332.06,433.9,PERCENT OF TOTAL BILLED CHARGES
SOMATOMEDIN-C,84305,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UC HEALTH,UC HEALTH COMMERCIAL,170.955,87,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
BFL-SPECIFIC GRAVITY,84315,CPT,301,RC,,OUTPATIENT,,,70.75,28.3,UC HEALTH,UC HEALTH COMMERCIAL,61.5525,87,,,OTHER,53.06,69.34,PERCENT OF TOTAL BILLED CHARGES
URINE CHEM STRIP AUTO,81003,CPT,301,RC,,OUTPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE NEISSERIA GONORRHEA DNA,87591,CPT,306,RC,,OUTPATIENT,,,91.5,36.6,UC HEALTH,UC HEALTH COMMERCIAL,79.605,87,,,OTHER,68.63,89.67,PERCENT OF TOTAL BILLED CHARGES
URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
Z URINE CHLORIDE,82436,CPT,300,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
Z URINE PHOSPHOROUS  24 HR,84105,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
SPERM ANTIBODY,89325,CPT,300,RC,,OUTPATIENT,,,182.75,73.1,UC HEALTH,UC HEALTH COMMERCIAL,158.9925,87,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
URINE VOLUME MEASUREMENT,81050,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
Z URINE URIC ACID  24 HRS,84560,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
AMINOLEVULENIC ACID 24 HR URIN,82135,CPT,301,RC,,OUTPATIENT,,,101.25,40.5,UC HEALTH,UC HEALTH COMMERCIAL,88.0875,87,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCREEN  PLASMA QUAL,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN  PLASMA QUANT,82139,CPT,301,RC,,OUTPATIENT,,,465,186,UC HEALTH,UC HEALTH COMMERCIAL,404.55,87,,,OTHER,348.75,455.7,PERCENT OF TOTAL BILLED CHARGES
AMINOLEVULENIC ACID (ALA),82135,CPT,301,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
AMNIODARONE LEVEL,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
AMITRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
AMITRIPTYLINE NORTRIPTYLINE,G0480,HCPCS,300,RC,,BOTH,,,55.25,22.1,UC HEALTH,UC HEALTH COMMERCIAL,48.0675,87,,,OTHER,41.44,54.15,PERCENT OF TOTAL BILLED CHARGES
AMPHETAMINE SCREEN SERUM,G0480,HCPCS,300,RC,,BOTH,,,298.25,119.3,UC HEALTH,UC HEALTH COMMERCIAL,259.4775,87,,,OTHER,223.69,292.29,PERCENT OF TOTAL BILLED CHARGES
ARSENIC LEVEL,82175,CPT,301,RC,,OUTPATIENT,,,129,51.6,UC HEALTH,UC HEALTH COMMERCIAL,112.23,87,,,OTHER,96.75,126.42,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE ASSAY,G0480,HCPCS,300,RC,,BOTH,,,78.75,31.5,UC HEALTH,UC HEALTH COMMERCIAL,68.5125,87,,,OTHER,59.06,77.18,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE ASSAY,8214559,CPT,300,RC,59,OUTPATIENT,,,56.25,22.5,UC HEALTH,UC HEALTH COMMERCIAL,48.9375,87,,,OTHER,42.19,55.13,PERCENT OF TOTAL BILLED CHARGES
AMPHENTAMINES ANALYSIS SERUM,G0480,HCPCS,300,RC,,BOTH,,,177.5,71,UC HEALTH,UC HEALTH COMMERCIAL,154.425,87,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
FECES EXAM (MEAT FIBERS),89160,CPT,300,RC,,OUTPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
AMNISURE FOR ROM,84112,CPT,300,RC,,OUTPATIENT,,,196.25,78.5,UC HEALTH,UC HEALTH COMMERCIAL,170.7375,87,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLOOD SCREENING,82270,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLOOD DIAGNOSTIC,82272,CPT,301,RC,,OUTPATIENT,,,47,18.8,UC HEALTH,UC HEALTH COMMERCIAL,40.89,87,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLD IMM,G0328,HCPCS,300,RC,,BOTH,,,206.25,82.5,UC HEALTH,UC HEALTH COMMERCIAL,179.4375,87,,,OTHER,154.69,202.13,PERCENT OF TOTAL BILLED CHARGES
BLOOD VISCOSITY EXAM,85810,CPT,305,RC,,OUTPATIENT,,,170.25,68.1,UC HEALTH,UC HEALTH COMMERCIAL,148.1175,87,,,OTHER,127.69,166.85,PERCENT OF TOTAL BILLED CHARGES
FACTOR XIII QUALITATIVE,85291,CPT,305,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
FIBRINOGEN TEST,85366,CPT,300,RC,,OUTPATIENT,,,165.5,66.2,UC HEALTH,UC HEALTH COMMERCIAL,143.985,87,,,OTHER,124.13,162.19,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PHEUM IGG 7 SER,86317,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PNEUM IGG 23 SER,8631759,CPT,300,RC,59,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
Z STREPTOCOCCUS PHEUM IGG 7SER,8631759,CPT,300,RC,59,OUTPATIENT,,,426.75,170.7,UC HEALTH,UC HEALTH COMMERCIAL,371.2725,87,,,OTHER,320.06,418.22,PERCENT OF TOTAL BILLED CHARGES
STREP PHEUMONIAE AG URINE,87899,CPT,300,RC,,OUTPATIENT,,,132,52.8,UC HEALTH,UC HEALTH COMMERCIAL,114.84,87,,,OTHER,99,129.36,PERCENT OF TOTAL BILLED CHARGES
STREPTOCOCCUS PNEUMO AG CSF,87899,CPT,300,RC,,OUTPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
Z VITAMIN A,84590,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B1 (THIAMINE),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,UC HEALTH,UC HEALTH COMMERCIAL,148.77,87,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
T3 UPTAKE,84479,CPT,300,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UC HEALTH,UC HEALTH COMMERCIAL,170.955,87,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE-TOTAL,84403,CPT,300,RC,,OUTPATIENT,,,77,30.8,UC HEALTH,UC HEALTH COMMERCIAL,66.99,87,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
Z TESTOSTERONE BIOAVAILABLE,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,UC HEALTH,UC HEALTH COMMERCIAL,89.2272,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE,84403,CPT,300,RC,,OUTPATIENT,,,196.5,78.6,UC HEALTH,UC HEALTH COMMERCIAL,170.955,87,,,OTHER,147.38,192.57,PERCENT OF TOTAL BILLED CHARGES
TESTOSTERONE-FREE,84402,CPT,300,RC,,OUTPATIENT,,,163.75,65.5,UC HEALTH,UC HEALTH COMMERCIAL,142.4625,87,,,OTHER,122.81,160.48,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B6,84207,CPT,301,RC,,OUTPATIENT,,,179.25,71.7,UC HEALTH,UC HEALTH COMMERCIAL,155.9475,87,,,OTHER,134.44,175.67,PERCENT OF TOTAL BILLED CHARGES
THEOPHYLLINE,80198,CPT,301,RC,,OUTPATIENT,,,212,84.8,UC HEALTH,UC HEALTH COMMERCIAL,184.44,87,,,OTHER,159,207.76,PERCENT OF TOTAL BILLED CHARGES
THIOCYANATE ASSAY,84430,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,UC HEALTH,UC HEALTH COMMERCIAL,162.255,87,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
THIORIDAZINE (MELLARIL),84022,CPT,301,RC,,OUTPATIENT,,,68.75,27.5,UC HEALTH,UC HEALTH COMMERCIAL,59.8125,87,,,OTHER,51.56,67.38,PERCENT OF TOTAL BILLED CHARGES
THIOTHIXENE (NAVANE),82491,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
THROMBIN TIME,85670,CPT,300,RC,,OUTPATIENT,,,111.25,44.5,UC HEALTH,UC HEALTH COMMERCIAL,96.7875,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN ASSAY (SO),84432,CPT,301,RC,,OUTPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN ANTIBODY,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN AB,86800,CPT,300,RC,,OUTPATIENT,,,124,49.6,UC HEALTH,UC HEALTH COMMERCIAL,107.88,87,,,OTHER,93,121.52,PERCENT OF TOTAL BILLED CHARGES
Z TYPHUS FEVER AB IGG,86757,CPT,300,RC,,OUTPATIENT,,,55.75,22.3,UC HEALTH,UC HEALTH COMMERCIAL,48.5025,87,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z TYPHUS FEVER AB IGM,8675791,CPT,300,RC,91,OUTPATIENT,,,55.75,22.3,UC HEALTH,UC HEALTH COMMERCIAL,48.5025,87,,,OTHER,41.81,54.64,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,83893,CPT,300,RC,,OUTPATIENT,,,29.75,11.9,UC HEALTH,UC HEALTH COMMERCIAL,25.8825,87,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,UC HEALTH,UC HEALTH COMMERCIAL,25.8825,87,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE DOT SLOT BLOT,8389391,CPT,300,RC,91,OUTPATIENT,,,29.75,11.9,UC HEALTH,UC HEALTH COMMERCIAL,25.8825,87,,,OTHER,22.31,29.16,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,58.75,23.5,UC HEALTH,UC HEALTH COMMERCIAL,51.1125,87,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
FACTOR VIII COAGULATION,85240,CPT,305,RC,,OUTPATIENT,,,277.5,111,UC HEALTH,UC HEALTH COMMERCIAL,241.425,87,,,OTHER,208.13,271.95,PERCENT OF TOTAL BILLED CHARGES
THCY,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UC HEALTH,UC HEALTH COMMERCIAL,163.125,87,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
ISOLATION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION X2,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
PROBES,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
APC,85307,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UC HEALTH,UC HEALTH COMMERCIAL,174.435,87,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
TSH - THYROID STIMU HORMONE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,83900,CPT,300,RC,,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC 2 SEQ,8390059,CPT,300,RC,59,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
P TSH,84443,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
TSH SENSITIVE,84443,CPT,301,RC,,OUTPATIENT,,,123,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.01,87,,,OTHER,92.25,120.54,PERCENT OF TOTAL BILLED CHARGES
FREE T4 THYROXINE,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
P THYROXINE (T4),84437,CPT,300,RC,,OUTPATIENT,,,18.5,7.4,UC HEALTH,UC HEALTH COMMERCIAL,16.095,87,,,OTHER,13.88,18.13,PERCENT OF TOTAL BILLED CHARGES
TOTAL T4,84436,CPT,301,RC,,OUTPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
T4 FREE BY DIALYSIS,84439,CPT,301,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.48,PERCENT OF TOTAL BILLED CHARGES
THYROXINE BINDING GLOBULIN,84442,CPT,300,RC,,OUTPATIENT,,,169,67.6,UC HEALTH,UC HEALTH COMMERCIAL,147.03,87,,,OTHER,126.75,165.62,PERCENT OF TOTAL BILLED CHARGES
TOBRAMYCIN PEAK,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TOBRAMYCIN TROUGH,80200,CPT,301,RC,,OUTPATIENT,,,76,30.4,UC HEALTH,UC HEALTH COMMERCIAL,66.12,87,,,OTHER,57,74.48,PERCENT OF TOTAL BILLED CHARGES
TOCAINIDE QUANT SERUM,80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY NONANTIBODY,8351691,CPT,300,RC,91,OUTPATIENT,,,29,11.6,UC HEALTH,UC HEALTH COMMERCIAL,25.23,87,,,OTHER,21.75,28.42,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANITBODY,86235,CPT,300,RC,,OUTPATIENT,,,45.5,18.2,UC HEALTH,UC HEALTH COMMERCIAL,39.585,87,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANITBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UC HEALTH,UC HEALTH COMMERCIAL,39.585,87,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UC HEALTH,UC HEALTH COMMERCIAL,39.585,87,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
NUCLEAR ANTIGEN ANTIBODY,8623591,CPT,300,RC,91,OUTPATIENT,,,45.5,18.2,UC HEALTH,UC HEALTH COMMERCIAL,39.585,87,,,OTHER,34.13,44.59,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,34.54,13.816,UC HEALTH,UC HEALTH COMMERCIAL,30.0498,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,UC HEALTH,UC HEALTH COMMERCIAL,30.0498,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
TOTAL PROTEIN,84155,CPT,301,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
IMMUNOASSAY QUANT NOS NONAB,8352091,CPT,300,RC,91,OUTPATIENT,,,34.54,13.816,UC HEALTH,UC HEALTH COMMERCIAL,30.0498,87,,,OTHER,24.19,31.61,PERCENT OF TOTAL BILLED CHARGES
CSF TOTAL PROTEIN,84157,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID SCRN URINE QUALIT,82128,CPT,301,RC,,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
LEUCINE AMINOPEPTIDASE,83670,CPT,300,RC,,OUTPATIENT,,,200.5,80.2,UC HEALTH,UC HEALTH COMMERCIAL,174.435,87,,,OTHER,150.38,196.49,PERCENT OF TOTAL BILLED CHARGES
Z VITAMIN E,84446,CPT,301,RC,,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
CORTISON BINDING GLOBULIN,84449,CPT,300,RC,,OUTPATIENT,,,203.75,81.5,UC HEALTH,UC HEALTH COMMERCIAL,177.2625,87,,,OTHER,152.81,199.68,PERCENT OF TOTAL BILLED CHARGES
NEPHELOMETRY ASSAY NOT SPEC,83916,CPT,301,RC,,OUTPATIENT,,,131,52.4,UC HEALTH,UC HEALTH COMMERCIAL,113.97,87,,,OTHER,98.25,128.38,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND MULTIMERIC,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,UC HEALTH,UC HEALTH COMMERCIAL,232.5075,87,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
RISTOCETIN,85245,CPT,300,RC,,OUTPATIENT,,,193.75,77.5,UC HEALTH,UC HEALTH COMMERCIAL,168.5625,87,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR MULTI,85247,CPT,300,RC,,OUTPATIENT,,,267.25,106.9,UC HEALTH,UC HEALTH COMMERCIAL,232.5075,87,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR ANTIGEN,85246,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
VON WILLEBRAND FACTOR ACTIVITY,85397,CPT,300,RC,,OUTPATIENT,,,318.5,127.4,UC HEALTH,UC HEALTH COMMERCIAL,277.095,87,,,OTHER,238.88,312.13,PERCENT OF TOTAL BILLED CHARGES
TOTAL PROTEIN URINE TIMED 24HR,84156,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
TRIIODOTHYRONINE T3; (TT-3),84480,CPT,301,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA IGG,86777,CPT,300,RC,,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
TRANSFERRIN,84466,CPT,300,RC,,OUTPATIENT,,,60.75,24.3,UC HEALTH,UC HEALTH COMMERCIAL,52.8525,87,,,OTHER,45.56,59.54,PERCENT OF TOTAL BILLED CHARGES
TRAZODONE (DESYREL),80299,CPT,300,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
OXYCARBAZAPINE (TRILIPTAL),80183,CPT,301,RC,,OUTPATIENT,,,137.25,54.9,UC HEALTH,UC HEALTH COMMERCIAL,119.4075,87,,,OTHER,102.94,134.51,PERCENT OF TOTAL BILLED CHARGES
TRIGLYCERIDES,84478,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
COXSACKIE A9 VIRUS ANTIBODY,86658,CPT,300,RC,,OUTPATIENT,,,69.25,27.7,UC HEALTH,UC HEALTH COMMERCIAL,60.2475,87,,,OTHER,51.94,67.87,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN URINE,84540,CPT,301,RC,,OUTPATIENT,,,150.5,60.2,UC HEALTH,UC HEALTH COMMERCIAL,130.935,87,,,OTHER,112.88,147.49,PERCENT OF TOTAL BILLED CHARGES
Z URINE UREA NITROGEN,84540,CPT,301,RC,,OUTPATIENT,,,16.15,6.46,UC HEALTH,UC HEALTH COMMERCIAL,14.0505,87,,,OTHER,12.1,15.8,PERCENT OF TOTAL BILLED CHARGES
UREA NITROGEN CLEARANCE,84545,CPT,300,RC,,OUTPATIENT,,,145,58,UC HEALTH,UC HEALTH COMMERCIAL,126.15,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
URIC ACID,84550,CPT,301,RC,,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
APO E GENOTYPE,81401,CPT,300,RC,,OUTPATIENT,,,313.25,125.3,UC HEALTH,UC HEALTH COMMERCIAL,272.5275,87,,,OTHER,234.94,306.99,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN A1,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  PLEURAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  SYNOVIAL FLD,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  URINE RANDOM,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URIC ACID  URINE TIMED,84560,CPT,301,RC,,OUTPATIENT,,,89.75,35.9,UC HEALTH,UC HEALTH COMMERCIAL,78.0825,87,,,OTHER,67.31,87.96,PERCENT OF TOTAL BILLED CHARGES
URINALYSIS/COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,71.25,28.5,UC HEALTH,UC HEALTH COMMERCIAL,61.9875,87,,,OTHER,53.44,69.83,PERCENT OF TOTAL BILLED CHARGES
VALPROIC ACID (DEPAKENE),80164,CPT,300,RC,,OUTPATIENT,,,69.75,27.9,UC HEALTH,UC HEALTH COMMERCIAL,60.6825,87,,,OTHER,52.31,68.36,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN PEAK/TROUGH,80202,CPT,301,RC,,OUTPATIENT,,,314.75,125.9,UC HEALTH,UC HEALTH COMMERCIAL,273.8325,87,,,OTHER,236.06,308.46,PERCENT OF TOTAL BILLED CHARGES
VON WB DZ INTERP,85390,CPT,300,RC,,OUTPATIENT,,,302.25,120.9,UC HEALTH,UC HEALTH COMMERCIAL,262.9575,87,,,OTHER,226.69,296.21,PERCENT OF TOTAL BILLED CHARGES
VON WB FACTOR MULT,85247,CPT,300,RC,,OUTPATIENT,,,390,156,UC HEALTH,UC HEALTH COMMERCIAL,339.3,87,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
VANILLYLMANDELIC ACID,84585,CPT,300,RC,,OUTPATIENT,,,80.75,32.3,UC HEALTH,UC HEALTH COMMERCIAL,70.2525,87,,,OTHER,60.56,79.14,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER IGG&IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UC HEALTH,UC HEALTH COMMERCIAL,116.58,87,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS AB IGM,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UC HEALTH,UC HEALTH COMMERCIAL,116.58,87,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS,87290,CPT,306,RC,,OUTPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER VIRUS BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
VARICELLA-ZOSTER AB-IGG,86787,CPT,300,RC,,OUTPATIENT,,,134,53.6,UC HEALTH,UC HEALTH COMMERCIAL,116.58,87,,,OTHER,100.5,131.32,PERCENT OF TOTAL BILLED CHARGES
LIQUID BASED PREPARATION,88174,CPT,300,RC,,OUTPATIENT,,,240,96,UC HEALTH,UC HEALTH COMMERCIAL,208.8,87,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
Z OVA PARASITES DIRECT SMEARS,87177,CPT,306,RC,,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z SMEAR COMPLEX STAIN,87209,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
MACROSCOPIC ARTHROPOD EXAM,87168,CPT,300,RC,,OUTPATIENT,,,57,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.59,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
MACROSCOPIC PARASITE EXAM,87169,CPT,300,RC,,OUTPATIENT,,,57,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.59,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
PARAKEET DROPPINGS BY GEL DIFF,86331,CPT,300,RC,,OUTPATIENT,,,106.25,42.5,UC HEALTH,UC HEALTH COMMERCIAL,92.4375,87,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
KRAS GENE 7 MUTATION PANEL TMR,81275,CPT,300,RC,,OUTPATIENT,,,1314.75,525.9,UC HEALTH,UC HEALTH COMMERCIAL,1143.8325,87,,,OTHER,986.06,1288.46,PERCENT OF TOTAL BILLED CHARGES
KPC PCR,87150,CPT,300,RC,,OUTPATIENT,,,185.5,74.2,UC HEALTH,UC HEALTH COMMERCIAL,161.385,87,,,OTHER,139.13,181.79,PERCENT OF TOTAL BILLED CHARGES
VIT D 1  25 DIHDROXY,82652,CPT,300,RC,,OUTPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
VIT D  HYDROXY,82306,CPT,300,RC,,OUTPATIENT,,,103.25,41.3,UC HEALTH,UC HEALTH COMMERCIAL,89.8275,87,,,OTHER,77.44,101.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN K1,84597,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,UC HEALTH,UC HEALTH COMMERCIAL,178.1325,87,,,OTHER,153.56,200.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN B12,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
VIT B2 RIBOFLAVIN,84252,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PERNICIOUS ANEMIA CASCADE,82607,CPT,300,RC,,OUTPATIENT,,,143.25,57.3,UC HEALTH,UC HEALTH COMMERCIAL,124.6275,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CLOSTRIDIUM DIFFICLE TOXIN,87324,CPT,306,RC,,OUTPATIENT,,,30.82,12.328,UC HEALTH,UC HEALTH COMMERCIAL,26.8134,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
CRYPTOSPORIDIUM,87328,CPT,306,RC,,OUTPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
GIARDIA,87329,CPT,300,RC,,OUTPATIENT,,,44.25,17.7,UC HEALTH,UC HEALTH COMMERCIAL,38.4975,87,,,OTHER,33.19,43.37,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOSPORIDIUM ANTIGEN, FECES",87328,CPT,306,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.19,102.17,PERCENT OF TOTAL BILLED CHARGES
WET PREP,87210,CPT,300,RC,,OUTPATIENT,,,72.25,28.9,UC HEALTH,UC HEALTH COMMERCIAL,62.8575,87,,,OTHER,54.19,70.81,PERCENT OF TOTAL BILLED CHARGES
WBC (WHITE BLOOD COUNT),85048,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.38,35.77,PERCENT OF TOTAL BILLED CHARGES
MANUAL SMEAR EXAM  NO DIFF,85008,CPT,300,RC,,OUTPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
HEMATOCRIT,85014,CPT,305,RC,,OUTPATIENT,,,24.5,9.8,UC HEALTH,UC HEALTH COMMERCIAL,21.315,87,,,OTHER,18.38,24.01,PERCENT OF TOTAL BILLED CHARGES
ZINC,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
ZINC  URINE,84630,CPT,301,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
D-XYLOSE,84620,CPT,301,RC,,OUTPATIENT,,,184.75,73.9,UC HEALTH,UC HEALTH COMMERCIAL,160.7325,87,,,OTHER,138.56,181.06,PERCENT OF TOTAL BILLED CHARGES
RENAL FUNCTION PANEL,80069,CPT,301,RC,,OUTPATIENT,,,186.5,74.6,UC HEALTH,UC HEALTH COMMERCIAL,162.255,87,,,OTHER,139.88,182.77,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA B,87804XU,CPT,300,RC,XU,OUTPATIENT,,,52,20.8,UC HEALTH,UC HEALTH COMMERCIAL,45.24,87,,,OTHER,39,50.96,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE INFLUENZAE A,3008987,CDM,,,,INPATIENT,,,25.75,10.3,UC HEALTH,UC HEALTH COMMERCIAL,22.4025,87,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
EMPLOYEE INFLUENZAE B,3008988,CDM,,,,INPATIENT,,,25.75,10.3,UC HEALTH,UC HEALTH COMMERCIAL,22.4025,87,,,OTHER,19.31,25.24,PERCENT OF TOTAL BILLED CHARGES
GIEMSA STAIN,87205,CPT,300,RC,,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA VIRUS ANTIBODY IGG,86710,CPT,302,RC,,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA VIRUS ANTIBODY IGM,8671059,CPT,300,RC,59,OUTPATIENT,,,47.75,19.1,UC HEALTH,UC HEALTH COMMERCIAL,41.5425,87,,,OTHER,35.81,46.8,PERCENT OF TOTAL BILLED CHARGES
ANTI-NEURONAL NUCLEAR ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA A H1N1 BY PCR,87502,CPT,306,RC,,OUTPATIENT,,,592,236.8,UC HEALTH,UC HEALTH COMMERCIAL,515.04,87,,,OTHER,444,580.16,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A H1N1 BY PCR,87798,CPT,306,RC,,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
Z INFLUENZA A H1N1 BY PCR,8779891,CPT,300,RC,91,OUTPATIENT,,,225.75,90.3,UC HEALTH,UC HEALTH COMMERCIAL,196.4025,87,,,OTHER,169.31,221.24,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
Z LYME DISEASE CONFIRM  SERUM,86617,CPT,300,RC,,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
KIT MUTATION EX 811&17,81272,CPT,300,RC,,OUTPATIENT,,,659.02,263.608,UC HEALTH,UC HEALTH COMMERCIAL,573.3474,87,,,OTHER,494.3,645.8,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATE & ID BY HIGH RESLTN,8390959,CPT,300,RC,59,OUTPATIENT,,,1601.75,640.7,UC HEALTH,UC HEALTH COMMERCIAL,1393.5225,87,,,OTHER,1201.31,1569.72,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z SEPARATION BY GEL ELECTOPHOR,83894,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.76,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,UC HEALTH,UC HEALTH COMMERCIAL,23.925,87,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,83914,CPT,300,RC,,OUTPATIENT,,,27.5,11,UC HEALTH,UC HEALTH COMMERCIAL,23.925,87,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION ID,8391459,CPT,300,RC,59,OUTPATIENT,,,27.5,11,UC HEALTH,UC HEALTH COMMERCIAL,23.925,87,,,OTHER,20.63,26.95,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,83905,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,8390559,CPT,300,RC,59,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,83906,CPT,300,RC,,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE MUTATION IDENTIFY,8390659,CPT,300,RC,59,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,83901,CPT,300,RC,,OUTPATIENT,,,78,31.2,UC HEALTH,UC HEALTH COMMERCIAL,67.86,87,,,OTHER,58.5,76.44,PERCENT OF TOTAL BILLED CHARGES
Z MOLECULE NUCLEIC AMPLI,8390159,CPT,300,RC,59,OUTPATIENT,,,39.75,15.9,UC HEALTH,UC HEALTH COMMERCIAL,34.5825,87,,,OTHER,29.81,38.96,PERCENT OF TOTAL BILLED CHARGES
BRCA1 2 GENE ANALYSIS,81162,CPT,300,RC,,OUTPATIENT,,,3017.9,1207.16,UC HEALTH,UC HEALTH COMMERCIAL,2625.573,87,,,OTHER,2263.4,2957.5,PERCENT OF TOTAL BILLED CHARGES
FECAL WBC STAIN,89055,CPT,300,RC,,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.75,63.7,PERCENT OF TOTAL BILLED CHARGES
B CELLS TOTAL COUNT,86355,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UC HEALTH,UC HEALTH COMMERCIAL,225.9825,87,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
NATURAL KILLER CELLS,86357,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UC HEALTH,UC HEALTH COMMERCIAL,225.9825,87,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
T CELLS TOTAL COUNT,86359,CPT,300,RC,,OUTPATIENT,,,259.75,103.9,UC HEALTH,UC HEALTH COMMERCIAL,225.9825,87,,,OTHER,194.81,254.56,PERCENT OF TOTAL BILLED CHARGES
ABSOLUTE CD4/CD8 COUNT,86360,CPT,300,RC,,OUTPATIENT,,,276.5,110.6,UC HEALTH,UC HEALTH COMMERCIAL,240.555,87,,,OTHER,207.38,270.97,PERCENT OF TOTAL BILLED CHARGES
NATURAL KILLER CYTOTOXICITY,86805,CPT,300,RC,,OUTPATIENT,,,379.02,151.608,UC HEALTH,UC HEALTH COMMERCIAL,329.7474,87,,,OTHER,270.56,353.54,PERCENT OF TOTAL BILLED CHARGES
HTLV I/II AB S,86790,CPT,300,RC,,OUTPATIENT,,,95.25,38.1,UC HEALTH,UC HEALTH COMMERCIAL,82.8675,87,,,OTHER,71.44,93.35,PERCENT OF TOTAL BILLED CHARGES
HTLV I/II AB CONFIRMATION S,86689,CPT,300,RC,,OUTPATIENT,,,494.75,197.9,UC HEALTH,UC HEALTH COMMERCIAL,430.4325,87,,,OTHER,371.06,484.86,PERCENT OF TOTAL BILLED CHARGES
URINE TRAMADOL AND METABOLITE,80373,CPT,300,RC,,OUTPATIENT,,,100.6,40.24,UC HEALTH,UC HEALTH COMMERCIAL,87.522,87,,,OTHER,75.45,98.59,PERCENT OF TOTAL BILLED CHARGES
CAROTENE BETA,82380,CPT,301,RC,,OUTPATIENT,,,184.13,73.652,UC HEALTH,UC HEALTH COMMERCIAL,160.1931,87,,,OTHER,138.1,180.45,PERCENT OF TOTAL BILLED CHARGES
CYTOMEGALOVIRUS IGG AVIDITY,86644,CPT,302,RC,,OUTPATIENT,,,217.82,87.128,UC HEALTH,UC HEALTH COMMERCIAL,189.5034,87,,,OTHER,163.37,213.46,PERCENT OF TOTAL BILLED CHARGES
NRAS GENE VARIANTS EXON 2&3,81311,CPT,300,RC,,OUTPATIENT,,,622.5,249,UC HEALTH,UC HEALTH COMMERCIAL,541.575,87,,,OTHER,466.88,610.05,PERCENT OF TOTAL BILLED CHARGES
M-PROT ISO MALD TOF CHARGE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,UC HEALTH,UC HEALTH COMMERCIAL,129.63,87,,,OTHER,111.8,146,PERCENT OF TOTAL BILLED CHARGES
ALL BLACK/WHITE PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GREEN PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CARROT IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL AVOCADO IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL ONION IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GARLIC IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL LENTIL IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GREEN STRING BEAN IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CHILI PEPPER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL OLIVE FOOD IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL CURRY IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL GINGER IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
ALL LETTUCE IGE,86003,CPT,300,RC,,OUTPATIENT,,,36.5,14.6,UC HEALTH,UC HEALTH COMMERCIAL,31.755,87,,,OTHER,27.4,35.8,PERCENT OF TOTAL BILLED CHARGES
THIOPURINE METHYLTRANS NUDIX15,0034U,HCPCS,300,RC,,INPATIENT,,,494,197.6,UC HEALTH,UC HEALTH COMMERCIAL,429.78,87,,,OTHER,370.5,484.1,PERCENT OF TOTAL BILLED CHARGES
CHROMO MICRO AUTO STILL,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,UC HEALTH,UC HEALTH COMMERCIAL,2987.58,87,,,OTHER,2575.5,3365.3,PERCENT OF TOTAL BILLED CHARGES
HLA I LOW RESOLUTION ONE ANTI,81374,CPT,300,RC,,OUTPATIENT,,,255,102,UC HEALTH,UC HEALTH COMMERCIAL,221.85,87,,,OTHER,191.3,249.9,PERCENT OF TOTAL BILLED CHARGES
GALACTOSEMIA GALT GENE PANEL,81401,CPT,300,RC,,OUTPATIENT,,,1259,503.6,UC HEALTH,UC HEALTH COMMERCIAL,1095.33,87,,,OTHER,944.3,1233.8,PERCENT OF TOTAL BILLED CHARGES
PT MIX 1:1,81448,CPT,300,RC,,OUTPATIENT,,,1169.8,467.92,UC HEALTH,UC HEALTH COMMERCIAL,1017.726,87,,,OTHER,877.4,1146.4,PERCENT OF TOTAL BILLED CHARGES
M PROTEIN ISOTYPE,0077U,HCPCS,300,RC,,INPATIENT,,,149,59.6,UC HEALTH,UC HEALTH COMMERCIAL,129.63,87,,,OTHER,111.8,146,PERCENT OF TOTAL BILLED CHARGES
BIRT HOGG DUB SYNDROME,81479,CPT,300,RC,,OUTPATIENT,,,1896.79,758.716,UC HEALTH,UC HEALTH COMMERCIAL,1650.2073,87,,,OTHER,1422.6,1858.9,PERCENT OF TOTAL BILLED CHARGES
PHARMACOGENOMICS PANEL V,0029U,HCPCS,300,RC,,INPATIENT,,,1484.54,593.816,UC HEALTH,UC HEALTH COMMERCIAL,1291.5498,87,,,OTHER,1113.4,1454.8,PERCENT OF TOTAL BILLED CHARGES
ZMOPATH PROCEDURE LEVEL 7,81406,CPT,300,RC,,OUTPATIENT,,,1650,660,UC HEALTH,UC HEALTH COMMERCIAL,1435.5,87,,,OTHER,1237.5,1617,PERCENT OF TOTAL BILLED CHARGES
ZUNLISTED MOLECULAR PATHOLOGY,81479,CPT,300,RC,,OUTPATIENT,,,550,220,UC HEALTH,UC HEALTH COMMERCIAL,478.5,87,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
CHROMO MICRO AUTO STILL FFPE,81229,CPT,300,RC,,OUTPATIENT,,,3434,1373.6,UC HEALTH,UC HEALTH COMMERCIAL,2987.58,87,,,OTHER,2575.5,3365.3,PERCENT OF TOTAL BILLED CHARGES
OUT-PT/OBS RESPIRATORY PANEL,87631,CPT,300,RC,,OUTPATIENT,,,285.26,114.104,UC HEALTH,UC HEALTH COMMERCIAL,248.1762,87,,,OTHER,213.9,279.6,PERCENT OF TOTAL BILLED CHARGES
ZINC TRANSPORT 8 AB,86341,CPT,302,RC,,OUTPATIENT,,,665.19,266.076,UC HEALTH,UC HEALTH COMMERCIAL,578.7153,87,,,OTHER,498.9,651.9,PERCENT OF TOTAL BILLED CHARGES
ALPHA-2-MCAROGLOBULIN,83883,CPT,301,RC,,OUTPATIENT,,,27.2,10.88,UC HEALTH,UC HEALTH COMMERCIAL,23.664,87,,,OTHER,20.4,26.7,PERCENT OF TOTAL BILLED CHARGES
Z HHTGG GENEIC PANEL 1,81406,CPT,300,RC,,OUTPATIENT,,,3779.96,1511.984,UC HEALTH,UC HEALTH COMMERCIAL,3288.5652,87,,,OTHER,2835,3704.4,PERCENT OF TOTAL BILLED CHARGES
Z HHTGG GENEIC PANEL 2,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,UC HEALTH,UC HEALTH COMMERCIAL,3846.8007,87,,,OTHER,3316.2,4333.2,PERCENT OF TOTAL BILLED CHARGES
NCDA GENE PANEL,81479,CPT,300,RC,,OUTPATIENT,,,4421.61,1768.644,UC HEALTH,UC HEALTH COMMERCIAL,3846.8007,87,,,OTHER,3316.2,4333.2,PERCENT OF TOTAL BILLED CHARGES
MUMPS PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,UC HEALTH,UC HEALTH COMMERCIAL,587.25,87,,,OTHER,506.3,661.5,PERCENT OF TOTAL BILLED CHARGES
MEASLES PCR,87798,CPT,306,RC,,OUTPATIENT,,,675,270,UC HEALTH,UC HEALTH COMMERCIAL,587.25,87,,,OTHER,506.3,661.5,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
Z MONOCLONAL PROTEIN,82784,CPT,301,RC,,OUTPATIENT,,,104.25,41.7,UC HEALTH,UC HEALTH COMMERCIAL,90.6975,87,,,OTHER,78.2,102.2,PERCENT OF TOTAL BILLED CHARGES
"THALLIUM, BLOOD",83018,CPT,300,RC,,OUTPATIENT,,,327,130.8,UC HEALTH,UC HEALTH COMMERCIAL,284.49,87,,,OTHER,245.3,320.5,PERCENT OF TOTAL BILLED CHARGES
HISTAMINE PLASMA,83088,CPT,301,RC,,OUTPATIENT,,,176.25,70.5,UC HEALTH,UC HEALTH COMMERCIAL,153.3375,87,,,OTHER,132.19,172.73,PERCENT OF TOTAL BILLED CHARGES
HOMOCYSTEINE TOTAL URINE,83090,CPT,301,RC,,OUTPATIENT,,,187.5,75,UC HEALTH,UC HEALTH COMMERCIAL,163.125,87,,,OTHER,140.63,183.75,PERCENT OF TOTAL BILLED CHARGES
FAMILIIAL AMYLOIDOSIS REFLEX,82542,CPT,301,RC,,OUTPATIENT,,,332,132.8,UC HEALTH,UC HEALTH COMMERCIAL,288.84,87,,,OTHER,249,325.4,PERCENT OF TOTAL BILLED CHARGES
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,18.6,7.44,UC HEALTH,UC HEALTH COMMERCIAL,16.182,87,,,OTHER,14,18.2,PERCENT OF TOTAL BILLED CHARGES
AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
ESTRADIOL SERUM,82670,CPT,300,RC,,OUTPATIENT,,,206.5,82.6,UC HEALTH,UC HEALTH COMMERCIAL,179.655,87,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
THYROGLOBULIN MASS SPECT MAYO,84432,CPT,301,RC,,OUTPATIENT,,,362.8,145.12,UC HEALTH,UC HEALTH COMMERCIAL,315.636,87,,,OTHER,272.1,355.5,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & REPORT,83912,CPT,300,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
BENZODIAZEPINE CONFIRM URINE,G0480,HCPCS,300,RC,,INPATIENT,,,228.86,91.544,UC HEALTH,UC HEALTH COMMERCIAL,199.1082,87,,,OTHER,171.6,224.3,PERCENT OF TOTAL BILLED CHARGES
INTERPRETATION & WRITTEN REPRT,86078,CPT,300,RC,,OUTPATIENT,,,136.5,54.6,UC HEALTH,UC HEALTH COMMERCIAL,118.755,87,,,OTHER,102.38,133.77,PERCENT OF TOTAL BILLED CHARGES
PANCREATIC ELASTASE SERUM,83519,CPT,300,RC,,OUTPATIENT,,,390,156,UC HEALTH,UC HEALTH COMMERCIAL,339.3,87,,,OTHER,292.5,382.2,PERCENT OF TOTAL BILLED CHARGES
MODECULE NUCLEIC AMPLIFICATION,83898,CPT,300,RC,,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
MOLECULE NUCLEIC AMPLIFICATION,8389859,CPT,301,RC,59,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389859,CPT,301,RC,59,OUTPATIENT,,,171.75,68.7,UC HEALTH,UC HEALTH COMMERCIAL,149.4225,87,,,OTHER,128.81,168.32,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,83898,CPT,300,RC,,OUTPATIENT,,,171.75,68.7,UC HEALTH,UC HEALTH COMMERCIAL,149.4225,87,,,OTHER,128.81,168.32,PERCENT OF TOTAL BILLED CHARGES
Z AMPLIFICATION NUCLEIC ACID,8389891,CPT,301,RC,91,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,83896,CPT,300,RC,,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z REVERSE TRANSCRIPTION,83902,CPT,300,RC,,OUTPATIENT,,,142.75,57.1,UC HEALTH,UC HEALTH COMMERCIAL,124.1925,87,,,OTHER,107.06,139.9,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
MOLECULAR ISOLATION/EXTRACTION,83890,CPT,301,RC,,OUTPATIENT,,,84,33.6,UC HEALTH,UC HEALTH COMMERCIAL,73.08,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
Z NUCLEIC ACID PROBE,8389691,CPT,300,RC,91,OUTPATIENT,,,44.75,17.9,UC HEALTH,UC HEALTH COMMERCIAL,38.9325,87,,,OTHER,33.56,43.86,PERCENT OF TOTAL BILLED CHARGES
MUTATION SCANNING,83903,CPT,300,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
HMG-COA REDUCTASE AB,82397,CPT,301,RC,,OUTPATIENT,,,274,109.6,UC HEALTH,UC HEALTH COMMERCIAL,238.38,87,,,OTHER,205.5,268.5,PERCENT OF TOTAL BILLED CHARGES
Z MUTATION SCANNING,8390359,CPT,300,RC,59,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
OSMOLALITY FECES,84999,CPT,301,RC,,OUTPATIENT,,,106.25,42.5,UC HEALTH,UC HEALTH COMMERCIAL,92.4375,87,,,OTHER,79.69,104.13,PERCENT OF TOTAL BILLED CHARGES
ALDOSTERONE URINE,82088,CPT,300,RC,,OUTPATIENT,,,255,102,UC HEALTH,UC HEALTH COMMERCIAL,221.85,87,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
NIACIN (NICOTINIC ACID),84425,CPT,301,RC,,OUTPATIENT,,,171,68.4,UC HEALTH,UC HEALTH COMMERCIAL,148.77,87,,,OTHER,128.25,167.58,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGEST,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
ENZYME DIGEST,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,83892,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME DIGESTION,8389259,CPT,300,RC,59,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.25,57.82,PERCENT OF TOTAL BILLED CHARGES
SODIUM QUANTITATIVE FECES,84302,CPT,301,RC,,OUTPATIENT,,,144.75,57.9,UC HEALTH,UC HEALTH COMMERCIAL,125.9325,87,,,OTHER,108.56,141.86,PERCENT OF TOTAL BILLED CHARGES
CYSTIC FIBROSIS MUTATION ANALY,81220,CPT,300,RC,,OUTPATIENT,,,1113.2,445.28,UC HEALTH,UC HEALTH COMMERCIAL,968.484,87,,,OTHER,301.88,394.45,PERCENT OF TOTAL BILLED CHARGES
CYSTATIN C,82610,CPT,300,RC,,OUTPATIENT,,,204.75,81.9,UC HEALTH,UC HEALTH COMMERCIAL,178.1325,87,,,OTHER,153.56,200.66,PERCENT OF TOTAL BILLED CHARGES
MTHFR MUTATION DETECTION,81291,CPT,300,RC,,OUTPATIENT,,,447.5,179,UC HEALTH,UC HEALTH COMMERCIAL,389.325,87,,,OTHER,335.63,438.55,PERCENT OF TOTAL BILLED CHARGES
UR PROSTAGLANDIN D2 (PG D2),84150,CPT,300,RC,,OUTPATIENT,,,603,241.2,UC HEALTH,UC HEALTH COMMERCIAL,524.61,87,,,OTHER,452.3,590.9,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UC HEALTH,UC HEALTH COMMERCIAL,57.7071,87,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UC HEALTH,UC HEALTH COMMERCIAL,57.7071,87,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
Z RHEUMATOID FACTOR IGG IGA IG,83520,CPT,300,RC,,OUTPATIENT,,,66.33,26.532,UC HEALTH,UC HEALTH COMMERCIAL,57.7071,87,,,OTHER,49.7,65,PERCENT OF TOTAL BILLED CHARGES
SEROTONIN RELEASE ASSAY,82542,CPT,301,RC,,OUTPATIENT,,,447,178.8,UC HEALTH,UC HEALTH COMMERCIAL,388.89,87,,,OTHER,335.3,438.1,PERCENT OF TOTAL BILLED CHARGES
QUAD SCREEN (SECOND TRIMESTER),81511,CPT,300,RC,,OUTPATIENT,,,307,122.8,UC HEALTH,UC HEALTH COMMERCIAL,267.09,87,,,OTHER,147.75,193.06,PERCENT OF TOTAL BILLED CHARGES
Z AFP,82105,CPT,300,RC,,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z ESTRIOL,82677,CPT,301,RC,,OUTPATIENT,,,66,26.4,UC HEALTH,UC HEALTH COMMERCIAL,57.42,87,,,OTHER,49.5,64.68,PERCENT OF TOTAL BILLED CHARGES
Z HCG,84702,CPT,301,RC,,OUTPATIENT,,,41.75,16.7,UC HEALTH,UC HEALTH COMMERCIAL,36.3225,87,,,OTHER,31.31,40.92,PERCENT OF TOTAL BILLED CHARGES
Z INHIBIN,86336,CPT,300,RC,,OUTPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,215,86,UC HEALTH,UC HEALTH COMMERCIAL,187.05,87,,,OTHER,161.3,210.7,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,210,84,UC HEALTH,UC HEALTH COMMERCIAL,182.7,87,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF PRIMIDONE,80188,CPT,300,RC,,OUTPATIENT,,,52.5,21,UC HEALTH,UC HEALTH COMMERCIAL,45.675,87,,,OTHER,39.4,51.5,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,OUTPATIENT,,,122,48.8,UC HEALTH,UC HEALTH COMMERCIAL,106.14,87,,,OTHER,91.5,119.6,PERCENT OF TOTAL BILLED CHARGES
OSTEOCALCIN SERUM,83937,CPT,301,RC,,OUTPATIENT,,,211.3,84.52,UC HEALTH,UC HEALTH COMMERCIAL,183.831,87,,,OTHER,158.5,207.1,PERCENT OF TOTAL BILLED CHARGES
Z ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.3,563.5,PERCENT OF TOTAL BILLED CHARGES
Z ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
CAROTENE BETA (LS),82380,CPT,301,RC,,OUTPATIENT,,,184,73.6,UC HEALTH,UC HEALTH COMMERCIAL,160.08,87,,,OTHER,138,180.3,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN COMPLEX,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,UC HEALTH,UC HEALTH COMMERCIAL,211.41,87,,,OTHER,182.3,238.1,PERCENT OF TOTAL BILLED CHARGES
ANTI MDA 5 AB,83520,CPT,300,RC,,OUTPATIENT,,,243,97.2,UC HEALTH,UC HEALTH COMMERCIAL,211.41,87,,,OTHER,182.3,238.1,PERCENT OF TOTAL BILLED CHARGES
ANTI MI 2 AB,83516,CPT,300,RC,,OUTPATIENT,,,164,65.6,UC HEALTH,UC HEALTH COMMERCIAL,142.68,87,,,OTHER,123,160.7,PERCENT OF TOTAL BILLED CHARGES
PHOSPHOLIPASE A2 RECEPTOR,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN B SINGLE,82172,CPT,301,RC,,OUTPATIENT,,,42.18,16.872,UC HEALTH,UC HEALTH COMMERCIAL,36.6966,87,,,OTHER,31.6,41.3,PERCENT OF TOTAL BILLED CHARGES
MECONIUM DRUG PANEL,80307,CPT,301,RC,,OUTPATIENT,,,224.25,89.7,UC HEALTH,UC HEALTH COMMERCIAL,195.0975,87,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
Z AMPHETAMINE,G0480,HCPCS,300,RC,,BOTH,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z COCAINE & METABOLITES,80353,CPT,301,RC,,OUTPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z CANNABINOIDS,80349,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z OPIATES,80361,CPT,300,RC,,OUTPATIENT,,,56.75,22.7,UC HEALTH,UC HEALTH COMMERCIAL,49.3725,87,,,OTHER,42.56,55.62,PERCENT OF TOTAL BILLED CHARGES
Z PHENCYCLIDINE,8010191,CPT,300,RC,91,OUTPATIENT,,,70.5,28.2,UC HEALTH,UC HEALTH COMMERCIAL,61.335,87,,,OTHER,52.88,69.09,PERCENT OF TOTAL BILLED CHARGES
MYASTHENIA GRAVIS MUSK REFLEX,83519,CPT,300,RC,,OUTPATIENT,,,195,78,UC HEALTH,UC HEALTH COMMERCIAL,169.65,87,,,OTHER,146.3,191.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB AB S CHARGE,82397,CPT,301,RC,,OUTPATIENT,,,236,94.4,UC HEALTH,UC HEALTH COMMERCIAL,205.32,87,,,OTHER,177,231.3,PERCENT OF TOTAL BILLED CHARGES
PORPHYRINS EVALUATION WB,84311,CPT,300,RC,,OUTPATIENT,,,164,65.6,UC HEALTH,UC HEALTH COMMERCIAL,142.68,87,,,OTHER,123,160.7,PERCENT OF TOTAL BILLED CHARGES
TISSUE NECROSIS FACTOR ALPHA,83520,CPT,300,RC,,OUTPATIENT,,,486,194.4,UC HEALTH,UC HEALTH COMMERCIAL,422.82,87,,,OTHER,364.5,476.3,PERCENT OF TOTAL BILLED CHARGES
MELANOCYTE STM HOR ALPHA,83519,CPT,300,RC,,OUTPATIENT,,,305.67,122.268,UC HEALTH,UC HEALTH COMMERCIAL,265.9329,87,,,OTHER,229.3,299.6,PERCENT OF TOTAL BILLED CHARGES
PRI MEMBRANOUS NEPHROPATH DIAG,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
OBSTETRIC PROFILE,80081,CPT,301,RC,,OUTPATIENT,,,149.72,59.888,UC HEALTH,UC HEALTH COMMERCIAL,130.2564,87,,,OTHER,112.3,146.7,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN STABILITY SCREEN,83068,CPT,300,RC,,OUTPATIENT,,,85,34,UC HEALTH,UC HEALTH COMMERCIAL,73.95,87,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
PROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,165,66,UC HEALTH,UC HEALTH COMMERCIAL,143.55,87,,,OTHER,123.8,161.7,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,OUTPATIENT,,,95,38,UC HEALTH,UC HEALTH COMMERCIAL,82.65,87,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,OUTPATIENT,,,160,64,UC HEALTH,UC HEALTH COMMERCIAL,139.2,87,,,OTHER,120,156.8,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF G6PD ENZYME,82955,CPT,300,RC,,OUTPATIENT,,,85,34,UC HEALTH,UC HEALTH COMMERCIAL,73.95,87,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF PYRUVATE KINASE,84220,CPT,300,RC,,OUTPATIENT,,,85,34,UC HEALTH,UC HEALTH COMMERCIAL,73.95,87,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,OUTPATIENT,,,95,38,UC HEALTH,UC HEALTH COMMERCIAL,82.65,87,,,OTHER,71.3,93.1,PERCENT OF TOTAL BILLED CHARGES
ENZYME CELL ACTIVITY,82657,CPT,300,RC,,OUTPATIENT,,,185,74,UC HEALTH,UC HEALTH COMMERCIAL,160.95,87,,,OTHER,138.8,181.3,PERCENT OF TOTAL BILLED CHARGES
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,OUTPATIENT,,,140,56,UC HEALTH,UC HEALTH COMMERCIAL,121.8,87,,,OTHER,105,137.2,PERCENT OF TOTAL BILLED CHARGES
PHOSPHATIDYLETHANOL CONFIRM B,80321,CPT,300,RC,,OUTPATIENT,,,126,50.4,UC HEALTH,UC HEALTH COMMERCIAL,109.62,87,,,OTHER,94.5,123.5,PERCENT OF TOTAL BILLED CHARGES
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,OUTPATIENT,,,258.4,103.36,UC HEALTH,UC HEALTH COMMERCIAL,224.808,87,,,OTHER,193.8,253.2,PERCENT OF TOTAL BILLED CHARGES
IL 2 RECEPTOR SOLUBLE,83520,CPT,300,RC,,OUTPATIENT,,,144.31,57.724,UC HEALTH,UC HEALTH COMMERCIAL,125.5497,87,,,OTHER,108.2,141.4,PERCENT OF TOTAL BILLED CHARGES
FLUORIDE PLASMA,82735,CPT,301,RC,,OUTPATIENT,,,135,54,UC HEALTH,UC HEALTH COMMERCIAL,117.45,87,,,OTHER,101.3,132.3,PERCENT OF TOTAL BILLED CHARGES
CLOBAZAM AND METABOLITE,80339,CPT,301,RC,,OUTPATIENT,,,228.86,91.544,UC HEALTH,UC HEALTH COMMERCIAL,199.1082,87,,,OTHER,171.6,224.3,PERCENT OF TOTAL BILLED CHARGES
NIACIN (NICOTINIC ACID),84591,CPT,300,RC,,OUTPATIENT,,,210,84,UC HEALTH,UC HEALTH COMMERCIAL,182.7,87,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
ZPROTEIN WESTERN BLOT TEST,84182,CPT,300,RC,,OUTPATIENT,,,553,221.2,UC HEALTH,UC HEALTH COMMERCIAL,481.11,87,,,OTHER,414.8,541.9,PERCENT OF TOTAL BILLED CHARGES
QUANTITATE BY HPLC,83021,CPT,301,RC,,OUTPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
QUANTITATE BY ELECTROPHORESIS,83020,CPT,300,RC,,OUTPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
UR PHENCYCLIDINE CONFIMATION,83992,CPT,301,RC,,OUTPATIENT,,,120,48,UC HEALTH,UC HEALTH COMMERCIAL,104.4,87,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
UR AMMONIUM RANDOM,82140,CPT,301,RC,,OUTPATIENT,,,538.66,215.464,UC HEALTH,UC HEALTH COMMERCIAL,468.6342,87,,,OTHER,404,527.9,PERCENT OF TOTAL BILLED CHARGES
Z BASIC METABOLIC PANEL,80048,CPT,301,RC,,OUTPATIENT,,,16.92,6.768,UC HEALTH,UC HEALTH COMMERCIAL,14.7204,87,,,OTHER,12.7,16.6,PERCENT OF TOTAL BILLED CHARGES
"Z BILIRUBIN,TOTAL",82247,CPT,301,RC,,OUTPATIENT,,,10.04,4.016,UC HEALTH,UC HEALTH COMMERCIAL,8.7348,87,,,OTHER,7.5,9.8,PERCENT OF TOTAL BILLED CHARGES
Z SGOT/AST,84450,CPT,301,RC,,OUTPATIENT,,,10.36,4.144,UC HEALTH,UC HEALTH COMMERCIAL,9.0132,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z SGPT/ALT,84460,CPT,300,RC,,OUTPATIENT,,,10.6,4.24,UC HEALTH,UC HEALTH COMMERCIAL,9.222,87,,,OTHER,8,10.4,PERCENT OF TOTAL BILLED CHARGES
Z AKALINE PHOSPHATASE,84075,CPT,300,RC,,OUTPATIENT,,,10.36,4.144,UC HEALTH,UC HEALTH COMMERCIAL,9.0132,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z RIA NONANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,188.05,75.22,UC HEALTH,UC HEALTH COMMERCIAL,163.6035,87,,,OTHER,141,184.3,PERCENT OF TOTAL BILLED CHARGES
Z VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,OUTPATIENT,,,188.05,75.22,UC HEALTH,UC HEALTH COMMERCIAL,163.6035,87,,,OTHER,141,184.3,PERCENT OF TOTAL BILLED CHARGES
ZLIPOPRO BLD ELECTROPHORETIC,83700,CPT,300,RC,,OUTPATIENT,,,22.52,9.008,UC HEALTH,UC HEALTH COMMERCIAL,19.5924,87,,,OTHER,16.9,22.1,PERCENT OF TOTAL BILLED CHARGES
ZLIPOPROTEIN BLD HR FRACTION,83701,CPT,301,RC,,OUTPATIENT,,,67.72,27.088,UC HEALTH,UC HEALTH COMMERCIAL,58.9164,87,,,OTHER,50.8,66.4,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,UC HEALTH,UC HEALTH COMMERCIAL,25.4475,87,,,OTHER,21.9,28.7,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF AMYLASE,82150,CPT,301,RC,,OUTPATIENT,,,29.25,11.7,UC HEALTH,UC HEALTH COMMERCIAL,25.4475,87,,,OTHER,21.9,28.7,PERCENT OF TOTAL BILLED CHARGES
TEST FW BOUND TOT TEST,84410,CPT,300,RC,,OUTPATIENT,,,102.56,41.024,UC HEALTH,UC HEALTH COMMERCIAL,89.2272,87,,,OTHER,76.9,100.5,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE SERUM,80299,CPT,300,RC,,OUTPATIENT,,,160.24,64.096,UC HEALTH,UC HEALTH COMMERCIAL,139.4088,87,,,OTHER,120.2,157,PERCENT OF TOTAL BILLED CHARGES
UR SYNTHETIC THC METABOLITE SC,80307,CPT,301,RC,,OUTPATIENT,,,206.56,82.624,UC HEALTH,UC HEALTH COMMERCIAL,179.7072,87,,,OTHER,154.9,202.4,PERCENT OF TOTAL BILLED CHARGES
GENERAL HEALTH PANEL,80050,CPT,301,RC,,OUTPATIENT,,,324.75,129.9,UC HEALTH,UC HEALTH COMMERCIAL,282.5325,87,,,OTHER,243.6,318.3,PERCENT OF TOTAL BILLED CHARGES
BIOTIN VITAMIN,84591,CPT,300,RC,,OUTPATIENT,,,210,84,UC HEALTH,UC HEALTH COMMERCIAL,182.7,87,,,OTHER,157.5,205.8,PERCENT OF TOTAL BILLED CHARGES
MAYO PSAD SENDOUT,84153,CPT,301,RC,,OUTPATIENT,,,151,60.4,UC HEALTH,UC HEALTH COMMERCIAL,131.37,87,,,OTHER,113.3,148,PERCENT OF TOTAL BILLED CHARGES
MAYO PSAS SENDOUT,G0103,HCPCS,301,RC,,INPATIENT,,,151,60.4,UC HEALTH,UC HEALTH COMMERCIAL,131.37,87,,,OTHER,113.3,148,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM QUANTITATIVE FECES,83735,CPT,300,RC,,OUTPATIENT,,,89.25,35.7,UC HEALTH,UC HEALTH COMMERCIAL,77.6475,87,,,OTHER,66.94,87.47,PERCENT OF TOTAL BILLED CHARGES
5 HYDROXYINDOLEACETIC ACID P,83497,CPT,300,RC,,OUTPATIENT,,,25.8,10.32,UC HEALTH,UC HEALTH COMMERCIAL,22.446,87,,,OTHER,19.4,25.3,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,363.8,145.52,UC HEALTH,UC HEALTH COMMERCIAL,316.506,87,,,OTHER,272.9,356.5,PERCENT OF TOTAL BILLED CHARGES
ZASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,OUTPATIENT,,,149.71,59.884,UC HEALTH,UC HEALTH COMMERCIAL,130.2477,87,,,OTHER,112.3,146.7,PERCENT OF TOTAL BILLED CHARGES
ZASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,OUTPATIENT,,,25,10,UC HEALTH,UC HEALTH COMMERCIAL,21.75,87,,,OTHER,18.8,24.5,PERCENT OF TOTAL BILLED CHARGES
ZPROTEIN E-PHORESIS SERUM,84165,CPT,300,RC,,OUTPATIENT,,,59,23.6,UC HEALTH,UC HEALTH COMMERCIAL,51.33,87,,,OTHER,44.3,57.8,PERCENT OF TOTAL BILLED CHARGES
APOLIPOPROTEIN B PLASMA,82172,CPT,301,RC,,OUTPATIENT,,,95.75,38.3,UC HEALTH,UC HEALTH COMMERCIAL,83.3025,87,,,OTHER,71.81,93.84,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY QUANT NOS NONAB,83520,CPT,300,RC,,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,295.5,386.1,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGG,86674,CPT,302,RC,,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGA,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
Z GIARDIA LAMBLIA AB IGM,8667491,CPT,300,RC,91,OUTPATIENT,,,48.75,19.5,UC HEALTH,UC HEALTH COMMERCIAL,42.4125,87,,,OTHER,36.56,47.78,PERCENT OF TOTAL BILLED CHARGES
BETA 2 GLYCOPROTEIN 1 ANTIBODY,86146,CPT,300,RC,,OUTPATIENT,,,65,26,UC HEALTH,UC HEALTH COMMERCIAL,56.55,87,,,OTHER,48.8,63.7,PERCENT OF TOTAL BILLED CHARGES
LOCUST BLACK IGE,86003,CPT,300,RC,,OUTPATIENT,,,88.72,35.488,UC HEALTH,UC HEALTH COMMERCIAL,77.1864,87,,,OTHER,66.5,86.9,PERCENT OF TOTAL BILLED CHARGES
FEATHER PANEL 2 ALLERGENS,86003,CPT,300,RC,,OUTPATIENT,,,52.82,21.128,UC HEALTH,UC HEALTH COMMERCIAL,45.9534,87,,,OTHER,39.6,51.8,PERCENT OF TOTAL BILLED CHARGES
EASTERN SYCAMORE IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UC HEALTH,UC HEALTH COMMERCIAL,10.44,87,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
STRONGYLOIDES IGG AB,86682,CPT,302,RC,,OUTPATIENT,,,147,58.8,UC HEALTH,UC HEALTH COMMERCIAL,127.89,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
JOHNSONS GRASS IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UC HEALTH,UC HEALTH COMMERCIAL,10.44,87,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
LAMBS QUARTER IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,12,4.8,UC HEALTH,UC HEALTH COMMERCIAL,10.44,87,,,OTHER,9,11.8,PERCENT OF TOTAL BILLED CHARGES
CASHEW IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
MACADAMIA NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
PINE NUT IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
PEANUT IGE COMPONENTS REFLEX,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
BELL PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UC HEALTH,UC HEALTH COMMERCIAL,58.377,87,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
BLACK PEPPER IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UC HEALTH,UC HEALTH COMMERCIAL,58.377,87,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
PEA GREEN IGG,86001,CPT,300,RC,,OUTPATIENT,,,67.1,26.84,UC HEALTH,UC HEALTH COMMERCIAL,58.377,87,,,OTHER,50.3,65.8,PERCENT OF TOTAL BILLED CHARGES
C DSDNA AB CRITHIDIA IFA IGG,86255,CPT,300,RC,,OUTPATIENT,,,223,89.2,UC HEALTH,UC HEALTH COMMERCIAL,194.01,87,,,OTHER,167.3,218.5,PERCENT OF TOTAL BILLED CHARGES
CANDIDA ALBICANS IGG,86001,CPT,300,RC,,OUTPATIENT,,,65.44,26.176,UC HEALTH,UC HEALTH COMMERCIAL,56.9328,87,,,OTHER,49.1,64.1,PERCENT OF TOTAL BILLED CHARGES
THSD7A AB S CHARGE,86255,CPT,300,RC,,OUTPATIENT,,,380,152,UC HEALTH,UC HEALTH COMMERCIAL,330.6,87,,,OTHER,285,372.4,PERCENT OF TOTAL BILLED CHARGES
TAPIOCA IGE ALLERGEN,86003,CPT,300,RC,,OUTPATIENT,,,57.41,22.964,UC HEALTH,UC HEALTH COMMERCIAL,49.9467,87,,,OTHER,43.1,56.3,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
ZHYPERSENSITIV PNEUMONITIS PNL,86001,CPT,300,RC,,OUTPATIENT,,,33.55,13.42,UC HEALTH,UC HEALTH COMMERCIAL,29.1885,87,,,OTHER,25.2,32.9,PERCENT OF TOTAL BILLED CHARGES
DIRECT ANTIGLOBULIN IGG,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
DIRECT ANTIGLOBULIN C3,86880,CPT,300,RC,,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.4,110.3,PERCENT OF TOTAL BILLED CHARGES
JALAPENO CHIPOTLE IGE,86003,CPT,300,RC,,OUTPATIENT,,,96,38.4,UC HEALTH,UC HEALTH COMMERCIAL,83.52,87,,,OTHER,72,94.1,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
ZMEAT ALERGY,86003,CPT,300,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.3,34.3,PERCENT OF TOTAL BILLED CHARGES
BRAZIL NUT IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,36.16,14.464,UC HEALTH,UC HEALTH COMMERCIAL,31.4592,87,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
Z ANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,UC HEALTH,UC HEALTH COMMERCIAL,31.4679,87,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,36.17,14.468,UC HEALTH,UC HEALTH COMMERCIAL,31.4679,87,,,OTHER,27.1,35.4,PERCENT OF TOTAL BILLED CHARGES
PINEAPPLE IGG,86001,CPT,300,RC,,OUTPATIENT,,,62,24.8,UC HEALTH,UC HEALTH COMMERCIAL,53.94,87,,,OTHER,46.5,60.8,PERCENT OF TOTAL BILLED CHARGES
C1Q BINDING ASSAY,86332,CPT,302,RC,,OUTPATIENT,,,48.74,19.496,UC HEALTH,UC HEALTH COMMERCIAL,42.4038,87,,,OTHER,36.6,47.8,PERCENT OF TOTAL BILLED CHARGES
GLIADIN DEAMIDATED AB,86258,CPT,300,RC,,OUTPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.3,61.7,PERCENT OF TOTAL BILLED CHARGES
ANTI TIF 1GAMMA AB,86235,CPT,300,RC,,OUTPATIENT,,,185.73,74.292,UC HEALTH,UC HEALTH COMMERCIAL,161.5851,87,,,OTHER,139.3,182,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UC HEALTH,UC HEALTH COMMERCIAL,20.8452,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UC HEALTH,UC HEALTH COMMERCIAL,20.8452,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UC HEALTH,UC HEALTH COMMERCIAL,20.8452,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UC HEALTH,UC HEALTH COMMERCIAL,20.8452,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNODIFFUSION OUCHTERLONY,86331,CPT,300,RC,,OUTPATIENT,,,23.96,9.584,UC HEALTH,UC HEALTH COMMERCIAL,20.8452,87,,,OTHER,18,23.5,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
FLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,70,28,UC HEALTH,UC HEALTH COMMERCIAL,60.9,87,,,OTHER,52.5,68.6,PERCENT OF TOTAL BILLED CHARGES
ISLET CELL ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,135,54,UC HEALTH,UC HEALTH COMMERCIAL,117.45,87,,,OTHER,101.3,132.3,PERCENT OF TOTAL BILLED CHARGES
COW EPITHELIUM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL POTATO,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL FRUIT PANEL,86001,CPT,300,RC,,OUTPATIENT,,,305.35,122.14,UC HEALTH,UC HEALTH COMMERCIAL,265.6545,87,,,OTHER,229,299.2,PERCENT OF TOTAL BILLED CHARGES
ZFLUORESCENT ANTIBODY SCREEN,86255,CPT,300,RC,,OUTPATIENT,,,380,152,UC HEALTH,UC HEALTH COMMERCIAL,330.6,87,,,OTHER,285,372.4,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
Z ALLERGEN SPECIFIC IGG,86001,CPT,300,RC,,OUTPATIENT,,,15.64,6.256,UC HEALTH,UC HEALTH COMMERCIAL,13.6068,87,,,OTHER,11.7,15.3,PERCENT OF TOTAL BILLED CHARGES
TRICHINELLA ANTIBODY,86784,CPT,302,RC,,OUTPATIENT,,,66,26.4,UC HEALTH,UC HEALTH COMMERCIAL,57.42,87,,,OTHER,49.5,64.7,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UC HEALTH,UC HEALTH COMMERCIAL,58.0986,87,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UC HEALTH,UC HEALTH COMMERCIAL,58.0986,87,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UC HEALTH,UC HEALTH COMMERCIAL,58.0986,87,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZNEISSERIA MENIN IGG VACC RESP,86317,CPT,300,RC,,OUTPATIENT,,,66.78,26.712,UC HEALTH,UC HEALTH COMMERCIAL,58.0986,87,,,OTHER,50.1,65.4,PERCENT OF TOTAL BILLED CHARGES
ZANTINUCLEAR ANTIBODIES,86038,CPT,300,RC,,OUTPATIENT,,,110,44,UC HEALTH,UC HEALTH COMMERCIAL,95.7,87,,,OTHER,82.5,107.8,PERCENT OF TOTAL BILLED CHARGES
ZFLUORESCENT ANTIBODY TITER,86256,CPT,300,RC,,OUTPATIENT,,,109,43.6,UC HEALTH,UC HEALTH COMMERCIAL,94.83,87,,,OTHER,81.8,106.8,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOASSAY NONANTIBODY,83516,CPT,300,RC,,OUTPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.3,97,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZNUCLEAR ANTIGEN ANTIBODY,86235,CPT,300,RC,,OUTPATIENT,,,23,9.2,UC HEALTH,UC HEALTH COMMERCIAL,20.01,87,,,OTHER,17.3,22.5,PERCENT OF TOTAL BILLED CHARGES
ZIMMUNOFIX E-PHORESIS SERUM,86334,CPT,300,RC,,OUTPATIENT,,,100,40,UC HEALTH,UC HEALTH COMMERCIAL,87,87,,,OTHER,75,98,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT IGG,86880,CPT,300,RC,,OUTPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.8,44.1,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT C3,86880,CPT,300,RC,,OUTPATIENT,,,45,18,UC HEALTH,UC HEALTH COMMERCIAL,39.15,87,,,OTHER,33.8,44.1,PERCENT OF TOTAL BILLED CHARGES
COOMBS TEST DIRECT POLY,86880,CPT,300,RC,,OUTPATIENT,,,58,23.2,UC HEALTH,UC HEALTH COMMERCIAL,50.46,87,,,OTHER,43.5,56.8,PERCENT OF TOTAL BILLED CHARGES
ALL SQUASH,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL WASP VENOM,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL DOG DANDER IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
ALL ROUGH PIGWEED IGE,86003,CPT,300,RC,,OUTPATIENT,,,10.44,4.176,UC HEALTH,UC HEALTH COMMERCIAL,9.0828,87,,,OTHER,7.8,10.2,PERCENT OF TOTAL BILLED CHARGES
RIA ANTIBODY,83519,CPT,300,RC,,OUTPATIENT,,,71.75,28.7,UC HEALTH,UC HEALTH COMMERCIAL,62.4225,87,,,OTHER,53.81,70.32,PERCENT OF TOTAL BILLED CHARGES
FLUROESCENT ANTIBODY,86255,CPT,300,RC,,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
ISLET ANTIBODY,86341,CPT,302,RC,,OUTPATIENT,,,119.5,47.8,UC HEALTH,UC HEALTH COMMERCIAL,103.965,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN - PF4 ANTIBODY,86022,CPT,302,RC,,OUTPATIENT,,,333.5,133.4,UC HEALTH,UC HEALTH COMMERCIAL,290.145,87,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
R D-DIMER,85379,CPT,300,RC,,OUTPATIENT,,,169.5,67.8,UC HEALTH,UC HEALTH COMMERCIAL,147.465,87,,,OTHER,127.13,166.11,PERCENT OF TOTAL BILLED CHARGES
Z HERPES VIRUS 6 IGG,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z HERPES VIRUS 6 IGM,86790,CPT,300,RC,,OUTPATIENT,,,108.75,43.5,UC HEALTH,UC HEALTH COMMERCIAL,94.6125,87,,,OTHER,81.56,106.58,PERCENT OF TOTAL BILLED CHARGES
Z DENGUE FEVER IGG,86790,CPT,300,RC,,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
Z DENGUE FEVER IGM,8679059,CPT,300,RC,59,OUTPATIENT,,,162,64.8,UC HEALTH,UC HEALTH COMMERCIAL,140.94,87,,,OTHER,121.5,158.76,PERCENT OF TOTAL BILLED CHARGES
ANTITHROMBIN III ACTVTY PLASMA,85300,CPT,300,RC,,OUTPATIENT,,,210.5,84.2,UC HEALTH,UC HEALTH COMMERCIAL,183.135,87,,,OTHER,157.88,206.29,PERCENT OF TOTAL BILLED CHARGES
ADMATS13 ACTIVITY INHIBITOR PF,85397,CPT,300,RC,,OUTPATIENT,,,337.5,135,UC HEALTH,UC HEALTH COMMERCIAL,293.625,87,,,OTHER,253.1,330.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD SMEAR INTERPRETATION,85007,CPT,305,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
RBC OSMOTIC FRAGILITY,85557,CPT,300,RC,,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.8,122.5,PERCENT OF TOTAL BILLED CHARGES
SOLUBLE FIBRIN MONOMER CHARGE,85366,CPT,300,RC,,OUTPATIENT,,,160.92,64.368,UC HEALTH,UC HEALTH COMMERCIAL,140.0004,87,,,OTHER,120.7,157.7,PERCENT OF TOTAL BILLED CHARGES
ENZYME DETECTION PER ENZYME,87185,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
FECAL REDUCING SUBSTANCE,84376,CPT,301,RC,,OUTPATIENT,,,191.75,76.7,UC HEALTH,UC HEALTH COMMERCIAL,166.8225,87,,,OTHER,143.81,187.92,PERCENT OF TOTAL BILLED CHARGES
MYCOBACTERIUM TB AMPLIFIED,87556,CPT,306,RC,,OUTPATIENT,,,529.75,211.9,UC HEALTH,UC HEALTH COMMERCIAL,460.8825,87,,,OTHER,397.31,519.16,PERCENT OF TOTAL BILLED CHARGES
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UC HEALTH,UC HEALTH COMMERCIAL,91.35,87,,,OTHER,78.8,102.9,PERCENT OF TOTAL BILLED CHARGES
Z HSV DNA AMP PROBE,87529,CPT,300,RC,,OUTPATIENT,,,105,42,UC HEALTH,UC HEALTH COMMERCIAL,91.35,87,,,OTHER,78.8,102.9,PERCENT OF TOTAL BILLED CHARGES
NOCARDIA SPECIES  MIC,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
INFECTIOUS AGENT ANTIGEN DETEC,87147,CPT,306,RC,,OUTPATIENT,,,51.5,20.6,UC HEALTH,UC HEALTH COMMERCIAL,44.805,87,,,OTHER,38.63,50.47,PERCENT OF TOTAL BILLED CHARGES
SUSCEPTABILITY STUDIES,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA HOMINIS PCR,87798,CPT,306,RC,,OUTPATIENT,,,195,78,UC HEALTH,UC HEALTH COMMERCIAL,169.65,87,,,OTHER,146.3,191.1,PERCENT OF TOTAL BILLED CHARGES
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,UC HEALTH,UC HEALTH COMMERCIAL,73.95,87,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
Z HPYLORI CLARITHROMYCIN RESIS,87798,CPT,306,RC,,OUTPATIENT,,,85,34,UC HEALTH,UC HEALTH COMMERCIAL,73.95,87,,,OTHER,63.8,83.3,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE BODY FLUID  NOT BLOOD,82945,CPT,301,RC,,OUTPATIENT,,,74.25,29.7,UC HEALTH,UC HEALTH COMMERCIAL,64.5975,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
CHCV GENTYPE RESOLUTION,87902,CPT,300,RC,,OUTPATIENT,,,514.9,205.96,UC HEALTH,UC HEALTH COMMERCIAL,447.963,87,,,OTHER,386.2,504.6,PERCENT OF TOTAL BILLED CHARGES
MYCOPLASMA GENITALIUM TMA,87563,CPT,306,RC,,OUTPATIENT,,,136,54.4,UC HEALTH,UC HEALTH COMMERCIAL,118.32,87,,,OTHER,102,133.3,PERCENT OF TOTAL BILLED CHARGES
MICROSTREP PLUS 1,87186,CPT,306,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
TOXOPLASMA GONDII PCR BLD,87798,CPT,306,RC,,OUTPATIENT,,,513.75,205.5,UC HEALTH,UC HEALTH COMMERCIAL,446.9625,87,,,OTHER,385.3,503.5,PERCENT OF TOTAL BILLED CHARGES
SHIGELLA CULTURE FECES,87046,CPT,306,RC,,OUTPATIENT,,,149.51,59.804,UC HEALTH,UC HEALTH COMMERCIAL,130.0737,87,,,OTHER,112.1,146.5,PERCENT OF TOTAL BILLED CHARGES
"CRYPTOCOCCUS AG TITER,LFA,CSF",87899,CPT,300,RC,,OUTPATIENT,,,87.66,35.064,UC HEALTH,UC HEALTH COMMERCIAL,76.2642,87,,,OTHER,65.7,85.9,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE (DIFLUCAN) SENS,87999,CPT,306,RC,,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
MONKEYPOX PCR,87593,CPT,306,RC,,OUTPATIENT,,,120,48,UC HEALTH,UC HEALTH COMMERCIAL,104.4,87,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
RICKETTSIA SPECIEIS DNA PCR,87798,CPT,306,RC,,OUTPATIENT,,,406.66,162.664,UC HEALTH,UC HEALTH COMMERCIAL,353.7942,87,,,OTHER,305,398.5,PERCENT OF TOTAL BILLED CHARGES
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,UC HEALTH,UC HEALTH COMMERCIAL,30.5283,87,,,OTHER,26.3,34.4,PERCENT OF TOTAL BILLED CHARGES
ZDETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,35.09,14.036,UC HEALTH,UC HEALTH COMMERCIAL,30.5283,87,,,OTHER,26.3,34.4,PERCENT OF TOTAL BILLED CHARGES
ZLYME DIS DNA AMP PROBE,87476,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UC HEALTH,UC HEALTH COMMERCIAL,61.0566,87,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
FUNGAL CULTURE ROUTINE,87102,CPT,306,RC,,OUTPATIENT,,,149.16,59.664,UC HEALTH,UC HEALTH COMMERCIAL,129.7692,87,,,OTHER,111.9,146.2,PERCENT OF TOTAL BILLED CHARGES
FUNGITELL CSF,87449,CPT,300,RC,,OUTPATIENT,,,204,81.6,UC HEALTH,UC HEALTH COMMERCIAL,177.48,87,,,OTHER,153,199.9,PERCENT OF TOTAL BILLED CHARGES
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,2316,926.4,UC HEALTH,UC HEALTH COMMERCIAL,2014.92,87,,,OTHER,1737,2269.7,PERCENT OF TOTAL BILLED CHARGES
CSF PCR MENINGO-ENCEPHAL PNL,87483,CPT,306,RC,,OUTPATIENT,,,833.56,333.424,UC HEALTH,UC HEALTH COMMERCIAL,725.1972,87,,,OTHER,625.2,816.9,PERCENT OF TOTAL BILLED CHARGES
Z DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,OUTPATIENT,,,70.18,28.072,UC HEALTH,UC HEALTH COMMERCIAL,61.0566,87,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
Z TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,300,RC,,OUTPATIENT,,,70.18,28.072,UC HEALTH,UC HEALTH COMMERCIAL,61.0566,87,,,OTHER,52.6,68.8,PERCENT OF TOTAL BILLED CHARGES
Z DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UC HEALTH,UC HEALTH COMMERCIAL,122.148,87,,,OTHER,105.3,137.6,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE FECES W/ISO PRE EXAM,87046,CPT,306,RC,,OUTPATIENT,,,27.25,10.9,UC HEALTH,UC HEALTH COMMERCIAL,23.7075,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE FECES W/ISO PRE EXAM,8704691,CPT,306,RC,91,OUTPATIENT,,,27.25,10.9,UC HEALTH,UC HEALTH COMMERCIAL,23.7075,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
Z CULTURE SPECIMEN CONCENTRATN,87015,CPT,300,RC,,OUTPATIENT,,,62.25,24.9,UC HEALTH,UC HEALTH COMMERCIAL,54.1575,87,,,OTHER,46.69,61.01,PERCENT OF TOTAL BILLED CHARGES
VISBY SEXUAL HEALTH TEST,87801,CPT,300,RC,,OUTPATIENT,,,140.4,56.16,UC HEALTH,UC HEALTH COMMERCIAL,122.148,87,,,OTHER,105.3,137.6,PERCENT OF TOTAL BILLED CHARGES
UA  NON AUTOMATED  NO MICRO,81002,CPT,307,RC,,OUTPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH LIQUID BASED NON GYN,88112,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY NON-GYN,88106,CPT,300,RC,,OUTPATIENT,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
MAYO RESP PANEL PCR,0202U,HCPCS,310,RC,,INPATIENT,,,833.56,333.424,UC HEALTH,UC HEALTH COMMERCIAL,725.1972,87,,,OTHER,625.2,816.9,PERCENT OF TOTAL BILLED CHARGES
JAK2 EX12 NON-V617F MUT DETECT,81403,CPT,300,RC,,OUTPATIENT,,,752.75,301.1,UC HEALTH,UC HEALTH COMMERCIAL,654.8925,87,,,OTHER,564.56,737.7,PERCENT OF TOTAL BILLED CHARGES
IN SITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,189,246.96,PERCENT OF TOTAL BILLED CHARGES
GENE POLYMORPHISM,81400,CPT,300,RC,,OUTPATIENT,,,653.4,261.36,UC HEALTH,UC HEALTH COMMERCIAL,568.458,87,,,OTHER,490.1,640.3,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOFLUORESCENT STUDY,88347,CPT,310,RC,,OUTPATIENT,,,315.75,126.3,UC HEALTH,UC HEALTH COMMERCIAL,274.7025,87,,,OTHER,236.81,309.44,PERCENT OF TOTAL BILLED CHARGES
Z IMMUNOFLUORESCENT STUDY,8834791,CPT,310,RC,91,OUTPATIENT,,,315.75,126.3,UC HEALTH,UC HEALTH COMMERCIAL,274.7025,87,,,OTHER,236.81,309.44,PERCENT OF TOTAL BILLED CHARGES
M/PHMTRC ALYS ISHQUANT/SEMIQ,88373,CPT,310,RC,,OUTPATIENT,,,228.69,91.476,UC HEALTH,UC HEALTH COMMERCIAL,198.9603,87,,,OTHER,171.5,224.1,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFLUOR ANTB 1ST STAIN,88346,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
IMMUNOFLUOR ANTB ADDL STAIN,88350,CPT,310,RC,,OUTPATIENT,,,174,69.6,UC HEALTH,UC HEALTH COMMERCIAL,151.38,87,,,OTHER,130.5,170.52,PERCENT OF TOTAL BILLED CHARGES
FLT3 GENE,81245,CPT,310,RC,,OUTPATIENT,,,331.02,132.408,UC HEALTH,UC HEALTH COMMERCIAL,287.9874,87,,,OTHER,248.3,324.4,PERCENT OF TOTAL BILLED CHARGES
NPM1 GENE,81310,CPT,310,RC,,OUTPATIENT,,,493.04,197.216,UC HEALTH,UC HEALTH COMMERCIAL,428.9448,87,,,OTHER,369.8,483.2,PERCENT OF TOTAL BILLED CHARGES
LACTOTYPE,81400,CPT,300,RC,,OUTPATIENT,,,531.75,212.7,UC HEALTH,UC HEALTH COMMERCIAL,462.6225,87,,,OTHER,398.81,521.12,PERCENT OF TOTAL BILLED CHARGES
"PROSTATE BIOPSY, ANY MTHD",G0416,HCPCS,314,RC,,INPATIENT,,,588.62,235.448,UC HEALTH,UC HEALTH COMMERCIAL,512.0994,87,,,OTHER,441.5,576.8,PERCENT OF TOTAL BILLED CHARGES
TARGETED GENOMIC SEQ ANALYS,81450,CPT,310,RC,,OUTPATIENT,,,1080,432,UC HEALTH,UC HEALTH COMMERCIAL,939.6,87,,,OTHER,810,1058.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTO ANTIBODY SLIDE,88344,CPT,312,RC,,OUTPATIENT,,,322,128.8,UC HEALTH,UC HEALTH COMMERCIAL,280.14,87,,,OTHER,241.5,315.6,PERCENT OF TOTAL BILLED CHARGES
Z UROVYSION DETECTION BLAD CA,88368,CPT,310,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
Z UROVYSION DETECTION BLAD CA,8836891,CPT,310,RC,91,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,146.25,191.1,PERCENT OF TOTAL BILLED CHARGES
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,OUTPATIENT,,,350.8,140.32,UC HEALTH,UC HEALTH COMMERCIAL,305.196,87,,,OTHER,263.1,343.8,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION,19086,CPT,610,RC,,OUTPATIENT,,,2441.25,976.5,UC HEALTH,UC HEALTH COMMERCIAL,2123.8875,87,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
RIBOSOME P ANTIBODIES IGG,83516,CPT,300,RC,,OUTPATIENT,,,152.25,60.9,UC HEALTH,UC HEALTH COMMERCIAL,132.4575,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
CENTROMERE ANTIBODIES,83516,CPT,300,RC,,OUTPATIENT,,,143,57.2,UC HEALTH,UC HEALTH COMMERCIAL,124.41,87,,,OTHER,107.25,140.14,PERCENT OF TOTAL BILLED CHARGES
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,OUTPATIENT,,,2730,1092,UC HEALTH,UC HEALTH COMMERCIAL,2375.1,87,,,OTHER,2047.5,2675.4,PERCENT OF TOTAL BILLED CHARGES
IGH VARI REGIONAL MUTATION,81263,CPT,300,RC,,OUTPATIENT,,,1682.14,672.856,UC HEALTH,UC HEALTH COMMERCIAL,1463.4618,87,,,OTHER,1261.6,1648.5,PERCENT OF TOTAL BILLED CHARGES
CHRONIC LYMPHOCYTIC LEUKEMIA,81351,CPT,,,,OUTPATIENT,,,2141.85,856.74,UC HEALTH,UC HEALTH COMMERCIAL,1863.4095,87,,,OTHER,1606.4,2099,PERCENT OF TOTAL BILLED CHARGES
MYELODYSPLASTIC SYNDROME,81219,CPT,300,RC,,OUTPATIENT,,,243.26,97.304,UC HEALTH,UC HEALTH COMMERCIAL,211.6362,87,,,OTHER,182.4,238.4,PERCENT OF TOTAL BILLED CHARGES
MYELODYSPLASTIC SYNDROME,81338,CPT,310,RC,,OUTPATIENT,,,300.66,120.264,UC HEALTH,UC HEALTH COMMERCIAL,261.5742,87,,,OTHER,225.5,294.6,PERCENT OF TOTAL BILLED CHARGES
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,OUTPATIENT,,,327.92,131.168,UC HEALTH,UC HEALTH COMMERCIAL,285.2904,87,,,OTHER,245.9,321.4,PERCENT OF TOTAL BILLED CHARGES
TGSAP SO NEO 5-50DNA/DNA&RNA,81445,CPT,310,RC,,OUTPATIENT,,,1195.82,478.328,UC HEALTH,UC HEALTH COMMERCIAL,1040.3634,87,,,OTHER,896.9,1171.9,PERCENT OF TOTAL BILLED CHARGES
THINPREP SCREEN  W/O PHYS INTR,88142,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
THINPREP PAP RESCREEN,88143,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
FINE NEEDLE BIOPSY INTRP&RPT,88173,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
PAP SMEAR  TECHNICAL FEE,88150,CPT,311,RC,,OUTPATIENT,,,40.75,16.3,UC HEALTH,UC HEALTH COMMERCIAL,35.4525,87,,,OTHER,30.56,39.94,PERCENT OF TOTAL BILLED CHARGES
PAP W/MATURATION INDEX,88165,CPT,311,RC,,OUTPATIENT,,,84.44,33.776,UC HEALTH,UC HEALTH COMMERCIAL,73.4628,87,,,OTHER,40.5,52.92,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY BODY FLUIDS MULT,88162,CPT,311,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH SMEAR,88108,CPT,311,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
EVALUATION OF FINE NEEDLE BX,88172,CPT,311,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
EVALUATION OF TOUCH PREP,88333,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,UC HEALTH,UC HEALTH COMMERCIAL,1137.7947,87,,,OTHER,117.19,153.13,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHLOGY FLUIDS WASH/BRUSH,88104,CPT,310,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
UROVYSION FISH,88120,CPT,311,RC,,OUTPATIENT,,,414.75,165.9,UC HEALTH,UC HEALTH COMMERCIAL,360.8325,87,,,OTHER,311.06,406.46,PERCENT OF TOTAL BILLED CHARGES
FISH TESTING,88271,CPT,300,RC,,OUTPATIENT,,,320,128,UC HEALTH,UC HEALTH COMMERCIAL,278.4,87,,,OTHER,240,313.6,PERCENT OF TOTAL BILLED CHARGES
CYTOGENETIC TESTING,88274,CPT,311,RC,,OUTPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
PATH REVIEW,85060,CPT,305,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CYTOPATH TBS  C/V  MANUAL,88164,CPT,311,RC,,OUTPATIENT,,,43.75,17.5,UC HEALTH,UC HEALTH COMMERCIAL,38.0625,87,,,OTHER,32.81,42.88,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88271,CPT,300,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,8827191,CPT,310,RC,91,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS 10-30,88273,CPT,310,RC,,OUTPATIENT,,,340.5,136.2,UC HEALTH,UC HEALTH COMMERCIAL,296.235,87,,,OTHER,255.38,333.69,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,UC HEALTH,UC HEALTH COMMERCIAL,51.1125,87,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
Z CYTO MOLECULAR REPORT,G0452,HCPCS,310,RC,,INPATIENT,,,86.5,34.6,UC HEALTH,UC HEALTH COMMERCIAL,75.255,87,,,OTHER,64.88,84.77,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,58.75,23.5,UC HEALTH,UC HEALTH COMMERCIAL,51.1125,87,,,OTHER,44.06,57.58,PERCENT OF TOTAL BILLED CHARGES
CONSULTATION COMPREHENSIVE,88325,CPT,310,RC,,OUTPATIENT,,,567,226.8,UC HEALTH,UC HEALTH COMMERCIAL,493.29,87,,,OTHER,425.25,555.66,PERCENT OF TOTAL BILLED CHARGES
PATHOLOGY CONSULATION,88323,CPT,310,RC,,OUTPATIENT,,,279,111.6,UC HEALTH,UC HEALTH COMMERCIAL,242.73,87,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
Z CYTOGENETICS DNA PROBE,88291,CPT,310,RC,,OUTPATIENT,,,73.25,29.3,UC HEALTH,UC HEALTH COMMERCIAL,63.7275,87,,,OTHER,54.94,71.79,PERCENT OF TOTAL BILLED CHARGES
BCR/ABL RNA QUANT MONITOR CML,81206,CPT,310,RC,,OUTPATIENT,,,600.25,240.1,UC HEALTH,UC HEALTH COMMERCIAL,522.2175,87,,,OTHER,450.19,588.25,PERCENT OF TOTAL BILLED CHARGES
OR CONS FRZ SEC ADDL TECHNICAL,88332,CPT,312,RC,,OUTPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
SPECIAL STAINS GROUP II,88313,CPT,300,RC,,OUTPATIENT,,,145,58,UC HEALTH,UC HEALTH COMMERCIAL,126.15,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
PATHOLOGY CONSULT DURING SURG,88329,CPT,310,RC,,OUTPATIENT,,,199.5,79.8,UC HEALTH,UC HEALTH COMMERCIAL,173.565,87,,,OTHER,149.63,195.51,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY EA ADD'L MRKR,88185,CPT,310,RC,,OUTPATIENT,,,271.75,108.7,UC HEALTH,UC HEALTH COMMERCIAL,236.4225,87,,,OTHER,203.81,266.32,PERCENT OF TOTAL BILLED CHARGES
CLINICAL PATHOLOGY CONSULT,80500,CPT,,,,OUTPATIENT,,,113.25,45.3,UC HEALTH,UC HEALTH COMMERCIAL,98.5275,87,,,OTHER,84.94,110.99,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY CELL SURFACE,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY CYTOPLASMIC,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
MORPHOMETRIC ANALYUSIS TMR IMM,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
MICRO GEN ANA OF TISSUE ADD'L,88369,CPT,310,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.6,223,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE FOR NEOPLASTIC,88237,CPT,311,RC,,OUTPATIENT,,,538.5,215.4,UC HEALTH,UC HEALTH COMMERCIAL,468.495,87,,,OTHER,403.88,527.73,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS 20-25 CELL,88264,CPT,310,RC,,OUTPATIENT,,,933.5,373.4,UC HEALTH,UC HEALTH COMMERCIAL,812.145,87,,,OTHER,700.13,914.83,PERCENT OF TOTAL BILLED CHARGES
CYTOPATHOLOGY SMEARS INTREPRET,88108,CPT,311,RC,,OUTPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
CONSULT AND REPORT SLIDES,88321,CPT,312,RC,,OUTPATIENT,,,567,226.8,UC HEALTH,UC HEALTH COMMERCIAL,493.29,87,,,OTHER,425.25,555.66,PERCENT OF TOTAL BILLED CHARGES
CHROMO ANALY ADD'L KARYOTYPES,88280,CPT,310,RC,,OUTPATIENT,,,77,30.8,UC HEALTH,UC HEALTH COMMERCIAL,66.99,87,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
SKIN OR OTH SOLID TISSUE BPSY,88233,CPT,310,RC,,OUTPATIENT,,,665.75,266.3,UC HEALTH,UC HEALTH COMMERCIAL,579.2025,87,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
DECALCIFICATION-TECHNICAL,88311,CPT,312,RC,,OUTPATIENT,,,33.75,13.5,UC HEALTH,UC HEALTH COMMERCIAL,29.3625,87,,,OTHER,25.31,33.08,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY INITIAL,88342,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY MULTIPLEX,G0462,HCPCS,312,RC,,BOTH,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
OR CONSULT W/FROZ SECTION SING,88331,CPT,312,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,159.38,208.25,PERCENT OF TOTAL BILLED CHARGES
SPEC GROUP STAIN I TECHNICAL,88312,CPT,312,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
TISSUE CULTURE ADD'L STUDY,87253,CPT,300,RC,,OUTPATIENT,,,442,176.8,UC HEALTH,UC HEALTH COMMERCIAL,384.54,87,,,OTHER,331.5,433.16,PERCENT OF TOTAL BILLED CHARGES
SURGICAL MACRO MICRO I,88302,CPT,312,RC,,OUTPATIENT,,,188.75,75.5,UC HEALTH,UC HEALTH COMMERCIAL,164.2125,87,,,OTHER,141.56,184.98,PERCENT OF TOTAL BILLED CHARGES
SURGICAL MACRO I,88300,CPT,312,RC,,OUTPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
TISSUE 1 COMPLEX TECHNICAL,88304,CPT,312,RC,,OUTPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
TISSUE 2 COMPLEX  TECHNICAL,88305,CPT,312,RC,,OUTPATIENT,,,146,58.4,UC HEALTH,UC HEALTH COMMERCIAL,127.02,87,,,OTHER,109.5,143.08,PERCENT OF TOTAL BILLED CHARGES
TISSUE 3 COMPLEX--TECHNICAL,88307,CPT,312,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
TISSUE 4 COMPLEX--TECHNICAL,88309,CPT,312,RC,,OUTPATIENT,,,1307.81,523.124,UC HEALTH,UC HEALTH COMMERCIAL,1137.7947,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRO 16+MRUS,88189,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRP 2-8 MRUS,88187,CPT,312,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
MICRODISSECTION - MANUAL,88381,CPT,312,RC,,OUTPATIENT,,,180.5,72.2,UC HEALTH,UC HEALTH COMMERCIAL,157.035,87,,,OTHER,135.38,176.89,PERCENT OF TOTAL BILLED CHARGES
EPIDERMAL GROWTH FACTOR RCPTR,81235,CPT,312,RC,,OUTPATIENT,,,905.25,362.1,UC HEALTH,UC HEALTH COMMERCIAL,787.5675,87,,,OTHER,678.94,887.15,PERCENT OF TOTAL BILLED CHARGES
IMMUNOHISTOCHEMISTRY ADD'L,88341,CPT,312,RC,,OUTPATIENT,,,227.5,91,UC HEALTH,UC HEALTH COMMERCIAL,197.925,87,,,OTHER,170.63,222.95,PERCENT OF TOTAL BILLED CHARGES
CHROMOSOME ANALYSIS 15-20 CELL,88262,CPT,310,RC,,OUTPATIENT,,,351.25,140.5,UC HEALTH,UC HEALTH COMMERCIAL,305.5875,87,,,OTHER,263.44,344.23,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY INTRP 9-15 MRKS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
R FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
FLOW CYTOMETRY EA ADD'L MRKER,88185,CPT,310,RC,,OUTPATIENT,,,432.75,173.1,UC HEALTH,UC HEALTH COMMERCIAL,376.4925,87,,,OTHER,324.56,424.1,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY 1 MARKER,88184,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,114.19,149.21,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY 9-15 MARKERS,88188,CPT,310,RC,,OUTPATIENT,,,146.75,58.7,UC HEALTH,UC HEALTH COMMERCIAL,127.6725,87,,,OTHER,110.06,143.82,PERCENT OF TOTAL BILLED CHARGES
Z FLOW CYTOMETRY ADD ON,88185,CPT,310,RC,,OUTPATIENT,,,52.25,20.9,UC HEALTH,UC HEALTH COMMERCIAL,45.4575,87,,,OTHER,39.19,51.21,PERCENT OF TOTAL BILLED CHARGES
MORPHOMETRIC ANALYSIS MANUAL,88368,CPT,310,RC,,OUTPATIENT,,,622.75,249.1,UC HEALTH,UC HEALTH COMMERCIAL,541.7925,87,,,OTHER,467.06,610.3,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 1 VIEW/KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
KUB,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
SITZ MARKER CAPSULE,A9698,HCPCS,636,RC,,INPATIENT,,,40,16,UC HEALTH,UC HEALTH COMMERCIAL,34.8,87,,,OTHER,30,39.2,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN SERIES 3 VIEWS  ACUTE,74022,CPT,320,RC,,OUTPATIENT,,,494.75,197.9,UC HEALTH,UC HEALTH COMMERCIAL,430.4325,87,,,OTHER,371.06,484.86,PERCENT OF TOTAL BILLED CHARGES
SITZ MARKER KUB SUBSEQUENT,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
ABCESS O GRAM,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,UC HEALTH,UC HEALTH COMMERCIAL,837.3576,87,,,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATH INSERTION SIMPLE,51702,CPT,320,RC,,OUTPATIENT,,,244.25,97.7,UC HEALTH,UC HEALTH COMMERCIAL,212.4975,87,,,OTHER,183.19,239.37,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATH INSERTION COMPLCTD,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,UC HEALTH,UC HEALTH COMMERCIAL,391.935,87,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE COMPLD CHANGE,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,UC HEALTH,UC HEALTH COMMERCIAL,2233.0725,87,,,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHNG IMAGE GD,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,UC HEALTH,UC HEALTH COMMERCIAL,896.3175,87,,,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
LOWER EXTREMITY INFANT,73592,CPT,320,RC,,OUTPATIENT,,,229,91.6,UC HEALTH,UC HEALTH COMMERCIAL,199.23,87,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY INFANT,73092,CPT,320,RC,,OUTPATIENT,,,229,91.6,UC HEALTH,UC HEALTH COMMERCIAL,199.23,87,,,OTHER,171.75,224.42,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY INFANT BIL,7309250,CPT,320,RC,50,OUTPATIENT,,,350,140,UC HEALTH,UC HEALTH COMMERCIAL,304.5,87,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
BE SCREENING,G0120,HCPCS,320,RC,,INPATIENT,,,910.75,364.3,UC HEALTH,UC HEALTH COMMERCIAL,792.3525,87,,,OTHER,683.06,892.54,PERCENT OF TOTAL BILLED CHARGES
VENOUS CATHETER REMOVAL,36589,CPT,760,RC,,OUTPATIENT,,,1885.5,754.2,UC HEALTH,UC HEALTH COMMERCIAL,1640.385,87,,,OTHER,1414.13,1847.79,PERCENT OF TOTAL BILLED CHARGES
FEEDING TUBE REPLACEMENT,43999,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,675,882,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE REPLACEMENT,75984,CPT,320,RC,,OUTPATIENT,,,1100,440,UC HEALTH,UC HEALTH COMMERCIAL,957,87,,,OTHER,2333.81,3049.52,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE REPLACEMENT,50435,CPT,361,RC,,OUTPATIENT,,,3000,1200,UC HEALTH,UC HEALTH COMMERCIAL,2610,87,,,OTHER,2064.56,2697.7,PERCENT OF TOTAL BILLED CHARGES
GASTROGRAFIN ABDOMEN 1 VIEW,74000,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA LT,20605LT,CPT,361,RC,LT,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA,20605RT,CPT,320,RC,RT,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
SELLA TURCICA EXAM,70240,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJECT JOINT/BURSA BI,2060550,CPT,320,RC,50,OUTPATIENT,,,1124.25,449.7,UC HEALTH,UC HEALTH COMMERCIAL,978.0975,87,,,OTHER,843.19,1101.77,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN 2 VIEWS,74019,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UC HEALTH,UC HEALTH COMMERCIAL,375.6225,87,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
CENTRAL VENOUS ACCESS EVAL,36598,CPT,320,RC,,OUTPATIENT,,,568,227.2,UC HEALTH,UC HEALTH COMMERCIAL,494.16,87,,,OTHER,426,556.64,PERCENT OF TOTAL BILLED CHARGES
BILIARY CATH CHANGE,47525,CPT,320,RC,,OUTPATIENT,,,6430.08,2572.032,UC HEALTH,UC HEALTH COMMERCIAL,5594.1696,87,,,OTHER,1387.13,1812.51,PERCENT OF TOTAL BILLED CHARGES
CHEST TUBE PLACEMENT,32557,CPT,320,RC,,OUTPATIENT,,,1708,683.2,UC HEALTH,UC HEALTH COMMERCIAL,1485.96,87,,,OTHER,1281,1673.84,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR KNEE XRAY,27370,CPT,320,RC,,OUTPATIENT,,,275.75,110.3,UC HEALTH,UC HEALTH COMMERCIAL,239.9025,87,,,OTHER,206.81,270.24,PERCENT OF TOTAL BILLED CHARGES
ACROMIOCLAVICULAR JOINTS,73050,CPT,320,RC,,OUTPATIENT,,,348.5,139.4,UC HEALTH,UC HEALTH COMMERCIAL,303.195,87,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
NEEDLE LOCAL BY XRAY BILATERAL,7700250,CPT,,,50,OUTPATIENT,,,550,220,UC HEALTH,UC HEALTH COMMERCIAL,478.5,87,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JNT/BURSA W/O US BIL,2061050,CPT,320,RC,50,OUTPATIENT,,,1300,520,UC HEALTH,UC HEALTH COMMERCIAL,1131,87,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
FEEDING TUBE PLACEMENT,43752,CPT,320,RC,,OUTPATIENT,,,538.59,215.436,UC HEALTH,UC HEALTH COMMERCIAL,468.5733,87,,,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE ARTHROGRAM RT,73615RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE ARTHROGRAM LT,73615LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
ANKLE 3 VIEWS RT,73610RT,CPT,320,RC,RT,OUTPATIENT,,,320.25,128.1,UC HEALTH,UC HEALTH COMMERCIAL,278.6175,87,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
ANKLE 3 VIEWS LT,73610LT,CPT,320,RC,LT,OUTPATIENT,,,320.25,128.1,UC HEALTH,UC HEALTH COMMERCIAL,278.6175,87,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
ANKLE 2 VIEWS RT,73600RT,CPT,320,RC,RT,OUTPATIENT,,,218,87.2,UC HEALTH,UC HEALTH COMMERCIAL,189.66,87,,,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
ANKLE 2 VIEWS LT,73600LT,CPT,320,RC,LT,OUTPATIENT,,,218,87.2,UC HEALTH,UC HEALTH COMMERCIAL,189.66,87,,,OTHER,163.5,213.64,PERCENT OF TOTAL BILLED CHARGES
ANKLE INJECTION RT,27648RT,CPT,320,RC,RT,OUTPATIENT,,,343.75,137.5,UC HEALTH,UC HEALTH COMMERCIAL,299.0625,87,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
ANKLE INJECTION LT,27648LT,CPT,320,RC,LT,OUTPATIENT,,,343.75,137.5,UC HEALTH,UC HEALTH COMMERCIAL,299.0625,87,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
ANKLE BILATERAL,7361050,CPT,320,RC,50,OUTPATIENT,,,640,256,UC HEALTH,UC HEALTH COMMERCIAL,556.8,87,,,OTHER,480,627.2,PERCENT OF TOTAL BILLED CHARGES
FLUOROSCOPIC GUIDANCE INJ PROC,77003,CPT,320,RC,,OUTPATIENT,,,296.5,118.6,UC HEALTH,UC HEALTH COMMERCIAL,257.955,87,,,OTHER,222.38,290.57,PERCENT OF TOTAL BILLED CHARGES
INTRO GASTROINTESTINAL TUBE,44500,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,525,686,PERCENT OF TOTAL BILLED CHARGES
FLURO GUIDED SI JOINT INJECTIO,27096,CPT,350,RC,,OUTPATIENT,,,2455.25,982.1,UC HEALTH,UC HEALTH COMMERCIAL,2136.0675,87,,,OTHER,1841.4,2406.1,PERCENT OF TOTAL BILLED CHARGES
KNEE INJECT RT,27369RT,CPT,361,RC,RT,OUTPATIENT,,,357,142.8,UC HEALTH,UC HEALTH COMMERCIAL,310.59,87,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
KNEE INJECT LT,27369LT,CPT,361,RC,LT,OUTPATIENT,,,357,142.8,UC HEALTH,UC HEALTH COMMERCIAL,310.59,87,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE CHANGE,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,490.5,640.92,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE CHANGE,75984,CPT,320,RC,,OUTPATIENT,,,1030.25,412.1,UC HEALTH,UC HEALTH COMMERCIAL,896.3175,87,,,OTHER,772.69,1009.65,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE CATH DEVICE,C1729,HCPCS,272,RC,,INPATIENT,,,395.5,158.2,UC HEALTH,UC HEALTH COMMERCIAL,344.085,87,,,OTHER,296.63,387.59,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1961.5,784.6,UC HEALTH,UC HEALTH COMMERCIAL,1706.505,87,,,OTHER,1471.13,1922.27,PERCENT OF TOTAL BILLED CHARGES
BABYGRAM,71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,UC HEALTH,UC HEALTH COMMERCIAL,281.6625,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
BABYGRAM,74018,CPT,320,RC,,OUTPATIENT,,,363.5,145.4,UC HEALTH,UC HEALTH COMMERCIAL,316.245,87,,,OTHER,272.63,356.23,PERCENT OF TOTAL BILLED CHARGES
XRAY FILTER GUIDANCE,37191,CPT,361,RC,,OUTPATIENT,,,3145.75,1258.3,UC HEALTH,UC HEALTH COMMERCIAL,2736.8025,87,,,OTHER,2359.31,3082.84,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED NEEDLE PLACEMENT,77002,CPT,320,RC,,OUTPATIENT,,,709,283.6,UC HEALTH,UC HEALTH COMMERCIAL,616.83,87,,,OTHER,531.8,694.8,PERCENT OF TOTAL BILLED CHARGES
BARIUM ENEMA W/AIR CONTRAST,74280,CPT,320,RC,,OUTPATIENT,,,910.75,364.3,UC HEALTH,UC HEALTH COMMERCIAL,792.3525,87,,,OTHER,683.06,892.54,PERCENT OF TOTAL BILLED CHARGES
BARIUM ENEMA SINGLE CONTRAST,74270,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,UC HEALTH,UC HEALTH COMMERCIAL,657.0675,87,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
BONE AGE STUDIES,77072,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,UC HEALTH,UC HEALTH COMMERCIAL,216.8475,87,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
DEXA BONE DENSITY/IVA,77082,CPT,320,RC,,OUTPATIENT,,,246.75,98.7,UC HEALTH,UC HEALTH COMMERCIAL,214.6725,87,,,OTHER,185.06,241.82,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY COMPLETE,77075,CPT,320,RC,,OUTPATIENT,,,1182,472.8,UC HEALTH,UC HEALTH COMMERCIAL,1028.34,87,,,OTHER,886.5,1158.36,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY LIMITED,77074,CPT,320,RC,,OUTPATIENT,,,679.25,271.7,UC HEALTH,UC HEALTH COMMERCIAL,590.9475,87,,,OTHER,509.44,665.67,PERCENT OF TOTAL BILLED CHARGES
BONE SURVEY INFANT,77076,CPT,320,RC,,OUTPATIENT,,,598,239.2,UC HEALTH,UC HEALTH COMMERCIAL,520.26,87,,,OTHER,448.5,586.04,PERCENT OF TOTAL BILLED CHARGES
DEXA W/O WRIST,77080,CPT,320,RC,,OUTPATIENT,,,428,171.2,UC HEALTH,UC HEALTH COMMERCIAL,372.36,87,,,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM PTOP,47531,CPT,320,RC,,OUTPATIENT,,,6345.05,2538.02,UC HEALTH,UC HEALTH COMMERCIAL,5520.1935,87,,,OTHER,478.31,625,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM ADD SET,74301,CPT,320,RC,,OUTPATIENT,,,150.75,60.3,UC HEALTH,UC HEALTH COMMERCIAL,131.1525,87,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
FNA BX W/CT GDN EA ADDL,10010,CPT,320,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
CHOLANGIOGRAM OPERATIVE,74300,CPT,320,RC,,OUTPATIENT,,,279,111.6,UC HEALTH,UC HEALTH COMMERCIAL,242.73,87,,,OTHER,209.25,273.42,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE RT,73000RT,CPT,320,RC,RT,OUTPATIENT,,,260.5,104.2,UC HEALTH,UC HEALTH COMMERCIAL,226.635,87,,,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE LT,73000LT,CPT,320,RC,LT,OUTPATIENT,,,260.5,104.2,UC HEALTH,UC HEALTH COMMERCIAL,226.635,87,,,OTHER,195.38,255.29,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 4 OR 5 VIEWS,72050,CPT,320,RC,,OUTPATIENT,,,560.25,224.1,UC HEALTH,UC HEALTH COMMERCIAL,487.4175,87,,,OTHER,420.19,549.05,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 3 VIEWS,72040,CPT,320,RC,,OUTPATIENT,,,364,145.6,UC HEALTH,UC HEALTH COMMERCIAL,316.68,87,,,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
CERVICAL SPINE 6 OR MORE VIEWS,72052,CPT,320,RC,,OUTPATIENT,,,618,247.2,UC HEALTH,UC HEALTH COMMERCIAL,537.66,87,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
FLUROSCOPY,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UC HEALTH,UC HEALTH COMMERCIAL,585.2925,87,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
CHEST 2 VIEWS,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,UC HEALTH,UC HEALTH COMMERCIAL,290.145,87,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
CHEST 1 VIEW,71045,CPT,320,RC,,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
INJ NEEDLE PLACEMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,UC HEALTH,UC HEALTH COMMERCIAL,548.97,87,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
NEEDLE LOCALIZATION BY XRAY,77002,CPT,320,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CHEST 4 VIEWS,71048,CPT,320,RC,,OUTPATIENT,,,384.5,153.8,UC HEALTH,UC HEALTH COMMERCIAL,334.515,87,,,OTHER,288.38,376.81,PERCENT OF TOTAL BILLED CHARGES
CHEST 3 VIEWS,71047,CPT,320,RC,,OUTPATIENT,,,371.75,148.7,UC HEALTH,UC HEALTH COMMERCIAL,323.4225,87,,,OTHER,278.81,364.32,PERCENT OF TOTAL BILLED CHARGES
CHEST (MINE),71045,CPT,320,RC,,OUTPATIENT,,,323.75,129.5,UC HEALTH,UC HEALTH COMMERCIAL,281.6625,87,,,OTHER,242.81,317.28,PERCENT OF TOTAL BILLED CHARGES
CHEST (MINE) 2 VIEWS PRE-EMP,71046,CPT,320,RC,,OUTPATIENT,,,333.5,133.4,UC HEALTH,UC HEALTH COMMERCIAL,290.145,87,,,OTHER,250.13,326.83,PERCENT OF TOTAL BILLED CHARGES
CYSTOGRAPHY 3 VIEWS,74430,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,408,533.12,PERCENT OF TOTAL BILLED CHARGES
INJ PROC CYSTOGRAPHY,51600,CPT,320,RC,,OUTPATIENT,,,436.5,174.6,UC HEALTH,UC HEALTH COMMERCIAL,379.755,87,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
DEXA/ARM W/WRIST RT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,UC HEALTH,UC HEALTH COMMERCIAL,181.83,87,,,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
DEXA/ARM W/WRIST LT,77081,CPT,320,RC,,OUTPATIENT,,,209,83.6,UC HEALTH,UC HEALTH COMMERCIAL,181.83,87,,,OTHER,156.75,204.82,PERCENT OF TOTAL BILLED CHARGES
DEXA HIP (R),76075RT,CPT,320,RC,RT,OUTPATIENT,,,62.75,25.1,UC HEALTH,UC HEALTH COMMERCIAL,54.5925,87,,,OTHER,47.06,61.5,PERCENT OF TOTAL BILLED CHARGES
ELBOW 3 VIEWS RT,73080RT,CPT,320,RC,RT,OUTPATIENT,,,317,126.8,UC HEALTH,UC HEALTH COMMERCIAL,275.79,87,,,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
ELBOW 3 VIEWS LT,73080LT,CPT,320,RC,LT,OUTPATIENT,,,317,126.8,UC HEALTH,UC HEALTH COMMERCIAL,275.79,87,,,OTHER,237.75,310.66,PERCENT OF TOTAL BILLED CHARGES
ELBOW 2 VIEWS RT,73070RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,UC HEALTH,UC HEALTH COMMERCIAL,185.9625,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
ELBOW 2 VIEWS LT,73070LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,UC HEALTH,UC HEALTH COMMERCIAL,185.9625,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
ELBOW ARTHROGRAM RT,73085RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,UC HEALTH,UC HEALTH COMMERCIAL,697.0875,87,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
ELBOW ARTHROGRAM LT,73085LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,UC HEALTH,UC HEALTH COMMERCIAL,697.0875,87,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
ESOPHAGRAM,74220,CPT,320,RC,,OUTPATIENT,,,496.25,198.5,UC HEALTH,UC HEALTH COMMERCIAL,431.7375,87,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
FACE BONE 3 VIEWS,70150,CPT,320,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS RT,73552RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS LT,73552LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
FEMUR 2 VIEWS BILATERAL,73552,CPT,320,RC,,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL,7355250,CPT,320,RC,50,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
FINGER THUMB LT,73140FA,CPT,320,RC,FA,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 2ND DIGIT LT,73140F1,CPT,320,RC,F1,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 3RD DIGIT LT,73140F2,CPT,320,RC,F2,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 4TH DIGIT LT,73140F3,CPT,320,RC,F3,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 5TH DIGIT LT,73140F4,CPT,320,RC,F4,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER THUMB RT,73140F5,CPT,320,RC,F5,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 2ND DIGIT RT,73140F6,CPT,320,RC,F6,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 3RD DIGIT RT,73140F7,CPT,320,RC,F7,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 4TH DIGIT RT,73140F8,CPT,320,RC,F8,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FINGER 5TH DIGIT RT,73140F9,CPT,320,RC,F9,OUTPATIENT,,,233.75,93.5,UC HEALTH,UC HEALTH COMMERCIAL,203.3625,87,,,OTHER,175.31,229.08,PERCENT OF TOTAL BILLED CHARGES
FISTULA SINUS W/CONTRAST,76080,CPT,350,RC,,OUTPATIENT,,,962.48,384.992,UC HEALTH,UC HEALTH COMMERCIAL,837.3576,87,,,OTHER,515.25,673.26,PERCENT OF TOTAL BILLED CHARGES
OR HIP LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,639.5,255.8,UC HEALTH,UC HEALTH COMMERCIAL,556.365,87,,,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
FLUORO LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UC HEALTH,UC HEALTH COMMERCIAL,585.2925,87,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
FLUORO MORE THAN 1HR EXTENSIVE,76000,CPT,320,RC,,OUTPATIENT,,,672.75,269.1,UC HEALTH,UC HEALTH COMMERCIAL,585.2925,87,,,OTHER,504.56,659.3,PERCENT OF TOTAL BILLED CHARGES
PICC PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,3124,1249.6,UC HEALTH,UC HEALTH COMMERCIAL,2717.88,87,,,OTHER,2343,3061.52,PERCENT OF TOTAL BILLED CHARGES
MIDLINE INSERTION,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,UC HEALTH,UC HEALTH COMMERCIAL,424.56,87,,,OTHER,366,478.2,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED NEEDLE PLCMNT,77002,CPT,320,RC,,OUTPATIENT,,,295,118,UC HEALTH,UC HEALTH COMMERCIAL,256.65,87,,,OTHER,221.25,289.1,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,662.75,265.1,UC HEALTH,UC HEALTH COMMERCIAL,576.5925,87,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,550,220,UC HEALTH,UC HEALTH COMMERCIAL,478.5,87,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE SPINAL FLUID,62328,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR BLADDER XRAY,51610,CPT,320,RC,,OUTPATIENT,,,856.5,342.6,UC HEALTH,UC HEALTH COMMERCIAL,745.155,87,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
URETHROCYSTOGRAM,74450,CPT,320,RC,,OUTPATIENT,,,537,214.8,UC HEALTH,UC HEALTH COMMERCIAL,467.19,87,,,OTHER,402.75,526.26,PERCENT OF TOTAL BILLED CHARGES
C-ARM LESS THAN 1 HR,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,UC HEALTH,UC HEALTH COMMERCIAL,760.815,87,,,OTHER,655.88,857.01,PERCENT OF TOTAL BILLED CHARGES
C-ARM CENTRAL VENOUS ACCESS,77001,CPT,320,RC,,OUTPATIENT,,,350,140,UC HEALTH,UC HEALTH COMMERCIAL,304.5,87,,,OTHER,262.5,343,PERCENT OF TOTAL BILLED CHARGES
C-ARM PAIN CLINIC,76000,CPT,320,RC,,OUTPATIENT,,,874.5,349.8,UC HEALTH,UC HEALTH COMMERCIAL,760.815,87,,,OTHER,655.9,857,PERCENT OF TOTAL BILLED CHARGES
FOREARM AP/LAT RT,73090RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,UC HEALTH,UC HEALTH COMMERCIAL,271.875,87,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
FOREARM AP/LAT LT,73090LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,UC HEALTH,UC HEALTH COMMERCIAL,271.875,87,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
FOREARM BILATERAL,7309050,CPT,320,RC,50,OUTPATIENT,,,624.75,249.9,UC HEALTH,UC HEALTH COMMERCIAL,543.5325,87,,,OTHER,468.56,612.26,PERCENT OF TOTAL BILLED CHARGES
FOOT 2 VIEWS RT,73620RT,CPT,320,RC,RT,OUTPATIENT,,,213.75,85.5,UC HEALTH,UC HEALTH COMMERCIAL,185.9625,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
FOOT 2 VIEWS LT,73620LT,CPT,320,RC,LT,OUTPATIENT,,,213.75,85.5,UC HEALTH,UC HEALTH COMMERCIAL,185.9625,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
FOOT 3 VIEWS RT,73630RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
FOOT 3 VIEWS LT,73630LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
FEET TWO VIEWS BILATERAL,73620,CPT,,,,OUTPATIENT,,,427.5,171,UC HEALTH,UC HEALTH COMMERCIAL,371.925,87,,,OTHER,320.6,419,PERCENT OF TOTAL BILLED CHARGES
HAND 3 VIEWS RT,73130RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HAND 3 VIEWS LT,73130LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEOUS RT,73650RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEOUS LT,73650LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HEEL CALCANEUS BILATERAL,7365050,CPT,320,RC,50,OUTPATIENT,,,525,210,UC HEALTH,UC HEALTH COMMERCIAL,456.75,87,,,OTHER,393.75,514.5,PERCENT OF TOTAL BILLED CHARGES
HIP INJECTION,73525,CPT,320,RC,,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR HIP XRAY,27093,CPT,320,RC,,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
HIP BILATERAL WITH PELVIS,73522,CPT,320,RC,,OUTPATIENT,,,550,220,UC HEALTH,UC HEALTH COMMERCIAL,478.5,87,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
SHOULDER BILATERAL,7303050,CPT,320,RC,50,OUTPATIENT,,,696.25,278.5,UC HEALTH,UC HEALTH COMMERCIAL,605.7375,87,,,OTHER,522.19,682.33,PERCENT OF TOTAL BILLED CHARGES
WRIST BILATERAL,7311050,CPT,320,RC,50,OUTPATIENT,,,490.5,196.2,UC HEALTH,UC HEALTH COMMERCIAL,426.735,87,,,OTHER,367.88,480.69,PERCENT OF TOTAL BILLED CHARGES
KNEE BILATERAL,7356250,CPT,320,RC,50,OUTPATIENT,,,749.75,299.9,UC HEALTH,UC HEALTH COMMERCIAL,652.2825,87,,,OTHER,562.31,734.76,PERCENT OF TOTAL BILLED CHARGES
HAND BILATERAL,7313050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UC HEALTH,UC HEALTH COMMERCIAL,587.0325,87,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
FOOT BILATERAL,7363050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UC HEALTH,UC HEALTH COMMERCIAL,587.0325,87,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
ELBOWS BILATERAL,7308050,CPT,320,RC,50,OUTPATIENT,,,633.5,253.4,UC HEALTH,UC HEALTH COMMERCIAL,551.145,87,,,OTHER,475.13,620.83,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS RT,73120RT,CPT,320,RC,RT,OUTPATIENT,,,217.19,86.876,UC HEALTH,UC HEALTH COMMERCIAL,188.9553,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS LT,73120LT,CPT,320,RC,LT,OUTPATIENT,,,217.19,86.876,UC HEALTH,UC HEALTH COMMERCIAL,188.9553,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
HAND 2 VIEWS BILATERAL,73120,CPT,,,,OUTPATIENT,,,434.38,173.752,UC HEALTH,UC HEALTH COMMERCIAL,377.9106,87,,,OTHER,325.8,425.7,PERCENT OF TOTAL BILLED CHARGES
HIP 2 VIEW RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,312.5,125,UC HEALTH,UC HEALTH COMMERCIAL,271.875,87,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
HIP 2 VIEW LT,73502LT,CPT,320,RC,LT,OUTPATIENT,,,312.5,125,UC HEALTH,UC HEALTH COMMERCIAL,271.875,87,,,OTHER,234.38,306.25,PERCENT OF TOTAL BILLED CHARGES
HIP/PELVIS CHILD 2 VIEWS,73502,CPT,320,RC,,OUTPATIENT,,,273.75,109.5,UC HEALTH,UC HEALTH COMMERCIAL,238.1625,87,,,OTHER,205.31,268.28,PERCENT OF TOTAL BILLED CHARGES
HIP 1 VIEW RIGHT,73501RT,CPT,320,RC,RT,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
HIP 1 VIEW LEFT,73501LT,CPT,320,RC,LT,OUTPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,237.19,309.93,PERCENT OF TOTAL BILLED CHARGES
HIP ARTHROGRAM RT,73525RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
HIP ARTHROGRAM LT,73525LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,382.31,499.56,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,662.75,265.1,UC HEALTH,UC HEALTH COMMERCIAL,576.5925,87,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
STEROID/CONTRAST INJECTION,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UC HEALTH,UC HEALTH COMMERCIAL,576.5925,87,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
STEROID/CONTRAST INJ LG JOINT,20610,CPT,320,RC,,OUTPATIENT,,,631,252.4,UC HEALTH,UC HEALTH COMMERCIAL,548.97,87,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
INJ/DRAIN MAJOR JOINT,2061050,CPT,320,RC,50,OUTPATIENT,,,1324.75,529.9,UC HEALTH,UC HEALTH COMMERCIAL,1152.5325,87,,,OTHER,993.56,1298.26,PERCENT OF TOTAL BILLED CHARGES
HUMERUS AP/LAT RT,73060RT,CPT,320,RC,RT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HUMERUS AP/LAT LT,73060LT,CPT,320,RC,LT,OUTPATIENT,,,337.75,135.1,UC HEALTH,UC HEALTH COMMERCIAL,293.8425,87,,,OTHER,253.31,331,PERCENT OF TOTAL BILLED CHARGES
HUMERUS BILATERAL,7306050,CPT,320,RC,50,OUTPATIENT,,,674.75,269.9,UC HEALTH,UC HEALTH COMMERCIAL,587.0325,87,,,OTHER,506.06,661.26,PERCENT OF TOTAL BILLED CHARGES
HYSTEO INJECTION,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,UC HEALTH,UC HEALTH COMMERCIAL,452.1825,87,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSALPINGOGRAM,74740,CPT,320,RC,,OUTPATIENT,,,458.69,183.476,UC HEALTH,UC HEALTH COMMERCIAL,399.0603,87,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
IVP LIMITED,7440052,CPT,,,52,OUTPATIENT,,,752.25,300.9,UC HEALTH,UC HEALTH COMMERCIAL,654.4575,87,,,OTHER,564.19,737.21,PERCENT OF TOTAL BILLED CHARGES
FLUOROSCOPIC PROCEDURE,76496,CPT,320,RC,,OUTPATIENT,,,347.5,139,UC HEALTH,UC HEALTH COMMERCIAL,302.325,87,,,OTHER,260.63,340.55,PERCENT OF TOTAL BILLED CHARGES
KNEE 3 VIEWS RT,73562RT,CPT,320,RC,RT,OUTPATIENT,,,375,150,UC HEALTH,UC HEALTH COMMERCIAL,326.25,87,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
KNEE 3 VIEWS LT,73562LT,CPT,320,RC,LT,OUTPATIENT,,,375,150,UC HEALTH,UC HEALTH COMMERCIAL,326.25,87,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
KNEE 2 VIEWS RT,73560RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
KNEE 2 VIEWS LT,73560LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
KNEE ARTHROGRAPHY RT,73580RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
KNEE ARTHROGRAPHY LT,73580LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
KNEE 4 VIEWS RT,73564RT,CPT,320,RC,RT,OUTPATIENT,,,440.75,176.3,UC HEALTH,UC HEALTH COMMERCIAL,383.4525,87,,,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
KNEE 4 VIEWS LT,73564LT,CPT,320,RC,LT,OUTPATIENT,,,440.75,176.3,UC HEALTH,UC HEALTH COMMERCIAL,383.4525,87,,,OTHER,330.56,431.94,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB RT,73590RT,CPT,320,RC,RT,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB LT,73590LT,CPT,320,RC,LT,OUTPATIENT,,,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TIB FIB BILATERAL,7359050,CPT,320,RC,50,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB BILATERAL,73590,CPT,320,RC,,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
LUMBAR AP & LAT 2 OR 3 VIEWS,72100,CPT,320,RC,,OUTPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
LUMBAR 4 VIEWS,72110,CPT,320,RC,,OUTPATIENT,,,595,238,UC HEALTH,UC HEALTH COMMERCIAL,517.65,87,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
LUMBAR FLEX/EXT 5 VIEWS,72114,CPT,320,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
MANDIBLE 4 VIEWS,70110,CPT,320,RC,,OUTPATIENT,,,420.75,168.3,UC HEALTH,UC HEALTH COMMERCIAL,366.0525,87,,,OTHER,315.56,412.34,PERCENT OF TOTAL BILLED CHARGES
MYELOGRAM/FLUOROSCOPY,72270,CPT,320,RC,,OUTPATIENT,,,2314,925.6,UC HEALTH,UC HEALTH COMMERCIAL,2013.18,87,,,OTHER,1735.5,2267.72,PERCENT OF TOTAL BILLED CHARGES
MYELOGRAM/FLUOROSCOPY,62284,CPT,350,RC,,OUTPATIENT,,,1052.5,421,UC HEALTH,UC HEALTH COMMERCIAL,915.675,87,,,OTHER,789.38,1031.45,PERCENT OF TOTAL BILLED CHARGES
NECK SOFT TISSUE,70360,CPT,320,RC,,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOGRAM,50431,CPT,320,RC,,OUTPATIENT,,,1542.5,617,UC HEALTH,UC HEALTH COMMERCIAL,1341.975,87,,,OTHER,1156.88,1511.65,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOGRAM,74425,CPT,320,RC,,OUTPATIENT,,,814.25,325.7,UC HEALTH,UC HEALTH COMMERCIAL,708.3975,87,,,OTHER,610.69,797.97,PERCENT OF TOTAL BILLED CHARGES
NASAL BONES,70160,CPT,320,RC,,OUTPATIENT,,,292,116.8,UC HEALTH,UC HEALTH COMMERCIAL,254.04,87,,,OTHER,219,286.16,PERCENT OF TOTAL BILLED CHARGES
ORTHO ROENT,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,UC HEALTH,UC HEALTH COMMERCIAL,307.98,87,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
OR HIP RT,73502RT,CPT,320,RC,RT,OUTPATIENT,,,639.5,255.8,UC HEALTH,UC HEALTH COMMERCIAL,556.365,87,,,OTHER,479.63,626.71,PERCENT OF TOTAL BILLED CHARGES
OBSTRUCTION REMOVAL FROM TUBE,49460,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,543.38,710.01,PERCENT OF TOTAL BILLED CHARGES
PELVIS 3 VIEWS,72190,CPT,320,RC,,OUTPATIENT,,,409.5,163.8,UC HEALTH,UC HEALTH COMMERCIAL,356.265,87,,,OTHER,307.13,401.31,PERCENT OF TOTAL BILLED CHARGES
PELVIS AP,72170,CPT,320,RC,,OUTPATIENT,,,249.25,99.7,UC HEALTH,UC HEALTH COMMERCIAL,216.8475,87,,,OTHER,186.94,244.27,PERCENT OF TOTAL BILLED CHARGES
RIBS-UNILAT/PA CHEST 3 VWS LT,71101LT,CPT,320,RC,LT,OUTPATIENT,,,431.75,172.7,UC HEALTH,UC HEALTH COMMERCIAL,375.6225,87,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
RIBS UNILATERAL 2 VIEWS,71100,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UC HEALTH,UC HEALTH COMMERCIAL,375.6225,87,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
RIBS UNILATERAL W/ 1 VIEW CHES,71101,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
RIBS BILATERAL,71110,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,UC HEALTH,UC HEALTH COMMERCIAL,464.145,87,,,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
RIBS BILATERAL W/ 1 VIEW CHEST,71111,CPT,320,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
RIBS-BILAT/PA CHEST 4 VIEWS,71111,CPT,320,RC,,OUTPATIENT,,,533.5,213.4,UC HEALTH,UC HEALTH COMMERCIAL,464.145,87,,,OTHER,400.13,522.83,PERCENT OF TOTAL BILLED CHARGES
RETROGRADE PYLEOGRAM,3202150,CDM,320,RC,,INPATIENT,,,595,238,UC HEALTH,UC HEALTH COMMERCIAL,517.65,87,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
SACRUM & COCCYX 2 VIEWS,72220,CPT,320,RC,,OUTPATIENT,,,362,144.8,UC HEALTH,UC HEALTH COMMERCIAL,314.94,87,,,OTHER,271.5,354.76,PERCENT OF TOTAL BILLED CHARGES
SACROILIAC REGION 3 VIEWS,72202,CPT,320,RC,,OUTPATIENT,,,458.5,183.4,UC HEALTH,UC HEALTH COMMERCIAL,398.895,87,,,OTHER,343.88,449.33,PERCENT OF TOTAL BILLED CHARGES
SMALL BOWEL SERIES,74250,CPT,320,RC,,OUTPATIENT,,,755.25,302.1,UC HEALTH,UC HEALTH COMMERCIAL,657.0675,87,,,OTHER,566.44,740.15,PERCENT OF TOTAL BILLED CHARGES
SCAPULA RT,73010RT,CPT,320,RC,RT,OUTPATIENT,,,258.75,103.5,UC HEALTH,UC HEALTH COMMERCIAL,225.1125,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
SCAPULA LT,73010LT,CPT,320,RC,LT,OUTPATIENT,,,258.75,103.5,UC HEALTH,UC HEALTH COMMERCIAL,225.1125,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
STERNOCLAVICULAR JT 3 VIEWS,71130,CPT,320,RC,,OUTPATIENT,,,357,142.8,UC HEALTH,UC HEALTH COMMERCIAL,310.59,87,,,OTHER,267.75,349.86,PERCENT OF TOTAL BILLED CHARGES
SCOLIOSIS AP,72082,CPT,320,RC,,OUTPATIENT,,,320.25,128.1,UC HEALTH,UC HEALTH COMMERCIAL,278.6175,87,,,OTHER,240.19,313.85,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 1 VIEW RT,73020RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 1 VIEW LT,73020LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
SHOULDER ARTHROGRAM RT,73040RT,CPT,320,RC,RT,OUTPATIENT,,,801.25,320.5,UC HEALTH,UC HEALTH COMMERCIAL,697.0875,87,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
SHOULDER ARTHROGRAM LT,73040LT,CPT,320,RC,LT,OUTPATIENT,,,801.25,320.5,UC HEALTH,UC HEALTH COMMERCIAL,697.0875,87,,,OTHER,600.94,785.23,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 2 OR MORE VIEWS RT,73030RT,CPT,320,RC,RT,OUTPATIENT,,,348.5,139.4,UC HEALTH,UC HEALTH COMMERCIAL,303.195,87,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
SHOULDER 2 OR MORE VIEWS LT,73030LT,CPT,320,RC,LT,OUTPATIENT,,,348.5,139.4,UC HEALTH,UC HEALTH COMMERCIAL,303.195,87,,,OTHER,261.38,341.53,PERCENT OF TOTAL BILLED CHARGES
SHOULDER INJECT RT,20610RT,CPT,320,RC,RT,OUTPATIENT,,,520.55,208.22,UC HEALTH,UC HEALTH COMMERCIAL,452.8785,87,,,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
SHOULDER INJECT LT,20610LT,CPT,320,RC,LT,OUTPATIENT,,,520.55,208.22,UC HEALTH,UC HEALTH COMMERCIAL,452.8785,87,,,OTHER,238.13,311.15,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR MRI ARTHRO RT,27093RT,CPT,320,RC,RT,OUTPATIENT,,,685,274,UC HEALTH,UC HEALTH COMMERCIAL,595.95,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
HIP INJECT FOR MR ARTHRO LT,27093LT,CPT,320,RC,LT,OUTPATIENT,,,685,274,UC HEALTH,UC HEALTH COMMERCIAL,595.95,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHROCENTISIS ASSIST ME,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
SHLDER INJ FOR MR/CT ARTHRO L,23350,CPT,,,,OUTPATIENT,,,598,239.2,UC HEALTH,UC HEALTH COMMERCIAL,520.26,87,,,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
SHLDER INJ FOR MR/CT ARTHRO R,23350,CPT,,,,OUTPATIENT,,,598,239.2,UC HEALTH,UC HEALTH COMMERCIAL,520.26,87,,,OTHER,448.5,586,PERCENT OF TOTAL BILLED CHARGES
WRIST INJ FOR MR/CT ARTHRO LT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,UC HEALTH,UC HEALTH COMMERCIAL,507.21,87,,,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
WRIST INJ FOR MR/CR ARTHRO RT,25246,CPT,320,RC,,OUTPATIENT,,,583,233.2,UC HEALTH,UC HEALTH COMMERCIAL,507.21,87,,,OTHER,437.3,571.3,PERCENT OF TOTAL BILLED CHARGES
SHOULDER BILATERAL 1 VIEW,7302050,CPT,320,RC,50,OUTPATIENT,,,491,196.4,UC HEALTH,UC HEALTH COMMERCIAL,427.17,87,,,OTHER,368.25,481.18,PERCENT OF TOTAL BILLED CHARGES
SIALAGRAM,70390,CPT,320,RC,,OUTPATIENT,,,563.5,225.4,UC HEALTH,UC HEALTH COMMERCIAL,490.245,87,,,OTHER,422.63,552.23,PERCENT OF TOTAL BILLED CHARGES
SINUS 1 VIEW,70210,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
SINUS 4 VIEWS,70220,CPT,320,RC,,OUTPATIENT,,,425,170,UC HEALTH,UC HEALTH COMMERCIAL,369.75,87,,,OTHER,318.75,416.5,PERCENT OF TOTAL BILLED CHARGES
SKULL COMPLETE,70260,CPT,320,RC,,OUTPATIENT,,,542.25,216.9,UC HEALTH,UC HEALTH COMMERCIAL,471.7575,87,,,OTHER,406.69,531.41,PERCENT OF TOTAL BILLED CHARGES
SKULL 3 VIEWS,70250,CPT,320,RC,,OUTPATIENT,,,431.75,172.7,UC HEALTH,UC HEALTH COMMERCIAL,375.6225,87,,,OTHER,323.81,423.12,PERCENT OF TOTAL BILLED CHARGES
STERNUM 2 VIEWS,71120,CPT,320,RC,,OUTPATIENT,,,350.25,140.1,UC HEALTH,UC HEALTH COMMERCIAL,304.7175,87,,,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
SPINE SINGLE VIEW,72020,CPT,320,RC,,OUTPATIENT,,,196,78.4,UC HEALTH,UC HEALTH COMMERCIAL,170.52,87,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
SPINE ENTIRE 1 VIEW,72081,CPT,,,,OUTPATIENT,,,196,78.4,UC HEALTH,UC HEALTH COMMERCIAL,170.52,87,,,OTHER,147,192.08,PERCENT OF TOTAL BILLED CHARGES
TEMPEROMANDIBULAR JT,70328,CPT,320,RC,,OUTPATIENT,,,581.75,232.7,UC HEALTH,UC HEALTH COMMERCIAL,506.1225,87,,,OTHER,436.31,570.12,PERCENT OF TOTAL BILLED CHARGES
TOE GREAT LT,73660TA,CPT,320,RC,TA,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 2ND DIGIT LT,73660T1,CPT,320,RC,T1,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 3RD DIGIT LT,73660T2,CPT,320,RC,T2,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 4TH DIGIT LT,73660T3,CPT,320,RC,T3,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 5TH DIGIT LT,73660T4,CPT,320,RC,T4,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE GREAT RT,73660T5,CPT,320,RC,T5,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 2ND DIGIT RT,73660T6,CPT,320,RC,T6,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 3RD DIGIT RT,73660T7,CPT,320,RC,T7,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 4TH DIGIT RT,73660T8,CPT,320,RC,T8,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
TOE 5TH DIGIT RT,73660T9,CPT,320,RC,T9,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
T-TUBE INJECTION,47505,CPT,320,RC,,OUTPATIENT,,,308,123.2,UC HEALTH,UC HEALTH COMMERCIAL,267.96,87,,,OTHER,231,301.84,PERCENT OF TOTAL BILLED CHARGES
THORACIC SPINE,72072,CPT,320,RC,,OUTPATIENT,,,375,150,UC HEALTH,UC HEALTH COMMERCIAL,326.25,87,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
THORACIC SPINE 2VIEWS,72070,CPT,320,RC,,OUTPATIENT,,,305.75,122.3,UC HEALTH,UC HEALTH COMMERCIAL,266.0025,87,,,OTHER,229.31,299.64,PERCENT OF TOTAL BILLED CHARGES
THORACOLUMBAR 2 VIEWS,72080,CPT,320,RC,,OUTPATIENT,,,375,150,UC HEALTH,UC HEALTH COMMERCIAL,326.25,87,,,OTHER,281.25,367.5,PERCENT OF TOTAL BILLED CHARGES
UPPER GI SERIES,74240,CPT,320,RC,,OUTPATIENT,,,694.75,277.9,UC HEALTH,UC HEALTH COMMERCIAL,604.4325,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
UGI/SMALL BOWEL-NO AIR,74240,CPT,320,RC,,OUTPATIENT,,,743.25,297.3,UC HEALTH,UC HEALTH COMMERCIAL,646.6275,87,,,OTHER,557.44,728.39,PERCENT OF TOTAL BILLED CHARGES
X-RAY SM INT F-THRU STD,74248,CPT,320,RC,,OUTPATIENT,,,200,80,UC HEALTH,UC HEALTH COMMERCIAL,174,87,,,OTHER,150,196,PERCENT OF TOTAL BILLED CHARGES
UPPER GI W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,760.75,304.3,UC HEALTH,UC HEALTH COMMERCIAL,661.8525,87,,,OTHER,570.56,745.54,PERCENT OF TOTAL BILLED CHARGES
UPPER GI/SMALL BOWEL W/AIR,74246,CPT,320,RC,,OUTPATIENT,,,785.75,314.3,UC HEALTH,UC HEALTH COMMERCIAL,683.6025,87,,,OTHER,589.31,770.04,PERCENT OF TOTAL BILLED CHARGES
TUBE PLACEMENT FLUORO/FILM,74340,CPT,320,RC,,OUTPATIENT,,,440,176,UC HEALTH,UC HEALTH COMMERCIAL,382.8,87,,,OTHER,330,431.2,PERCENT OF TOTAL BILLED CHARGES
URETHROCYSTOGRAPH,74450,CPT,320,RC,,OUTPATIENT,,,474.25,189.7,UC HEALTH,UC HEALTH COMMERCIAL,412.5975,87,,,OTHER,355.69,464.77,PERCENT OF TOTAL BILLED CHARGES
URETHRA/BLADDER,74455,CPT,320,RC,,OUTPATIENT,,,1399,559.6,UC HEALTH,UC HEALTH COMMERCIAL,1217.13,87,,,OTHER,1049.25,1371.02,PERCENT OF TOTAL BILLED CHARGES
VENOGRAM UNILATERAL RT,75820RT,CPT,320,RC,RT,OUTPATIENT,,,2802.66,1121.064,UC HEALTH,UC HEALTH COMMERCIAL,2438.3142,87,,,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
VENOGRAM UNILATERAL LT,75820LT,CPT,320,RC,LT,OUTPATIENT,,,2802.66,1121.064,UC HEALTH,UC HEALTH COMMERCIAL,2438.3142,87,,,OTHER,846,1105.44,PERCENT OF TOTAL BILLED CHARGES
WRIST RT,73110RT,CPT,320,RC,RT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
WRIST LT,73110LT,CPT,320,RC,LT,OUTPATIENT,,,245.5,98.2,UC HEALTH,UC HEALTH COMMERCIAL,213.585,87,,,OTHER,184.13,240.59,PERCENT OF TOTAL BILLED CHARGES
WRISTS BILAT 4 VIEWS ONLY,73100,CPT,,,,OUTPATIENT,,,491,196.4,UC HEALTH,UC HEALTH COMMERCIAL,427.17,87,,,OTHER,368.3,481.2,PERCENT OF TOTAL BILLED CHARGES
WRIST 2 VIEWS RT,73100RT,CPT,320,RC,RT,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
WRIST 2 VIEWS LT,73100LT,CPT,320,RC,LT,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,85.69,111.97,PERCENT OF TOTAL BILLED CHARGES
WRIST ARTHRO RT,73115RT,CPT,320,RC,RT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
WRIST ARTHRO LT,73115LT,CPT,320,RC,LT,OUTPATIENT,,,733.72,293.488,UC HEALTH,UC HEALTH COMMERCIAL,638.3364,87,,,OTHER,438.19,572.57,PERCENT OF TOTAL BILLED CHARGES
"LUMBAR AP,FLEX/EXT",72120,CPT,320,RC,,OUTPATIENT,,,215.38,86.152,UC HEALTH,UC HEALTH COMMERCIAL,187.3806,87,,,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
FOREIGN BODY EVALUATION  CHILD,76010,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UC HEALTH,UC HEALTH COMMERCIAL,232.5075,87,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
X-RAY XM SWLNG FUNCJ C+,74230,CPT,320,RC,,OUTPATIENT,,,363.42,145.368,UC HEALTH,UC HEALTH COMMERCIAL,316.1754,87,,,OTHER,272.6,356.2,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE CHANGE FLUORO,50435,CPT,361,RC,,OUTPATIENT,,,3738.02,1495.208,UC HEALTH,UC HEALTH COMMERCIAL,3252.0774,87,,,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
ANKLE BILATERAL 4 VIEWS,73600,CPT,,,,OUTPATIENT,,,350.16,140.064,UC HEALTH,UC HEALTH COMMERCIAL,304.6392,87,,,OTHER,262.6,343.2,PERCENT OF TOTAL BILLED CHARGES
US PICC LINE PLACEMENT,36569,CPT,361,RC,,OUTPATIENT,,,2033,813.2,UC HEALTH,UC HEALTH COMMERCIAL,1768.71,87,,,OTHER,1524.75,1992.34,PERCENT OF TOTAL BILLED CHARGES
CHEST DECUBITUS,71046,CPT,320,RC,,OUTPATIENT,,,243.5,97.4,UC HEALTH,UC HEALTH COMMERCIAL,211.845,87,,,OTHER,182.63,238.63,PERCENT OF TOTAL BILLED CHARGES
ORBITS FOR MRI,70030,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UC HEALTH,UC HEALTH COMMERCIAL,232.5075,87,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
ORBITS,70190,CPT,320,RC,,OUTPATIENT,,,267.25,106.9,UC HEALTH,UC HEALTH COMMERCIAL,232.5075,87,,,OTHER,200.44,261.91,PERCENT OF TOTAL BILLED CHARGES
FLURO,36573,CPT,320,RC,,OUTPATIENT,,,660.75,264.3,UC HEALTH,UC HEALTH COMMERCIAL,574.8525,87,,,OTHER,495.56,647.54,PERCENT OF TOTAL BILLED CHARGES
DEXA HIPS/PELVIS/SPINE,77080XU,CPT,320,RC,XU,OUTPATIENT,,,428,171.2,UC HEALTH,UC HEALTH COMMERCIAL,372.36,87,,,OTHER,321,419.44,PERCENT OF TOTAL BILLED CHARGES
DEXA RADIUS/WRIST/HEEL,77081,CPT,320,RC,,OUTPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,62.06,81.1,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL I,3210001,CDM,320,RC,,INPATIENT,,,856.5,342.6,UC HEALTH,UC HEALTH COMMERCIAL,745.155,87,,,OTHER,642.38,839.37,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL II,3210002,CDM,320,RC,,INPATIENT,,,1497.75,599.1,UC HEALTH,UC HEALTH COMMERCIAL,1303.0425,87,,,OTHER,1123.31,1467.8,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL III,3210003,CDM,361,RC,,INPATIENT,,,2139.5,855.8,UC HEALTH,UC HEALTH COMMERCIAL,1861.365,87,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL IV,3210004,CDM,320,RC,,INPATIENT,,,2781,1112.4,UC HEALTH,UC HEALTH COMMERCIAL,2419.47,87,,,OTHER,2085.75,2725.38,PERCENT OF TOTAL BILLED CHARGES
PROCEDURE LEVEL V,3210005,CDM,320,RC,,INPATIENT,,,3422,1368.8,UC HEALTH,UC HEALTH COMMERCIAL,2977.14,87,,,OTHER,2566.5,3353.56,PERCENT OF TOTAL BILLED CHARGES
BONE BIOPSY TROCAR/NEEDLE,20220,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UC HEALTH,UC HEALTH COMMERCIAL,1861.365,87,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
BONE BIOPSY TROCAR/NEEDLE DEEP,20225,CPT,321,RC,,OUTPATIENT,,,2139.5,855.8,UC HEALTH,UC HEALTH COMMERCIAL,1861.365,87,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
XRAY SHOULDER INJECTION,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,UC HEALTH,UC HEALTH COMMERCIAL,463.4925,87,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
XRAY SHOULDER INJECTION RT,23350,CPT,,,,OUTPATIENT,,,532.75,213.1,UC HEALTH,UC HEALTH COMMERCIAL,463.4925,87,,,OTHER,399.6,522.1,PERCENT OF TOTAL BILLED CHARGES
XRAY WRIST INJECTION,25246,CPT,320,RC,,OUTPATIENT,,,532.75,213.1,UC HEALTH,UC HEALTH COMMERCIAL,463.4925,87,,,OTHER,399.56,522.1,PERCENT OF TOTAL BILLED CHARGES
FLUORO GUIDED FACET JOINT INJ,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,UC HEALTH,UC HEALTH COMMERCIAL,1477.521,87,,,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
REFILL MAINTAIN PUMP,96521,CPT,760,RC,,OUTPATIENT,,,604.75,241.9,UC HEALTH,UC HEALTH COMMERCIAL,526.1325,87,,,OTHER,453.56,592.66,PERCENT OF TOTAL BILLED CHARGES
INTRAVESICAL CHEMO ADMIN,51720,CPT,331,RC,,OUTPATIENT,,,1252.97,501.188,UC HEALTH,UC HEALTH COMMERCIAL,1090.0839,87,,,OTHER,939.73,1227.91,PERCENT OF TOTAL BILLED CHARGES
CHEMO IV PUSH ADD'L DRUG,96411,CPT,331,RC,,OUTPATIENT,,,491.75,196.7,UC HEALTH,UC HEALTH COMMERCIAL,427.8225,87,,,OTHER,368.81,481.92,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP SNGL/INT LVL I,96409,CPT,331,RC,,OUTPATIENT,,,602,240.8,UC HEALTH,UC HEALTH COMMERCIAL,523.74,87,,,OTHER,451.5,589.96,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP SNGL/INT LVL II,96409,CPT,331,RC,,OUTPATIENT,,,534,213.6,UC HEALTH,UC HEALTH COMMERCIAL,464.58,87,,,OTHER,400.5,523.32,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP PICC LVL III,96409,CPT,331,RC,,OUTPATIENT,,,468.25,187.3,UC HEALTH,UC HEALTH COMMERCIAL,407.3775,87,,,OTHER,351.19,458.89,PERCENT OF TOTAL BILLED CHARGES
CHEM ADMIN IVP PICC LVL IV,96409,CPT,331,RC,,OUTPATIENT,,,520.25,208.1,UC HEALTH,UC HEALTH COMMERCIAL,452.6175,87,,,OTHER,390.19,509.85,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION CHEMO EA ADD'L HR,96415,CPT,335,RC,,OUTPATIENT,,,148.75,59.5,UC HEALTH,UC HEALTH COMMERCIAL,129.4125,87,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
EA ADD'L/SEQ INFUSED CHEMO<1HR,96417,CPT,335,RC,,OUTPATIENT,,,159.25,63.7,UC HEALTH,UC HEALTH COMMERCIAL,138.5475,87,,,OTHER,119.44,156.07,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL I,96413,CPT,335,RC,,OUTPATIENT,,,793.25,317.3,UC HEALTH,UC HEALTH COMMERCIAL,690.1275,87,,,OTHER,594.94,777.39,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL II,96413,CPT,335,RC,,OUTPATIENT,,,694,277.6,UC HEALTH,UC HEALTH COMMERCIAL,603.78,87,,,OTHER,520.5,680.12,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL III,96413,CPT,335,RC,,OUTPATIENT,,,740.75,296.3,UC HEALTH,UC HEALTH COMMERCIAL,644.4525,87,,,OTHER,555.56,725.94,PERCENT OF TOTAL BILLED CHARGES
IV INFUS CHEMO INIT LEVEL IV,96413,CPT,335,RC,,OUTPATIENT,,,662,264.8,UC HEALTH,UC HEALTH COMMERCIAL,575.94,87,,,OTHER,496.5,648.76,PERCENT OF TOTAL BILLED CHARGES
CYSTOGRAM,78740,CPT,340,RC,,OUTPATIENT,,,1170.75,468.3,UC HEALTH,UC HEALTH COMMERCIAL,1018.5525,87,,,OTHER,878.06,1147.34,PERCENT OF TOTAL BILLED CHARGES
THYROID CARCINOMA MET IMAGING,78018,CPT,340,RC,,OUTPATIENT,,,1658,663.2,UC HEALTH,UC HEALTH COMMERCIAL,1442.46,87,,,OTHER,1243.5,1624.84,PERCENT OF TOTAL BILLED CHARGES
CEREBROSPINAL FLUID FLOW IMAGE,78630,CPT,340,RC,,OUTPATIENT,,,3353,1341.2,UC HEALTH,UC HEALTH COMMERCIAL,2917.11,87,,,OTHER,2514.75,3285.94,PERCENT OF TOTAL BILLED CHARGES
CAPTOPRIL RENAL,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UC HEALTH,UC HEALTH COMMERCIAL,1454.4225,87,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
BONE IMAGING LIMITED (BONL),78300,CPT,341,RC,,OUTPATIENT,,,1688.25,675.3,UC HEALTH,UC HEALTH COMMERCIAL,1468.7775,87,,,OTHER,1266.19,1654.49,PERCENT OF TOTAL BILLED CHARGES
BONE WHOLE BODY (BONW),78306,CPT,341,RC,,OUTPATIENT,,,1814.25,725.7,UC HEALTH,UC HEALTH COMMERCIAL,1578.3975,87,,,OTHER,1360.69,1777.97,PERCENT OF TOTAL BILLED CHARGES
BONE IMAGING 3 PHASE (BON3),78315,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UC HEALTH,UC HEALTH COMMERCIAL,1454.4225,87,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
TAGGED RBC GI BLEED (TRBC),78278,CPT,341,RC,,OUTPATIENT,,,2035,814,UC HEALTH,UC HEALTH COMMERCIAL,1770.45,87,,,OTHER,1526.25,1994.3,PERCENT OF TOTAL BILLED CHARGES
HIDA W/O,78226,CPT,341,RC,,OUTPATIENT,,,952.25,380.9,UC HEALTH,UC HEALTH COMMERCIAL,828.4575,87,,,OTHER,714.19,933.21,PERCENT OF TOTAL BILLED CHARGES
VQ SCAN VENT/PERFUSION,78598,CPT,341,RC,,OUTPATIENT,,,1837,734.8,UC HEALTH,UC HEALTH COMMERCIAL,1598.19,87,,,OTHER,1377.75,1800.26,PERCENT OF TOTAL BILLED CHARGES
HIDA W/CCK,78227,CPT,341,RC,,OUTPATIENT,,,1721.75,688.7,UC HEALTH,UC HEALTH COMMERCIAL,1497.9225,87,,,OTHER,1291.31,1687.32,PERCENT OF TOTAL BILLED CHARGES
LUNG PERFUSION,78580,CPT,341,RC,,OUTPATIENT,,,1403.5,561.4,UC HEALTH,UC HEALTH COMMERCIAL,1221.045,87,,,OTHER,1052.63,1375.43,PERCENT OF TOTAL BILLED CHARGES
LUNG VENTILATION,78582,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UC HEALTH,UC HEALTH COMMERCIAL,1454.4225,87,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
MECKLES IMAGING (MECK),78290,CPT,341,RC,,OUTPATIENT,,,1462,584.8,UC HEALTH,UC HEALTH COMMERCIAL,1271.94,87,,,OTHER,1096.5,1432.76,PERCENT OF TOTAL BILLED CHARGES
RENAL FLOW/FUNCTION,78708,CPT,341,RC,,OUTPATIENT,,,1671.75,668.7,UC HEALTH,UC HEALTH COMMERCIAL,1454.4225,87,,,OTHER,1253.81,1638.32,PERCENT OF TOTAL BILLED CHARGES
THYROID IMAGING ONLY (THYI),78013,CPT,341,RC,,OUTPATIENT,,,751.66,300.664,UC HEALTH,UC HEALTH COMMERCIAL,653.9442,87,,,OTHER,491.81,642.64,PERCENT OF TOTAL BILLED CHARGES
THYROID UPTAKE W/MULT DETE,78012,CPT,341,RC,,OUTPATIENT,,,1586,634.4,UC HEALTH,UC HEALTH COMMERCIAL,1379.82,87,,,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
BONE SPECT (BNSP),78320,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,UC HEALTH,UC HEALTH COMMERCIAL,1205.6025,87,,,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
GASTRO EMPTYING STUDY (GASE),78264,CPT,341,RC,,OUTPATIENT,,,1586,634.4,UC HEALTH,UC HEALTH COMMERCIAL,1379.82,87,,,OTHER,1189.5,1554.28,PERCENT OF TOTAL BILLED CHARGES
LIVER/SPLEEN IMAGING W/FLOW,78216,CPT,341,RC,,OUTPATIENT,,,1237.5,495,UC HEALTH,UC HEALTH COMMERCIAL,1076.625,87,,,OTHER,928.13,1212.75,PERCENT OF TOTAL BILLED CHARGES
LIVER (SPECT) (LIVS),78205,CPT,341,RC,,OUTPATIENT,,,1385.75,554.3,UC HEALTH,UC HEALTH COMMERCIAL,1205.6025,87,,,OTHER,1039.31,1358.04,PERCENT OF TOTAL BILLED CHARGES
LYMPH GLAND INJECTION,78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,UC HEALTH,UC HEALTH COMMERCIAL,1542.945,87,,,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERFUSION,78452,CPT,341,RC,,OUTPATIENT,,,3980.75,1592.3,UC HEALTH,UC HEALTH COMMERCIAL,3463.2525,87,,,OTHER,2985.56,3901.14,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERF WALL MOTION,78453,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,UC HEALTH,UC HEALTH COMMERCIAL,2264.5665,87,,,OTHER,931.69,1217.41,PERCENT OF TOTAL BILLED CHARGES
MYOCARDIAL PERF EJECTION FRACT,78496,CPT,341,RC,,OUTPATIENT,,,811.25,324.5,UC HEALTH,UC HEALTH COMMERCIAL,705.7875,87,,,OTHER,608.44,795.03,PERCENT OF TOTAL BILLED CHARGES
MUGA SCAN,78472,CPT,341,RC,,OUTPATIENT,,,2449,979.6,UC HEALTH,UC HEALTH COMMERCIAL,2130.63,87,,,OTHER,1836.75,2400.02,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID IMAGING,78070,CPT,341,RC,,OUTPATIENT,,,1799,719.6,UC HEALTH,UC HEALTH COMMERCIAL,1565.13,87,,,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
SPECT,78807,CPT,340,RC,,OUTPATIENT,,,2279.5,911.8,UC HEALTH,UC HEALTH COMMERCIAL,1983.165,87,,,OTHER,1709.63,2233.91,PERCENT OF TOTAL BILLED CHARGES
PARATHYROID IMAGING WITH SPECT,78071,CPT,341,RC,,OUTPATIENT,,,1984.5,793.8,UC HEALTH,UC HEALTH COMMERCIAL,1726.515,87,,,OTHER,1488.38,1944.81,PERCENT OF TOTAL BILLED CHARGES
TUMOR LOCAL WHOLE BODY,78804,CPT,341,RC,,OUTPATIENT,,,2752,1100.8,UC HEALTH,UC HEALTH COMMERCIAL,2394.24,87,,,OTHER,2064,2696.96,PERCENT OF TOTAL BILLED CHARGES
TUMOR LOCAL (LTD) (TLLT),78800,CPT,341,RC,,OUTPATIENT,,,1799,719.6,UC HEALTH,UC HEALTH COMMERCIAL,1565.13,87,,,OTHER,1349.25,1763.02,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC (LTD) (TWBL),78805,CPT,341,RC,,OUTPATIENT,,,3635,1454,UC HEALTH,UC HEALTH COMMERCIAL,3162.45,87,,,OTHER,2726.25,3562.3,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC WHOLE BODY (TWBW),78806,CPT,341,RC,,OUTPATIENT,,,3823,1529.2,UC HEALTH,UC HEALTH COMMERCIAL,3326.01,87,,,OTHER,2867.25,3746.54,PERCENT OF TOTAL BILLED CHARGES
LIVER IMAGING SPECT W/FLOW,78206,CPT,340,RC,,OUTPATIENT,,,1589.75,635.9,UC HEALTH,UC HEALTH COMMERCIAL,1383.0825,87,,,OTHER,1192.31,1557.96,PERCENT OF TOTAL BILLED CHARGES
TAGGED WBC SPECT (TWBS),78807,CPT,340,RC,,OUTPATIENT,,,4529,1811.6,UC HEALTH,UC HEALTH COMMERCIAL,3940.23,87,,,OTHER,3396.75,4438.42,PERCENT OF TOTAL BILLED CHARGES
PET SCAN LIMITED INITIAL,78814PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
LOCAL TUMOR ONCOSCENT IN 111,78802,CPT,341,RC,,OUTPATIENT,,,2602.95,1041.18,UC HEALTH,UC HEALTH COMMERCIAL,2264.5665,87,,,OTHER,1386.75,1812.02,PERCENT OF TOTAL BILLED CHARGES
PET SCAN SKULL TO THIGH INITAL,78815PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
BRAIN IMAGINE WITH FLOW,78606,CPT,341,RC,,OUTPATIENT,,,1544.75,617.9,UC HEALTH,UC HEALTH COMMERCIAL,1343.9325,87,,,OTHER,1158.56,1513.86,PERCENT OF TOTAL BILLED CHARGES
PET SCAN WHOLE BODY INITIAL,78816PI,CPT,404,RC,PI,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN LIMITED SUBSEQUENT,78814PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN WHOLE BODY SUBSEQUENT,78816PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
PET SCAN PROSTATE,78815,CPT,404,RC,,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.8,PERCENT OF TOTAL BILLED CHARGES
PET SCAN SKULL-THIGH SUBSEQUET,78815PS,CPT,404,RC,PS,OUTPATIENT,,,8362,3344.8,UC HEALTH,UC HEALTH COMMERCIAL,7274.94,87,,,OTHER,6271.5,8194.76,PERCENT OF TOTAL BILLED CHARGES
LYMPHOSCINTIGRAPHY (LYSC),78195,CPT,341,RC,,OUTPATIENT,,,1773.5,709.4,UC HEALTH,UC HEALTH COMMERCIAL,1542.945,87,,,OTHER,1330.13,1738.03,PERCENT OF TOTAL BILLED CHARGES
ABDOMINAL SCINTIGRAPHY,78999,CPT,341,RC,,OUTPATIENT,,,1575,630,UC HEALTH,UC HEALTH COMMERCIAL,1370.25,87,,,OTHER,1181.25,1543.5,PERCENT OF TOTAL BILLED CHARGES
TC99M PERTECHNETATE,A9512,HCPCS,343,RC,,INPATIENT,,,142.5,57,UC HEALTH,UC HEALTH COMMERCIAL,123.975,87,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M DISOFENIN,A9510,HCPCS,343,RC,,INPATIENT,,,169.75,67.9,UC HEALTH,UC HEALTH COMMERCIAL,147.6825,87,,,OTHER,127.31,166.36,PERCENT OF TOTAL BILLED CHARGES
TC99M MAA,A9540,HCPCS,343,RC,,INPATIENT,,,142.5,57,UC HEALTH,UC HEALTH COMMERCIAL,123.975,87,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M BICISATE,A9557,HCPCS,343,RC,,INPATIENT,,,142.5,57,UC HEALTH,UC HEALTH COMMERCIAL,123.975,87,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M MERTIATIDE,A9562,HCPCS,343,RC,,INPATIENT,,,720.5,288.2,UC HEALTH,UC HEALTH COMMERCIAL,626.835,87,,,OTHER,540.38,706.09,PERCENT OF TOTAL BILLED CHARGES
IODINE I-123 SOD IODIDE,A9584,HCPCS,343,RC,,INPATIENT,,,234,93.6,UC HEALTH,UC HEALTH COMMERCIAL,203.58,87,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,142.5,57,UC HEALTH,UC HEALTH COMMERCIAL,123.975,87,,,OTHER,106.88,139.65,PERCENT OF TOTAL BILLED CHARGES
TC99M SULFUR COLLOID,A9541,HCPCS,343,RC,,INPATIENT,,,259.25,103.7,UC HEALTH,UC HEALTH COMMERCIAL,225.5475,87,,,OTHER,194.44,254.07,PERCENT OF TOTAL BILLED CHARGES
TC99M SESTAMIBI (ONE DOSE),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,UC HEALTH,UC HEALTH COMMERCIAL,532.005,87,,,OTHER,458.63,599.27,PERCENT OF TOTAL BILLED CHARGES
TC99M SESTAMIBI (2 DOSES),A9500,HCPCS,343,RC,,INPATIENT,,,611.5,244.6,UC HEALTH,UC HEALTH COMMERCIAL,532.005,87,,,OTHER,458.63,599.27,PERCENT OF TOTAL BILLED CHARGES
GA67 GALLIUM,A9556,HCPCS,343,RC,,INPATIENT,,,275,110,UC HEALTH,UC HEALTH COMMERCIAL,239.25,87,,,OTHER,206.25,269.5,PERCENT OF TOTAL BILLED CHARGES
IN111 OXYQUINOLINE,A9547,HCPCS,343,RC,,INPATIENT,,,2250.5,900.2,UC HEALTH,UC HEALTH COMMERCIAL,1957.935,87,,,OTHER,1687.88,2205.49,PERCENT OF TOTAL BILLED CHARGES
IN111 PENTERTEOTIDE,A9572,HCPCS,343,RC,,INPATIENT,,,4420.25,1768.1,UC HEALTH,UC HEALTH COMMERCIAL,3845.6175,87,,,OTHER,3315.19,4331.85,PERCENT OF TOTAL BILLED CHARGES
CT AORTA,74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UC HEALTH,UC HEALTH COMMERCIAL,1754.355,87,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT CALCIUM SCORING,75571,CPT,,,,OUTPATIENT,,,172,68.8,UC HEALTH,UC HEALTH COMMERCIAL,149.64,87,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS ANGIO W/RUNOFF,75635,CPT,350,RC,,OUTPATIENT,,,3501.5,1400.6,UC HEALTH,UC HEALTH COMMERCIAL,3046.305,87,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS ANGIO W/RUNOFF,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,UC HEALTH,UC HEALTH COMMERCIAL,3046.305,87,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PELVIS W/CONT (ABPE),74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,UC HEALTH,UC HEALTH COMMERCIAL,3246.6225,87,,,OTHER,2798.81,3657.12,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/WO CONT (ABDB),74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,UC HEALTH,UC HEALTH COMMERCIAL,1991.2125,87,,,OTHER,1716.56,2242.98,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/WO CONTRAST,74170,CPT,350,RC,,OUTPATIENT,,,2288.75,915.5,UC HEALTH,UC HEALTH COMMERCIAL,1991.2125,87,,,OTHER,1716.56,2242.98,PERCENT OF TOTAL BILLED CHARGES
CT BONE LENGTH SCANOGRAM,77073,CPT,320,RC,,OUTPATIENT,,,354,141.6,UC HEALTH,UC HEALTH COMMERCIAL,307.98,87,,,OTHER,265.5,346.92,PERCENT OF TOTAL BILLED CHARGES
CT CHOLECYSTOSTOMY W DRAIN,47533,CPT,350,RC,,OUTPATIENT,,,6430.08,2572.032,UC HEALTH,UC HEALTH COMMERCIAL,5594.1696,87,,,OTHER,3633.94,4748.35,PERCENT OF TOTAL BILLED CHARGES
LOWDOSE LUNG SCREENING,G0297,HCPCS,350,RC,,BOTH,,,1563.5,625.4,UC HEALTH,UC HEALTH COMMERCIAL,1360.245,87,,,OTHER,1172.63,1532.23,PERCENT OF TOTAL BILLED CHARGES
CT FIDUCIAL MARKER PLACEMENT,32553,CPT,760,RC,,OUTPATIENT,,,2515.73,1006.292,UC HEALTH,UC HEALTH COMMERCIAL,2188.6851,87,,,OTHER,1541.25,2013.9,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO BILATERAL,7320650,CPT,350,RC,50,OUTPATIENT,,,3097.5,1239,UC HEALTH,UC HEALTH COMMERCIAL,2694.825,87,,,OTHER,2323.13,3035.55,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/CONT (ABDW),74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,UC HEALTH,UC HEALTH COMMERCIAL,1737.1725,87,,,OTHER,1497.56,1956.82,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/CONTRAST,74160,CPT,350,RC,,OUTPATIENT,,,1996.75,798.7,UC HEALTH,UC HEALTH COMMERCIAL,1737.1725,87,,,OTHER,1497.56,1956.82,PERCENT OF TOTAL BILLED CHARGES
CT ADRENAL CORE BX,60699,CPT,,,,OUTPATIENT,,,1513,605.2,UC HEALTH,UC HEALTH COMMERCIAL,1316.31,87,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
CT ADRENAL CORE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,2275,910,UC HEALTH,UC HEALTH COMMERCIAL,1979.25,87,,,OTHER,1706.25,2229.5,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496QQ,CPT,350,RC,QQ,OUTPATIENT,,,2275,910,UC HEALTH,UC HEALTH COMMERCIAL,1979.25,87,,,OTHER,1706.25,2229.5,PERCENT OF TOTAL BILLED CHARGES
CT ABD AND PELVIS W CONTRAST,74177,CPT,350,RC,,OUTPATIENT,,,3731.75,1492.7,UC HEALTH,UC HEALTH COMMERCIAL,3246.6225,87,,,OTHER,2798.81,3657.12,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/WO CONTRAST,74178QQ,CPT,350,RC,QQ,OUTPATIENT,,,4262.75,1705.1,UC HEALTH,UC HEALTH COMMERCIAL,3708.5925,87,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/O CONTRAST,74176QQ,CPT,350,RC,QQ,OUTPATIENT,,,3079.5,1231.8,UC HEALTH,UC HEALTH COMMERCIAL,2679.165,87,,,OTHER,2309.63,3017.91,PERCENT OF TOTAL BILLED CHARGES
CT ABD & PELVIS W/WO CONTRAST,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,UC HEALTH,UC HEALTH COMMERCIAL,3708.5925,87,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABDOMEN W/O CONTRAST (ABWO),74150,CPT,350,RC,,OUTPATIENT,,,1705.25,682.1,UC HEALTH,UC HEALTH COMMERCIAL,1483.5675,87,,,OTHER,1278.94,1671.15,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PEL W/O,74176,CPT,350,RC,,OUTPATIENT,,,3079.5,1231.8,UC HEALTH,UC HEALTH COMMERCIAL,2679.165,87,,,OTHER,2309.63,3017.91,PERCENT OF TOTAL BILLED CHARGES
CT ABD/PEL W/WO HEMATURIA(APWW,74178,CPT,350,RC,,OUTPATIENT,,,4262.75,1705.1,UC HEALTH,UC HEALTH COMMERCIAL,3708.5925,87,,,OTHER,3197.06,4177.5,PERCENT OF TOTAL BILLED CHARGES
CT ABSCESS DRAINAGE W/CATH,49406,CPT,361,RC,,OUTPATIENT,,,4165.75,1666.3,UC HEALTH,UC HEALTH COMMERCIAL,3624.2025,87,,,OTHER,3124.31,4082.44,PERCENT OF TOTAL BILLED CHARGES
CT ABSCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UC HEALTH,UC HEALTH COMMERCIAL,647.28,87,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE PLACEMENT,50432,CPT,361,RC,,OUTPATIENT,,,2752.75,1101.1,UC HEALTH,UC HEALTH COMMERCIAL,2394.8925,87,,,OTHER,2064.56,2697.7,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ LEVEL 1,64493,CPT,350,RC,,OUTPATIENT,,,1777.25,710.9,UC HEALTH,UC HEALTH COMMERCIAL,1546.2075,87,,,OTHER,1332.94,1741.71,PERCENT OF TOTAL BILLED CHARGES
CT CHEST TUBE PLCMT FOR ABCESS,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
CT CHEST TUBE PLCMT FOR PNEUMO,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
CT NECK/CHEST BIOPSY,21550,CPT,350,RC,,OUTPATIENT,,,1862.25,744.9,UC HEALTH,UC HEALTH COMMERCIAL,1620.1575,87,,,OTHER,1396.69,1825.01,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/O CONT,70480,CPT,350,RC,,OUTPATIENT,,,1659.5,663.8,UC HEALTH,UC HEALTH COMMERCIAL,1443.765,87,,,OTHER,1244.63,1626.31,PERCENT OF TOTAL BILLED CHARGES
LUMBAR INJECTION CT MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,825,330,UC HEALTH,UC HEALTH COMMERCIAL,717.75,87,,,OTHER,618.75,808.5,PERCENT OF TOTAL BILLED CHARGES
LUMBAR INJECTION FOR MYELOGRAM,62284,CPT,350,RC,,OUTPATIENT,,,2329,931.6,UC HEALTH,UC HEALTH COMMERCIAL,2026.23,87,,,OTHER,1746.75,2282.42,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE CT MYELOGRAM,72265,CPT,320,RC,,OUTPATIENT,,,2314,925.6,UC HEALTH,UC HEALTH COMMERCIAL,2013.18,87,,,OTHER,1735.5,2267.72,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAIN W/CATH ST,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UC HEALTH,UC HEALTH COMMERCIAL,647.28,87,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
LUMBAR SPINE W/WO CONTRAST,72133,CPT,350,RC,,OUTPATIENT,,,2495,998,UC HEALTH,UC HEALTH COMMERCIAL,2170.65,87,,,OTHER,1871.25,2445.1,PERCENT OF TOTAL BILLED CHARGES
LUMBAR SPINE W/CONTRAST,72132,CPT,350,RC,,OUTPATIENT,,,2145.25,858.1,UC HEALTH,UC HEALTH COMMERCIAL,1866.3675,87,,,OTHER,1608.94,2102.35,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/CONT (IACW),70481,CPT,350,RC,,OUTPATIENT,,,2050.75,820.3,UC HEALTH,UC HEALTH COMMERCIAL,1784.1525,87,,,OTHER,1538.06,2009.74,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/CONTRAST,70481QQ,CPT,350,RC,QQ,OUTPATIENT,,,2050.75,820.3,UC HEALTH,UC HEALTH COMMERCIAL,1784.1525,87,,,OTHER,1538.06,2009.74,PERCENT OF TOTAL BILLED CHARGES
CT NEPHROSTOMY TUBE CHANGE,50435,CPT,361,RC,,OUTPATIENT,,,1839.5,735.8,UC HEALTH,UC HEALTH COMMERCIAL,1600.365,87,,,OTHER,1379.63,1802.71,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/WO CNT(IAWW,70482,CPT,350,RC,,OUTPATIENT,,,2516,1006.4,UC HEALTH,UC HEALTH COMMERCIAL,2188.92,87,,,OTHER,1887,2465.68,PERCENT OF TOTAL BILLED CHARGES
CT IAC/ORB/SELLA W/WO CONTRAST,70482QQ,CPT,350,RC,QQ,OUTPATIENT,,,2516,1006.4,UC HEALTH,UC HEALTH COMMERCIAL,2188.92,87,,,OTHER,1887,2465.68,PERCENT OF TOTAL BILLED CHARGES
CT THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UC HEALTH,UC HEALTH COMMERCIAL,1709.55,87,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CORE BX (RNBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,UC HEALTH,UC HEALTH COMMERCIAL,1479.435,87,,,OTHER,1275.38,1666.49,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
ASPIRATION OF BLADDER,51102,CPT,350,RC,,OUTPATIENT,,,2759,1103.6,UC HEALTH,UC HEALTH COMMERCIAL,2400.33,87,,,OTHER,2069.25,2703.82,PERCENT OF TOTAL BILLED CHARGES
CT FNA W/IMAGE GUIDANCE,10009,CPT,350,RC,,OUTPATIENT,,,3220.25,1288.1,UC HEALTH,UC HEALTH COMMERCIAL,2801.6175,87,,,OTHER,2415.19,3155.85,PERCENT OF TOTAL BILLED CHARGES
CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
CT ASPIRATION GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE LT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,UC HEALTH,UC HEALTH COMMERCIAL,765.3738,87,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE RT,73706,CPT,,,,OUTPATIENT,,,879.74,351.896,UC HEALTH,UC HEALTH COMMERCIAL,765.3738,87,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO LWR EXTR W/O&W/DYE BI,73706,CPT,,,,OUTPATIENT,,,1319.61,527.844,UC HEALTH,UC HEALTH COMMERCIAL,1148.0607,87,,,OTHER,989.7,1293.2,PERCENT OF TOTAL BILLED CHARGES
CT FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,UC HEALTH,UC HEALTH COMMERCIAL,1168.845,87,,,OTHER,1007.63,1316.63,PERCENT OF TOTAL BILLED CHARGES
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,UC HEALTH,UC HEALTH COMMERCIAL,2136.0675,87,,,OTHER,1841.44,2406.15,PERCENT OF TOTAL BILLED CHARGES
CT SI JOINT INJECTION,G0260,HCPCS,350,RC,,BOTH,,,2455.25,982.1,UC HEALTH,UC HEALTH COMMERCIAL,2136.0675,87,,,OTHER,1841.44,2406.15,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE FOR INJECTION,77012,CPT,350,RC,,OUTPATIENT,,,1062,424.8,UC HEALTH,UC HEALTH COMMERCIAL,923.94,87,,,OTHER,796.5,1040.76,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UC HEALTH,UC HEALTH COMMERCIAL,1659.96,87,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO PARATHYROID W/WO,70498,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UC HEALTH,UC HEALTH COMMERCIAL,1659.96,87,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/CONTRAST,72126,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW BIOPSY,38221,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UC HEALTH,UC HEALTH COMMERCIAL,1861.365,87,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW BX & ASP SAME SITE,38222,CPT,350,RC,,OUTPATIENT,,,2139.5,855.8,UC HEALTH,UC HEALTH COMMERCIAL,1861.365,87,,,OTHER,1604.63,2096.71,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O CNT(CSWO,72125,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O CONTRAST,72125QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CERVICAL SPINE W/O & W/DYE,72127,CPT,352,RC,,OUTPATIENT,,,3099,1239.6,UC HEALTH,UC HEALTH COMMERCIAL,2696.13,87,,,OTHER,2324.3,3037,PERCENT OF TOTAL BILLED CHARGES
GASTROSTOMY TUBE PLACEMENT,49440,CPT,320,RC,,OUTPATIENT,,,1868,747.2,UC HEALTH,UC HEALTH COMMERCIAL,1625.16,87,,,OTHER,1401,1830.64,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE NEEDLE PLMNT,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT NEEDLE CYST ASPIRATION,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT NEEDLE BIOPSY (NDBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/WO CONTRAST (HDWW),70470,CPT,350,RC,,OUTPATIENT,,,2113.75,845.5,UC HEALTH,UC HEALTH COMMERCIAL,1838.9625,87,,,OTHER,1585.31,2071.48,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/WO CONTRAST,70470QQ,CPT,350,RC,QQ,OUTPATIENT,,,2113.75,845.5,UC HEALTH,UC HEALTH COMMERCIAL,1838.9625,87,,,OTHER,1585.31,2071.48,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/CONTRAST (HDWC),70460,CPT,350,RC,,OUTPATIENT,,,1877.5,751,UC HEALTH,UC HEALTH COMMERCIAL,1633.425,87,,,OTHER,1408.13,1839.95,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/CONTRAST,70460QQ,CPT,350,RC,QQ,OUTPATIENT,,,1877.5,751,UC HEALTH,UC HEALTH COMMERCIAL,1633.425,87,,,OTHER,1408.13,1839.95,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO,70498,CPT,350,RC,,OUTPATIENT,,,945,378,UC HEALTH,UC HEALTH COMMERCIAL,822.15,87,,,OTHER,708.75,926.1,PERCENT OF TOTAL BILLED CHARGES
CT ANGIO HEAD W/CONTRAST,70496,CPT,350,RC,,OUTPATIENT,,,1470,588,UC HEALTH,UC HEALTH COMMERCIAL,1278.9,87,,,OTHER,1102.5,1440.6,PERCENT OF TOTAL BILLED CHARGES
CT HEAD W/O CONTRAST (HDWO),70450,CPT,350,RC,,OUTPATIENT,,,1525,610,UC HEALTH,UC HEALTH COMMERCIAL,1326.75,87,,,OTHER,1143.75,1494.5,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO RIGHT,73206RT,CPT,350,RC,RT,OUTPATIENT,,,2069.75,827.9,UC HEALTH,UC HEALTH COMMERCIAL,1800.6825,87,,,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
UPPER EXT ANGIO LEFT,73206LT,CPT,350,RC,LT,OUTPATIENT,,,2069.75,827.9,UC HEALTH,UC HEALTH COMMERCIAL,1800.6825,87,,,OTHER,1552.31,2028.36,PERCENT OF TOTAL BILLED CHARGES
NEPHROSTOMY TUBE CHANGE BIL,5043550,CPT,350,RC,50,OUTPATIENT,,,3200,1280,UC HEALTH,UC HEALTH COMMERCIAL,2784,87,,,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT RT,73701,CPT,350,RC,,OUTPATIENT,,,2437.25,974.9,UC HEALTH,UC HEALTH COMMERCIAL,2120.4075,87,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT RT,73701QQ,CPT,350,RC,QQ,OUTPATIENT,,,2437.25,974.9,UC HEALTH,UC HEALTH COMMERCIAL,2120.4075,87,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,UC HEALTH,UC HEALTH COMMERCIAL,2120.4075,87,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXTREMITY W/CONT LT,73701LT,CPT,350,RC,LT,OUTPATIENT,,,2437.25,974.9,UC HEALTH,UC HEALTH COMMERCIAL,2120.4075,87,,,OTHER,1827.94,2388.51,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT BI,7370050,CPT,350,RC,50,OUTPATIENT,,,3125.75,1250.3,UC HEALTH,UC HEALTH COMMERCIAL,2719.4025,87,,,OTHER,2344.31,3063.24,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT RT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,UC HEALTH,UC HEALTH COMMERCIAL,1381.3425,87,,,OTHER,1475.81,1928.4,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT RT,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,UC HEALTH,UC HEALTH COMMERCIAL,1381.3425,87,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
CT LOWER EXT W/O CONT LT,73700,CPT,350,RC,,OUTPATIENT,,,1587.75,635.1,UC HEALTH,UC HEALTH COMMERCIAL,1381.3425,87,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT RT,73201,CPT,350,RC,,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT RT,73201QQ,CPT,350,RC,QQ,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT LT,73201LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/CONT LT,73201LTQQ,CPT,350,RC,LTQQ,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT LIVER NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS CORE BX,48102,CPT,361,RC,,OUTPATIENT,,,2769,1107.6,UC HEALTH,UC HEALTH COMMERCIAL,2409.03,87,,,OTHER,2076.75,2713.62,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3179.75,1271.9,UC HEALTH,UC HEALTH COMMERCIAL,2766.3825,87,,,OTHER,2384.81,3116.16,PERCENT OF TOTAL BILLED CHARGES
CT LUNG FNA BIOPSY,10009,CPT,350,RC,,OUTPATIENT,,,3360,1344,UC HEALTH,UC HEALTH COMMERCIAL,2923.2,87,,,OTHER,2520,3292.8,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR HIP LT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,UC HEALTH,UC HEALTH COMMERCIAL,595.95,87,,,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR HIP CT RIGHT,27093,CPT,320,RC,,OUTPATIENT,,,685,274,UC HEALTH,UC HEALTH COMMERCIAL,595.95,87,,,OTHER,513.8,671.3,PERCENT OF TOTAL BILLED CHARGES
CT LUMBAR SPINE W/O CONT (LSWO,72131,CPT,350,RC,,OUTPATIENT,,,1769.25,707.7,UC HEALTH,UC HEALTH COMMERCIAL,1539.2475,87,,,OTHER,1326.94,1733.87,PERCENT OF TOTAL BILLED CHARGES
CT LUMBAR SPINE W/O CONTRAST,72131QQ,CPT,350,RC,QQ,OUTPATIENT,,,1831.5,732.6,UC HEALTH,UC HEALTH COMMERCIAL,1593.405,87,,,OTHER,1373.63,1794.87,PERCENT OF TOTAL BILLED CHARGES
CT MYELOGRAM,72131,CPT,350,RC,,OUTPATIENT,,,2626.5,1050.6,UC HEALTH,UC HEALTH COMMERCIAL,2285.055,87,,,OTHER,1969.88,2573.97,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER DISLOCATION RT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,UC HEALTH,UC HEALTH COMMERCIAL,1016.16,87,,,OTHER,876,1144.64,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER DISLOCATION LT,76380,CPT,350,RC,,OUTPATIENT,,,1168,467.2,UC HEALTH,UC HEALTH COMMERCIAL,1016.16,87,,,OTHER,876,1144.64,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/O CONT,70486,CPT,350,RC,,OUTPATIENT,,,1200,480,UC HEALTH,UC HEALTH COMMERCIAL,1044,87,,,OTHER,900,1176,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/O CONTRAST,70486QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
MAXILLOFACIAL W/WO,70488,CPT,350,RC,,OUTPATIENT,,,1300,520,UC HEALTH,UC HEALTH COMMERCIAL,1131,87,,,OTHER,975,1274,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/CONT(MFWC),70487,CPT,350,RC,,OUTPATIENT,,,1250,500,UC HEALTH,UC HEALTH COMMERCIAL,1087.5,87,,,OTHER,937.5,1225,PERCENT OF TOTAL BILLED CHARGES
CT MAXILLO FACIAL W/CONTRAST,70487QQ,CPT,350,RC,QQ,OUTPATIENT,,,2224.5,889.8,UC HEALTH,UC HEALTH COMMERCIAL,1935.315,87,,,OTHER,1668.38,2180.01,PERCENT OF TOTAL BILLED CHARGES
CT SINUS (SINU),70486,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT SINUS  W/O LIMITED,76380QQ,CPT,350,RC,QQ,OUTPATIENT,,,776.5,310.6,UC HEALTH,UC HEALTH COMMERCIAL,675.555,87,,,OTHER,582.38,760.97,PERCENT OF TOTAL BILLED CHARGES
CT SINUS LIMITED,76380,CPT,350,RC,,OUTPATIENT,,,776.5,310.6,UC HEALTH,UC HEALTH COMMERCIAL,675.555,87,,,OTHER,582.38,760.97,PERCENT OF TOTAL BILLED CHARGES
CT LUNG/MEDIASTINUM CORE BX,3500390,CDM,,,,INPATIENT,,,1198.25,479.3,UC HEALTH,UC HEALTH COMMERCIAL,1042.4775,87,,,OTHER,898.69,1174.29,PERCENT OF TOTAL BILLED CHARGES
CT LUNG/MEDIASTINUM NEEDLE BX,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT CORE LUNG/MEDIA NEEDLE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,UC HEALTH,UC HEALTH COMMERCIAL,1331.97,87,,,OTHER,1148.25,1500.38,PERCENT OF TOTAL BILLED CHARGES
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,UC HEALTH,UC HEALTH COMMERCIAL,1303.26,87,,,OTHER,1123.5,1468.04,PERCENT OF TOTAL BILLED CHARGES
CT CORONARY ARTERIES,75574QQ,CPT,350,RC,QQ,OUTPATIENT,,,1498,599.2,UC HEALTH,UC HEALTH COMMERCIAL,1303.26,87,,,OTHER,1123.5,1468.04,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NCK W/WO (NEWW),70492,CPT,350,RC,,OUTPATIENT,,,1908,763.2,UC HEALTH,UC HEALTH COMMERCIAL,1659.96,87,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NCK W/WO (NEWW),70492QQ,CPT,350,RC,QQ,OUTPATIENT,,,2228.5,891.4,UC HEALTH,UC HEALTH COMMERCIAL,1938.795,87,,,OTHER,1671.38,2183.93,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/CONT,70491,CPT,350,RC,,OUTPATIENT,,,1684.25,673.7,UC HEALTH,UC HEALTH COMMERCIAL,1465.2975,87,,,OTHER,1263.19,1650.57,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/CONTRAST,70491QQ,CPT,350,RC,QQ,OUTPATIENT,,,1684.25,673.7,UC HEALTH,UC HEALTH COMMERCIAL,1465.2975,87,,,OTHER,1263.19,1650.57,PERCENT OF TOTAL BILLED CHARGES
IMAGE CATH FLUID COLXN VISC CT,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,UC HEALTH,UC HEALTH COMMERCIAL,2473.9668,87,,,OTHER,2132.7,2786.8,PERCENT OF TOTAL BILLED CHARGES
CT SOFT TISSUE NECK W/O (NEWO),70490,CPT,350,RC,,OUTPATIENT,,,1100.5,440.2,UC HEALTH,UC HEALTH COMMERCIAL,957.435,87,,,OTHER,825.38,1078.49,PERCENT OF TOTAL BILLED CHARGES
CT ANGIOGRAPH PELV W/O&W/DYE,72191,CPT,352,RC,,OUTPATIENT,,,879.74,351.896,UC HEALTH,UC HEALTH COMMERCIAL,765.3738,87,,,OTHER,659.8,862.1,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/WO LT,73202LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
UPPER EXTREMITY W/WO RT,73202RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/WO CONTRAST (PELB),72194,CPT,350,RC,,OUTPATIENT,,,2135.75,854.3,UC HEALTH,UC HEALTH COMMERCIAL,1858.1025,87,,,OTHER,1601.81,2093.04,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/WO CONTRAST,72194QQ,CPT,350,RC,QQ,OUTPATIENT,,,2135.75,854.3,UC HEALTH,UC HEALTH COMMERCIAL,1858.1025,87,,,OTHER,1601.81,2093.04,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/CONTRAST (PELW),72193,CPT,350,RC,,OUTPATIENT,,,1871,748.4,UC HEALTH,UC HEALTH COMMERCIAL,1627.77,87,,,OTHER,1403.25,1833.58,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/CONTRAST,72193QQ,CPT,350,RC,QQ,OUTPATIENT,,,1871,748.4,UC HEALTH,UC HEALTH COMMERCIAL,1627.77,87,,,OTHER,1403.25,1833.58,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS W/O CONTRAST,72192,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,UC HEALTH,UC HEALTH COMMERCIAL,1331.3175,87,,,OTHER,1147.69,1499.65,PERCENT OF TOTAL BILLED CHARGES
ABSCESSOGRAM,76080,CPT,350,RC,,OUTPATIENT,,,1530.25,612.1,UC HEALTH,UC HEALTH COMMERCIAL,1331.3175,87,,,OTHER,1147.69,1499.65,PERCENT OF TOTAL BILLED CHARGES
CT PELVIS/HIP FRACTURE,73700QQ,CPT,350,RC,QQ,OUTPATIENT,,,1587.75,635.1,UC HEALTH,UC HEALTH COMMERCIAL,1381.3425,87,,,OTHER,1190.81,1556,PERCENT OF TOTAL BILLED CHARGES
ASSESS CYST CONTRACT INJ,49424,CPT,350,RC,,OUTPATIENT,,,500,200,UC HEALTH,UC HEALTH COMMERCIAL,435,87,,,OTHER,375,490,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,UC HEALTH,UC HEALTH COMMERCIAL,1669.095,87,,,OTHER,1438.88,1880.13,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/CONTRAST (THWC),71260,CPT,350,RC,,OUTPATIENT,,,1918.5,767.4,UC HEALTH,UC HEALTH COMMERCIAL,1669.095,87,,,OTHER,1438.88,1880.13,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/O CONTRAST (THWO),71250,CPT,350,RC,,OUTPATIENT,,,1563.5,625.4,UC HEALTH,UC HEALTH COMMERCIAL,1360.245,87,,,OTHER,1172.63,1532.23,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2697,1078.8,UC HEALTH,UC HEALTH COMMERCIAL,2346.39,87,,,OTHER,2022.75,2643.06,PERCENT OF TOTAL BILLED CHARGES
CT CHEST W/WO CONTRAST (THWW),71270,CPT,350,RC,,OUTPATIENT,,,2458.75,983.5,UC HEALTH,UC HEALTH COMMERCIAL,2139.1125,87,,,OTHER,1844.06,2409.58,PERCENT OF TOTAL BILLED CHARGES
CT MPR/3D RECONSTRUCTION (MPRS,76377,CPT,350,RC,,OUTPATIENT,,,534,213.6,UC HEALTH,UC HEALTH COMMERCIAL,464.58,87,,,OTHER,400.5,523.32,PERCENT OF TOTAL BILLED CHARGES
CLAVICLE BILATERAL,7300050,CPT,320,RC,50,OUTPATIENT,,,520.75,208.3,UC HEALTH,UC HEALTH COMMERCIAL,453.0525,87,,,OTHER,390.56,510.34,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/CONT (TSWC,72129,CPT,350,RC,,OUTPATIENT,,,2478.5,991.4,UC HEALTH,UC HEALTH COMMERCIAL,2156.295,87,,,OTHER,1858.88,2428.93,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/CONTRAST,72129QQ,CPT,350,RC,QQ,OUTPATIENT,,,2478.5,991.4,UC HEALTH,UC HEALTH COMMERCIAL,2156.295,87,,,OTHER,1858.88,2428.93,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/O (TSWO),72128,CPT,350,RC,,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT THORACIC SPINE W/O CONTRAST,72128QQ,CPT,350,RC,QQ,OUTPATIENT,,,2123,849.2,UC HEALTH,UC HEALTH COMMERCIAL,1847.01,87,,,OTHER,1592.25,2080.54,PERCENT OF TOTAL BILLED CHARGES
CT CHEST SPINE W/O & W/DYE,72130,CPT,352,RC,,OUTPATIENT,,,2951.14,1180.456,UC HEALTH,UC HEALTH COMMERCIAL,2567.4918,87,,,OTHER,2213.4,2892.1,PERCENT OF TOTAL BILLED CHARGES
CT RENAL CYST/PELVIS ASPIRATE,50390,CPT,361,RC,,OUTPATIENT,,,3053,1221.2,UC HEALTH,UC HEALTH COMMERCIAL,2656.11,87,,,OTHER,2289.75,2991.94,PERCENT OF TOTAL BILLED CHARGES
CT MUSCLE NEEDLE BX (MSBX),77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT JOINT INJECTION 2 SITE,64494,CPT,350,RC,,OUTPATIENT,,,772.5,309,UC HEALTH,UC HEALTH COMMERCIAL,672.075,87,,,OTHER,579.38,757.05,PERCENT OF TOTAL BILLED CHARGES
CT THORACENTESIS (BNSP),32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UC HEALTH,UC HEALTH COMMERCIAL,1709.55,87,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
CT GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT THYROID BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT THYROID CORE BX,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,631.88,825.65,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O CONT RT,73200RT,CPT,350,RC,RT,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O RT,73200RTQQ,CPT,350,RC,RTQQ,OUTPATIENT,,,1934.25,773.7,UC HEALTH,UC HEALTH COMMERCIAL,1682.7975,87,,,OTHER,1450.69,1895.57,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY W/O LT,73200LT,CPT,350,RC,LT,OUTPATIENT,,,1374,549.6,UC HEALTH,UC HEALTH COMMERCIAL,1195.38,87,,,OTHER,1030.5,1346.52,PERCENT OF TOTAL BILLED CHARGES
CT UPPER EXTREMITY BIL,7320050,CPT,350,RC,50,OUTPATIENT,,,2400,960,UC HEALTH,UC HEALTH COMMERCIAL,2088,87,,,OTHER,1800,2352,PERCENT OF TOTAL BILLED CHARGES
CT COLONOSCOPY SCREENING,74263,CPT,350,RC,,OUTPATIENT,,,1719.75,687.9,UC HEALTH,UC HEALTH COMMERCIAL,1496.1825,87,,,OTHER,1289.81,1685.36,PERCENT OF TOTAL BILLED CHARGES
CT INJ 1 LEV PARAVRT F JNT L/S,6449350,CPT,350,RC,50,OUTPATIENT,,,2665,1066,UC HEALTH,UC HEALTH COMMERCIAL,2318.55,87,,,OTHER,1998.75,2611.7,PERCENT OF TOTAL BILLED CHARGES
CT INJ 2 LEV PARAVRT F JNT L/S,6449450,CPT,350,RC,50,OUTPATIENT,,,639,255.6,UC HEALTH,UC HEALTH COMMERCIAL,555.93,87,,,OTHER,479.25,626.22,PERCENT OF TOTAL BILLED CHARGES
CT INJ 3 LEV PARAVRT F JNT L/S,6449550,CPT,350,RC,50,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
GUIDED GASTROSTOMY TUBE PLC,49450,CPT,350,RC,,OUTPATIENT,,,2507.5,1003,UC HEALTH,UC HEALTH COMMERCIAL,2181.525,87,,,OTHER,1880.63,2457.35,PERCENT OF TOTAL BILLED CHARGES
CT GUIDED GASTROSTOMY TUBE PLC,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT MUSCLE NEEDLE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,UC HEALTH,UC HEALTH COMMERCIAL,1085.76,87,,,OTHER,936,1223.04,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 1 LEVEL,64493,CPT,350,RC,,OUTPATIENT,,,1777,710.8,UC HEALTH,UC HEALTH COMMERCIAL,1545.99,87,,,OTHER,1332.75,1741.46,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 2 LEVELS,64494,CPT,350,RC,,OUTPATIENT,,,426,170.4,UC HEALTH,UC HEALTH COMMERCIAL,370.62,87,,,OTHER,319.5,417.48,PERCENT OF TOTAL BILLED CHARGES
CT FACET INJ 3 LEVELS,64495,CPT,350,RC,,OUTPATIENT,,,399.75,159.9,UC HEALTH,UC HEALTH COMMERCIAL,347.7825,87,,,OTHER,299.81,391.76,PERCENT OF TOTAL BILLED CHARGES
INJ TENDON SHEATH LIGAMENT,20550,CPT,320,RC,,OUTPATIENT,,,631,252.4,UC HEALTH,UC HEALTH COMMERCIAL,548.97,87,,,OTHER,473.25,618.38,PERCENT OF TOTAL BILLED CHARGES
CT SCAN FOR NEEDLE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL INJECTION,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,894,1168.16,PERCENT OF TOTAL BILLED CHARGES
ABDOMEN/PELVIS ANGIO,74174,CPT,350,RC,,OUTPATIENT,,,2016,806.4,UC HEALTH,UC HEALTH COMMERCIAL,1753.92,87,,,OTHER,1512,1975.68,PERCENT OF TOTAL BILLED CHARGES
CT BONE BIOPSY,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT EXTREMITY ANGIO,75635QQ,CPT,350,RC,QQ,OUTPATIENT,,,3501.5,1400.6,UC HEALTH,UC HEALTH COMMERCIAL,3046.305,87,,,OTHER,2626.13,3431.47,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER ARTHROGRAM RIGHT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,UC HEALTH,UC HEALTH COMMERCIAL,1974.2475,87,,,OTHER,1701.9,2223.9,PERCENT OF TOTAL BILLED CHARGES
CT SHOULDER ARTHROGRAM LEFT,73201,CPT,350,RC,,OUTPATIENT,,,2269.25,907.7,UC HEALTH,UC HEALTH COMMERCIAL,1974.2475,87,,,OTHER,1701.9,2223.9,PERCENT OF TOTAL BILLED CHARGES
CT CAROTID ANGIO (CAAN),70498QQ,CPT,350,RC,QQ,OUTPATIENT,,,1908,763.2,UC HEALTH,UC HEALTH COMMERCIAL,1659.96,87,,,OTHER,1431,1869.84,PERCENT OF TOTAL BILLED CHARGES
"CT CHEST ANGIO(PE,AORTA)(CTAC)",71275,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UC HEALTH,UC HEALTH COMMERCIAL,1754.355,87,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT CHEST ANGIO,71275QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,UC HEALTH,UC HEALTH COMMERCIAL,1754.355,87,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT ABD ANGIO (CTAA),74175,CPT,350,RC,,OUTPATIENT,,,2016.5,806.6,UC HEALTH,UC HEALTH COMMERCIAL,1754.355,87,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT ABD ANGIO (CTAA),74175QQ,CPT,350,RC,QQ,OUTPATIENT,,,2016.5,806.6,UC HEALTH,UC HEALTH COMMERCIAL,1754.355,87,,,OTHER,1512.38,1976.17,PERCENT OF TOTAL BILLED CHARGES
CT PANCREAS CORE BX GUIDANCE,77012,CPT,350,RC,,OUTPATIENT,,,2373,949.2,UC HEALTH,UC HEALTH COMMERCIAL,2064.51,87,,,OTHER,1779.75,2325.54,PERCENT OF TOTAL BILLED CHARGES
CT GUIDED PARACENTESIS,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,1210.2,1581.4,PERCENT OF TOTAL BILLED CHARGES
LITHOTRIPSY (ESWL),3600010,CDM,,,,INPATIENT,,,17451.5,6980.6,UC HEALTH,UC HEALTH COMMERCIAL,15182.805,87,,,OTHER,13088.63,17102.47,PERCENT OF TOTAL BILLED CHARGES
LITHOTRIPSY (LASER),3600012,CDM,,,,INPATIENT,,,7544.75,3017.9,UC HEALTH,UC HEALTH COMMERCIAL,6563.9325,87,,,OTHER,5658.56,7393.86,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL1,3600102,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL2,3600202,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INJ FOR SACROILIAC JT ANESTH,G0260,HCPCS,350,RC,,INPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
IVC FILTER PLACEMENT,37191,CPT,361,RC,,OUTPATIENT,,,6206.5,2482.6,UC HEALTH,UC HEALTH COMMERCIAL,5399.655,87,,,OTHER,4654.88,6082.37,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL3,3600302,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
OR INPT LEVEL4,3600402,CDM,,,,INPATIENT,,,4778,1911.2,UC HEALTH,UC HEALTH COMMERCIAL,4156.86,87,,,OTHER,3583.5,4682.44,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 1 EA ADD'L 15 MIN,3600500,CDM,,,,INPATIENT,,,277.75,111.1,UC HEALTH,UC HEALTH COMMERCIAL,241.6425,87,,,OTHER,208.31,272.2,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 2 EA ADD'L 15 MIN,3600502,CDM,,,,INPATIENT,,,306.25,122.5,UC HEALTH,UC HEALTH COMMERCIAL,266.4375,87,,,OTHER,229.69,300.13,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 3 EA ADD'L 15 MIN,3600504,CDM,,,,INPATIENT,,,334.25,133.7,UC HEALTH,UC HEALTH COMMERCIAL,290.7975,87,,,OTHER,250.69,327.57,PERCENT OF TOTAL BILLED CHARGES
OR/IP LEVEL 4 EA ADD'L 15 MIN,3600506,CDM,,,,INPATIENT,,,365,146,UC HEALTH,UC HEALTH COMMERCIAL,317.55,87,,,OTHER,273.75,357.7,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION LEVEL 1,3600510,CDM,,,,INPATIENT,,,343.75,137.5,UC HEALTH,UC HEALTH COMMERCIAL,299.0625,87,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION LEVEL 2,3600512,CDM,,,,INPATIENT,,,514.25,205.7,UC HEALTH,UC HEALTH COMMERCIAL,447.3975,87,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
GI TUBE PLACEMENT,49452,CPT,320,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,987.56,1290.42,PERCENT OF TOTAL BILLED CHARGES
ADENOIDECTOMY               II,3601002,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ADENOIDECTOMY/MYRING        II,3601003,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE STUMP REVIS        II,3601004,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE TOES/FINGER       I,3601005,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
AMPUTATE STUMP DEBRIDE      II,3601006,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ART/SHAVE/LIG/REPAIR       III,3601009,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ARTHROSCOPY                III,3601011,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ARTHROSCOPY/SHAVING        III,3601013,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
BX ABD/RETROPERITONEAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,UC HEALTH,UC HEALTH COMMERCIAL,1316.31,87,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
BIOPSY OF PAROTID           II,3601016,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
BUNIONECTOMY UNI/SIM        II,3601017,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
BURSA OLECRANON REM II,3601018,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL RELEASE       II,3601025,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL DEQUERVAINS   II,3601026,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CATARACT EXTRACTION         II,3601027,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CERVICAL CONE W/ D&C         I,3601028,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION ADULT II,3601029,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION PED II,3601030,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT W/ CAST          I,3601031,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
CONTIGEN INJECTION         III,3601033,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/BLADDER BIOPSY       III,3601035,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/BLADDER EXTRAC        II,3601036,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYSTO/RETROGRADE PYE        II,3601037,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYSTO/URETER/LITHO         III,3601038,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
CYSTO/URETERAL EXTRA        II,3601039,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CYTOSCOPY                   II,3601040,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
D&C                          I,3601041,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT WOUND           II,3601042,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
DUPUYTRENS CONTRACT         II,3601043,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ECCE W/ IOL                 II,3601044,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPIC SINUS            II,3601045,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXC BREAST MASS UNIL         I,3601046,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXCISION LIPOMA             II,3601047,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXCISION MISC/MINOR          I,3601048,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXCISION TOENAIL             I,3601049,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
EXOSTOSIS EXCISION          II,3601050,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
EXP. JNT SOFT TISSUE        II,3601051,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
FRENULECTOMY                 I,3601054,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
GANGLIONECTOMY              II,3601055,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HAMMER TOES EX BILA II,3601056,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HAMMER TOES EX UNI II,3601057,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HARDWARE REMOVAL MAJOR      II,3601058,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HARDWARE REMOVAL MINOR       I,3601059,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
HEMORRHOIDECTOMY            II,3601060,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
HYDROCELECTOMY               I,3601061,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
INCIS HERNIA REPAIR         II,3601062,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INGUINAL HERNIA UNIL         I,3601063,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
INGUINAL HERNIA BIL         II,3601064,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INSERT/REMOVE HICKMAN CATH  II,3601065,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
LAPAROSCOPY                 II,3601066,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
LAP CHOLECYSTECTOMY  III,3601067,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
LIG/HAND/FOOT REPAIR        II,3601068,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MEATOTOMY                    I,3601069,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
MICROLARYNGOSCOPY           II,3601070,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MINI LAP TUBAL/PPTL         II,3601071,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 1,3601072,CDM,,,,INPATIENT,,,1400,560,UC HEALTH,UC HEALTH COMMERCIAL,1218,87,,,OTHER,1050,1372,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 2,3601073,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 3,3601074,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
MISC OP SURG LEVEL 4,3601075,CDM,,,,INPATIENT,,,4778,1911.2,UC HEALTH,UC HEALTH COMMERCIAL,4156.86,87,,,OTHER,3583.5,4682.44,PERCENT OF TOTAL BILLED CHARGES
MYRINGOTOMY W/WO TUBES       I,3601076,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
NODE BIOPSY                 II,3601077,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
MORTONS NEUROMA II,3601078,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F FINGERS/TOES        II,3601079,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F RADIUS/ULNA         II,3601080,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F ARM                 II,3601081,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
OPEN REDUCT NASAL FX        II,3601082,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ORCHIECTOMY                 II,3601083,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
ORCHIOPEXY                  II,3601084,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
O R I F ANKLE               II,3601085,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
PARS PLANA VITRECTOMY      III,3601087,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
PILONIDAL CYSTECTOMY        II,3601089,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
POLYPECTOMY NASAL           II,3601090,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
PTOSIS REPAIR               II,3601092,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SECONDARY LENS IMPLANT      II,3601094,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SEPTO W/TURBINECTOMY        II,3601095,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SEPTOPLASTY                 II,3601096,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SILASTIC IMPT HD & FT       II,3601097,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL SIMPLE         I,3601098,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
TENDON REPAIR SIMPLE I,3601099,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
SKIN GRAFTING MINOR         II,3602002,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
SPERMATOCELECTOMY           II,3602003,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
STRABISMUS                  II,3602004,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
T & A TUBES                 II,3602007,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TND/TRAN FINER/O R I F      II,3602008,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TONSIL/ADENOIDECTOMY        II,3602009,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TONSILLECTOMY               II,3602010,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRABECULECTOMY              II,3602011,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRIGGER FINGER RELEASE      II,3602012,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TRIPPLE ENDOSCOPY           II,3602013,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TURP                        II,3602014,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
TYMPANOPLASTY              III,3602015,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
ULNAR NERVE TRANSFER        II,3602016,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL HERNIA             I,3602017,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
URETHRAL DILATATION          I,3602018,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
VARICOSE VEIN STRIP         II,3602019,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
VASOVASOSTOMY               II,3602020,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
Z-PLASTY HD OR FT            I,3602021,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
OP SURGERY 15 MIN,3602022,CDM,,,,INPATIENT,,,271,108.4,UC HEALTH,UC HEALTH COMMERCIAL,235.77,87,,,OTHER,203.25,265.58,PERCENT OF TOTAL BILLED CHARGES
APPENDECTOMY                II,3602023,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
CARPAL TUNNEL ENDOSCOPIC   III,3602024,CDM,,,,INPATIENT,,,3588,1435.2,UC HEALTH,UC HEALTH COMMERCIAL,3121.56,87,,,OTHER,2691,3516.24,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSCOPY                II,3602025,CDM,,,,INPATIENT,,,2689.25,1075.7,UC HEALTH,UC HEALTH COMMERCIAL,2339.6475,87,,,OTHER,2016.94,2635.47,PERCENT OF TOTAL BILLED CHARGES
INSERT/REMOVE GROSHONG CATH  I,3602026,CDM,,,,INPATIENT,,,1402.25,560.9,UC HEALTH,UC HEALTH COMMERCIAL,1219.9575,87,,,OTHER,1051.69,1374.21,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE INJ FOR NM,3602030,CDM,361,RC,,INPATIENT,,,1369.75,547.9,UC HEALTH,UC HEALTH COMMERCIAL,1191.6825,87,,,OTHER,1027.31,1342.36,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE (SPINAL TAP),3602032,CDM,,,,INPATIENT,,,303.25,121.3,UC HEALTH,UC HEALTH COMMERCIAL,263.8275,87,,,OTHER,227.44,297.19,PERCENT OF TOTAL BILLED CHARGES
TURP GREEN LIGHT,52648,CPT,360,RC,,INPATIENT,,,11506.75,4602.7,UC HEALTH,UC HEALTH COMMERCIAL,10010.8725,87,,,OTHER,8630.06,11276.62,PERCENT OF TOTAL BILLED CHARGES
TURP W/LASER,52648,CPT,360,RC,,INPATIENT,,,8082.75,3233.1,UC HEALTH,UC HEALTH COMMERCIAL,7031.9925,87,,,OTHER,6062.06,7921.1,PERCENT OF TOTAL BILLED CHARGES
PX SMALL INTESTINE,44799,CPT,360,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,977.06,1276.7,PERCENT OF TOTAL BILLED CHARGES
GASTRO TUBE REPLACEMENT,49450,CPT,350,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,570,744.8,PERCENT OF TOTAL BILLED CHARGES
ERCP,43260,CPT,361,RC,,INPATIENT,,,6622,2648.8,UC HEALTH,UC HEALTH COMMERCIAL,5761.14,87,,,OTHER,4966.5,6489.56,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,INPATIENT,,,2927.25,1170.9,UC HEALTH,UC HEALTH COMMERCIAL,2546.7075,87,,,OTHER,2195.44,2868.71,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS W/PLASMA SEQUEST,3605010,CDM,,,,INPATIENT,,,3543.25,1417.3,UC HEALTH,UC HEALTH COMMERCIAL,3082.6275,87,,,OTHER,2657.44,3472.39,PERCENT OF TOTAL BILLED CHARGES
HYSTEROSALPINGOGRAM,58340,CPT,320,RC,,OUTPATIENT,,,519.75,207.9,UC HEALTH,UC HEALTH COMMERCIAL,452.1825,87,,,OTHER,389.81,509.36,PERCENT OF TOTAL BILLED CHARGES
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,OUTPATIENT,,,543,217.2,UC HEALTH,UC HEALTH COMMERCIAL,472.41,87,,,OTHER,407.25,532.14,PERCENT OF TOTAL BILLED CHARGES
FNA ADDITIONAL LESION,10006,CPT,402,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 1,64493,CPT,350,RC,,OUTPATIENT,,,1763.58,705.432,UC HEALTH,UC HEALTH COMMERCIAL,1534.3146,87,,,OTHER,1322.7,1728.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 2,64494,CPT,350,RC,,OUTPATIENT,,,2730.94,1092.376,UC HEALTH,UC HEALTH COMMERCIAL,2375.9178,87,,,OTHER,2048.2,2676.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S LEV 3,64495,CPT,350,RC,,OUTPATIENT,,,2490,996,UC HEALTH,UC HEALTH COMMERCIAL,2166.3,87,,,OTHER,1867.5,2440.2,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION (PACU),92960,CPT,450,RC,,INPATIENT,,,1481.5,592.6,UC HEALTH,UC HEALTH COMMERCIAL,1288.905,87,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
TTL COLONSCOPY BIOPSY/SNARE,3610050,CDM,,,,INPATIENT,,,2691.25,1076.5,UC HEALTH,UC HEALTH COMMERCIAL,2341.3875,87,,,OTHER,2018.44,2637.43,PERCENT OF TOTAL BILLED CHARGES
COLONOSCOPY TOTAL,3610070,CDM,,,,INPATIENT,,,1992.75,797.1,UC HEALTH,UC HEALTH COMMERCIAL,1733.6925,87,,,OTHER,1494.56,1952.9,PERCENT OF TOTAL BILLED CHARGES
SIGMOIDOSCOPY LOW LEVEL,3610074,CDM,,,,INPATIENT,,,1000,400,UC HEALTH,UC HEALTH COMMERCIAL,870,87,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
BIOPSY W/PROCEDURE,3610076,CDM,,,,INPATIENT,,,698.5,279.4,UC HEALTH,UC HEALTH COMMERCIAL,607.695,87,,,OTHER,523.88,684.53,PERCENT OF TOTAL BILLED CHARGES
EGD,3610080,CDM,,,,INPATIENT,,,2537,1014.8,UC HEALTH,UC HEALTH COMMERCIAL,2207.19,87,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
EGD WITH COLONOSCOPY,3610090,CDM,,,,INPATIENT,,,656.25,262.5,UC HEALTH,UC HEALTH COMMERCIAL,570.9375,87,,,OTHER,492.19,643.13,PERCENT OF TOTAL BILLED CHARGES
EGD WITH PEG INCISION,3610100,CDM,,,,INPATIENT,,,2537,1014.8,UC HEALTH,UC HEALTH COMMERCIAL,2207.19,87,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
EGD W/BIOPSY,3610110,CDM,,,,INPATIENT,,,2630.25,1052.1,UC HEALTH,UC HEALTH COMMERCIAL,2288.3175,87,,,OTHER,1972.69,2577.65,PERCENT OF TOTAL BILLED CHARGES
EGD W/FOREIGN BODY REMOVAL,3610112,CDM,361,RC,,INPATIENT,,,2537,1014.8,UC HEALTH,UC HEALTH COMMERCIAL,2207.19,87,,,OTHER,1902.75,2486.26,PERCENT OF TOTAL BILLED CHARGES
FLUSHING IMPLANTABLE PORT,96523,CPT,260,RC,,OUTPATIENT,,,282.25,112.9,UC HEALTH,UC HEALTH COMMERCIAL,245.5575,87,,,OTHER,211.69,276.61,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD PICC LINE LVL I,36592,CPT,761,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,132.94,173.71,PERCENT OF TOTAL BILLED CHARGES
DECLOTTING AGENT OF IMPLT,36593,CPT,761,RC,,OUTPATIENT,,,804,321.6,UC HEALTH,UC HEALTH COMMERCIAL,699.48,87,,,OTHER,603,787.92,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD PICC LINE LVL II,36592,CPT,761,RC,,OUTPATIENT,,,232,92.8,UC HEALTH,UC HEALTH COMMERCIAL,201.84,87,,,OTHER,174,227.36,PERCENT OF TOTAL BILLED CHARGES
BLOOD DRAW FROM IMPLNT PORT,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,UC HEALTH,UC HEALTH COMMERCIAL,250.125,87,,,OTHER,215.63,281.75,PERCENT OF TOTAL BILLED CHARGES
HEMORRDOID BANDING,3610140,CDM,,,,INPATIENT,,,722.25,288.9,UC HEALTH,UC HEALTH COMMERCIAL,628.3575,87,,,OTHER,541.69,707.81,PERCENT OF TOTAL BILLED CHARGES
PARACENTESIS,49080,CPT,361,RC,,OUTPATIENT,,,582.5,233,UC HEALTH,UC HEALTH COMMERCIAL,506.775,87,,,OTHER,436.88,570.85,PERCENT OF TOTAL BILLED CHARGES
SIGMOIDOSCOPY,3610170,CDM,361,RC,,INPATIENT,,,1891,756.4,UC HEALTH,UC HEALTH COMMERCIAL,1645.17,87,,,OTHER,1418.25,1853.18,PERCENT OF TOTAL BILLED CHARGES
ANOSCOPY DIAGNOSTIC,3610225,CDM,,,,INPATIENT,,,206.5,82.6,UC HEALTH,UC HEALTH COMMERCIAL,179.655,87,,,OTHER,154.88,202.37,PERCENT OF TOTAL BILLED CHARGES
INJ TRIGGER POINT 1/2 MUSCL,20552,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UC HEALTH,UC HEALTH COMMERCIAL,452.8872,87,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
INJECT TRIGGER POINTS 3/>,20553,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UC HEALTH,UC HEALTH COMMERCIAL,452.8872,87,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20600,CPT,320,RC,,OUTPATIENT,,,528.02,211.208,UC HEALTH,UC HEALTH COMMERCIAL,459.3774,87,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN/INJ JOINT/BURSA W/O US,20610,CPT,320,RC,,OUTPATIENT,,,520.56,208.224,UC HEALTH,UC HEALTH COMMERCIAL,452.8872,87,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
DRN/INJ JNT/BURSA W/O US BILA,20610,CPT,320,RC,,OUTPATIENT,,,1041.12,416.448,UC HEALTH,UC HEALTH COMMERCIAL,905.7744,87,,,OTHER,780.8,1020.3,PERCENT OF TOTAL BILLED CHARGES
DRAIN SPINAL CORD CYST,62268,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,UC HEALTH,UC HEALTH COMMERCIAL,1447.419,87,,,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62323,CPT,350,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,320,RC,,OUTPATIENT,,,1283.34,513.336,UC HEALTH,UC HEALTH COMMERCIAL,1116.5058,87,,,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD GR OCPL NRV,64405,CPT,361,RC,,OUTPATIENT,,,520.56,208.224,UC HEALTH,UC HEALTH COMMERCIAL,452.8872,87,,,OTHER,390.4,510.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD BRACH PLEXUS,64415,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,UC HEALTH,UC HEALTH COMMERCIAL,1426.191,87,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD AXILLARY NRV,64417,CPT,361,RC,,OUTPATIENT,,,1639.3,655.72,UC HEALTH,UC HEALTH COMMERCIAL,1426.191,87,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,OUTPATIENT,,,1283.34,513.336,UC HEALTH,UC HEALTH COMMERCIAL,1116.5058,87,,,OTHER,962.5,1257.7,PERCENT OF TOTAL BILLED CHARGES
PVB THORACIC SINGLE INJ SITE,64461,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 LT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T LT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,UC HEALTH,UC HEALTH COMMERCIAL,2304.63,87,,,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S 1,64483,CPT,361,RC,,OUTPATIENT,,,1693.3,677.32,UC HEALTH,UC HEALTH COMMERCIAL,1473.171,87,,,OTHER,1270,1659.4,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S EA,64484,CPT,361,RC,,OUTPATIENT,,,1270.87,508.348,UC HEALTH,UC HEALTH COMMERCIAL,1105.6569,87,,,OTHER,953.2,1245.5,PERCENT OF TOTAL BILLED CHARGES
TAP BLOCK BI INJECTION,64488,CPT,361,RC,,OUTPATIENT,,,7130,2852,UC HEALTH,UC HEALTH COMMERCIAL,6203.1,87,,,OTHER,5347.5,6987.4,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV L,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,UC HEALTH,UC HEALTH COMMERCIAL,1426.191,87,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.34,942.136,UC HEALTH,UC HEALTH COMMERCIAL,2049.1458,87,,,OTHER,1766.5,2308.2,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 3 LEV,64492,CPT,350,RC,,OUTPATIENT,,,2287.66,915.064,UC HEALTH,UC HEALTH COMMERCIAL,1990.2642,87,,,OTHER,1715.7,2241.9,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 1 LEV,64493,CPT,350,RC,,OUTPATIENT,,,1698.3,679.32,UC HEALTH,UC HEALTH COMMERCIAL,1477.521,87,,,OTHER,1273.7,1664.3,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 2 LEV,64494,CPT,350,RC,,OUTPATIENT,,,826,330.4,UC HEALTH,UC HEALTH COMMERCIAL,718.62,87,,,OTHER,619.5,809.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 3 LEV,64495,CPT,350,RC,,OUTPATIENT,,,1186,474.4,UC HEALTH,UC HEALTH COMMERCIAL,1031.82,87,,,OTHER,889.5,1162.3,PERCENT OF TOTAL BILLED CHARGES
CHEMODENERV MUSC MIGRAINE,64615,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UC HEALTH,UC HEALTH COMMERCIAL,459.3774,87,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,OUTPATIENT,,,3548.74,1419.496,UC HEALTH,UC HEALTH COMMERCIAL,3087.4038,87,,,OTHER,2661.6,3477.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY C/T FACET JNT,64633,CPT,361,RC,,OUTPATIENT,,,3469.78,1387.912,UC HEALTH,UC HEALTH COMMERCIAL,3018.7086,87,,,OTHER,2602.3,3400.4,PERCENT OF TOTAL BILLED CHARGES
DESTROY C/T FACET JNT ADDL,64634,CPT,361,RC,,OUTPATIENT,,,3512,1404.8,UC HEALTH,UC HEALTH COMMERCIAL,3055.44,87,,,OTHER,2634,3441.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,OUTPATIENT,,,3496.78,1398.712,UC HEALTH,UC HEALTH COMMERCIAL,3042.1986,87,,,OTHER,2622.6,3426.8,PERCENT OF TOTAL BILLED CHARGES
DESTROY L/S FACET JNT ADDL,64636,CPT,361,RC,,OUTPATIENT,,,4010,1604,UC HEALTH,UC HEALTH COMMERCIAL,3488.7,87,,,OTHER,3007.5,3929.8,PERCENT OF TOTAL BILLED CHARGES
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,OUTPATIENT,,,1663.7,665.48,UC HEALTH,UC HEALTH COMMERCIAL,1447.419,87,,,OTHER,1247.8,1630.4,PERCENT OF TOTAL BILLED CHARGES
NERVOUS SYSTEM SURGERY UNLISTE,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UC HEALTH,UC HEALTH COMMERCIAL,459.3774,87,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 RT,64479,CPT,,,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T RT,64480,CPT,,,,OUTPATIENT,,,2649,1059.6,UC HEALTH,UC HEALTH COMMERCIAL,2304.63,87,,,OTHER,1986.8,2596,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV R,64490,CPT,350,RC,,OUTPATIENT,,,1639.3,655.72,UC HEALTH,UC HEALTH COMMERCIAL,1426.191,87,,,OTHER,1229.5,1606.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV L,64491,CPT,350,RC,,OUTPATIENT,,,2355.54,942.216,UC HEALTH,UC HEALTH COMMERCIAL,2049.3198,87,,,OTHER,1766.7,2308.4,PERCENT OF TOTAL BILLED CHARGES
THER/PROPH/DIAG IV INF INIT,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,UC HEALTH,UC HEALTH COMMERCIAL,413.9025,87,,,OTHER,356.8,466.2,PERCENT OF TOTAL BILLED CHARGES
THER/PROPH/DIAG IV INF ADDON,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.7,96.3,PERCENT OF TOTAL BILLED CHARGES
INJ FOR SACROILIAC JT ANESTH B,G0260,HCPCS,350,RC,,INPATIENT,,,2529.68,1011.872,UC HEALTH,UC HEALTH COMMERCIAL,2200.8216,87,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA LOCAL ADDT'L 15,3700600,CDM,,,,INPATIENT,,,49.75,19.9,UC HEALTH,UC HEALTH COMMERCIAL,43.2825,87,,,OTHER,37.31,48.76,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA LOCAL,3700602,CDM,,,,INPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA REGIONAL ADDT'L 15,3700700,CDM,,,,INPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA REGIONAL SUPPLIES,3700703,CDM,,,,INPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA GENERAL ADDT'L 15,3700800,CDM,,,,INPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
ANESTHESIA GENERAL,3700803,CDM,,,,INPATIENT,,,941.5,376.6,UC HEALTH,UC HEALTH COMMERCIAL,819.105,87,,,OTHER,706.13,922.67,PERCENT OF TOTAL BILLED CHARGES
EPIDURAL INJECTION ANESTHESIA,3701112,CDM,,,,INPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD NRV NRVTG SI JT B,64451,CPT,361,RC,,OUTPATIENT,,,2529.68,1011.872,UC HEALTH,UC HEALTH COMMERCIAL,2200.8216,87,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T 1 BI,64479,CPT,,,,OUTPATIENT,,,2529.68,1011.872,UC HEALTH,UC HEALTH COMMERCIAL,2200.8216,87,,,OTHER,1897.3,2479.1,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI C/T BIL,64480,CPT,,,,OUTPATIENT,,,5298,2119.2,UC HEALTH,UC HEALTH COMMERCIAL,4609.26,87,,,OTHER,3973.5,5192,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD TFRM EPI L/S 1 BI,64483,CPT,361,RC,,OUTPATIENT,,,3278.6,1311.44,UC HEALTH,UC HEALTH COMMERCIAL,2852.382,87,,,OTHER,2459,3213,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 1 LEV B,64490,CPT,350,RC,,OUTPATIENT,,,2458.95,983.58,UC HEALTH,UC HEALTH COMMERCIAL,2139.2865,87,,,OTHER,1844.2,2409.8,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT C/T 2 LEV B,64491,CPT,350,RC,,OUTPATIENT,,,4710.68,1884.272,UC HEALTH,UC HEALTH COMMERCIAL,4098.2916,87,,,OTHER,3533,4616.5,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 1 LEV B,64493,CPT,350,RC,,OUTPATIENT,,,3396.6,1358.64,UC HEALTH,UC HEALTH COMMERCIAL,2955.042,87,,,OTHER,2547.5,3328.7,PERCENT OF TOTAL BILLED CHARGES
INJ PARAVERT F JNT L/S 2 LEV B,64494,CPT,350,RC,,OUTPATIENT,,,1652,660.8,UC HEALTH,UC HEALTH COMMERCIAL,1437.24,87,,,OTHER,1239,1619,PERCENT OF TOTAL BILLED CHARGES
INJECTION TRTMNT OF NERVE BILA,64640,CPT,361,RC,,OUTPATIENT,,,3327.4,1330.96,UC HEALTH,UC HEALTH COMMERCIAL,2894.838,87,,,OTHER,2495.6,3260.9,PERCENT OF TOTAL BILLED CHARGES
RHO(D) IMMUNE GLOBULIN RHIGIV,90386,CPT,636,RC,,OUTPATIENT,,,386,154.4,UC HEALTH,UC HEALTH COMMERCIAL,335.82,87,,,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
RHO(D) IMMUNE GLOBULIN (RHIG),90384,CPT,636,RC,,OUTPATIENT,,,386,154.4,UC HEALTH,UC HEALTH COMMERCIAL,335.82,87,,,OTHER,289.5,378.28,PERCENT OF TOTAL BILLED CHARGES
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,INPATIENT,,,402.25,160.9,UC HEALTH,UC HEALTH COMMERCIAL,349.9575,87,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANS BLD OR COMP,36430,CPT,391,RC,,OUTPATIENT,,,1003.75,401.5,UC HEALTH,UC HEALTH COMMERCIAL,873.2625,87,,,OTHER,752.81,983.68,PERCENT OF TOTAL BILLED CHARGES
PLATELET PHERESIS LEU IRR,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,UC HEALTH,UC HEALTH COMMERCIAL,1498.7925,87,,,OTHER,1292.06,1688.3,PERCENT OF TOTAL BILLED CHARGES
PLATELET EACH - LR,P9032,HCPCS,390,RC,,INPATIENT,,,394.75,157.9,UC HEALTH,UC HEALTH COMMERCIAL,343.4325,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
ABO (BLOOD TYPING),86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
ABO BLOOD TYPING,86900,CPT,300,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY SCREENING (RBC),86850,CPT,300,RC,,OUTPATIENT,,,99.18,39.672,UC HEALTH,UC HEALTH COMMERCIAL,86.2866,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN TYPING (UNIT),86902,CPT,300,RC,,OUTPATIENT,,,295,118,UC HEALTH,UC HEALTH COMMERCIAL,256.65,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN TYPING (PATIENT),86905,CPT,300,RC,,OUTPATIENT,,,295,118,UC HEALTH,UC HEALTH COMMERCIAL,256.65,87,,,OTHER,20.44,26.71,PERCENT OF TOTAL BILLED CHARGES
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,32,12.8,UC HEALTH,UC HEALTH COMMERCIAL,27.84,87,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
RH TYPING,86901,CPT,300,RC,,OUTPATIENT,,,94.25,37.7,UC HEALTH,UC HEALTH COMMERCIAL,81.9975,87,,,OTHER,70.69,92.37,PERCENT OF TOTAL BILLED CHARGES
FETAL SCREEN,85461,CPT,300,RC,,OUTPATIENT,,,45.25,18.1,UC HEALTH,UC HEALTH COMMERCIAL,39.3675,87,,,OTHER,33.94,44.35,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY IDENTIFICATION,86870,CPT,300,RC,,OUTPATIENT,,,580.53,232.212,UC HEALTH,UC HEALTH COMMERCIAL,505.0611,87,,,OTHER,269.81,352.56,PERCENT OF TOTAL BILLED CHARGES
ANTIBODY TITER,86886,CPT,390,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
Z PROGEST RECEPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
Z ESTROGEN RECPTOR HER-2/NEU,88360,CPT,310,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,194.06,253.58,PERCENT OF TOTAL BILLED CHARGES
CLOSURE PUNCTURE DEVICE,3900883,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
PRBC LR EA UNIT,P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,UC HEALTH,UC HEALTH COMMERCIAL,474.3675,87,,,OTHER,408.94,534.35,PERCENT OF TOTAL BILLED CHARGES
PLATELET APHERESIS LR/UNIT,P9035,HCPCS,390,RC,,INPATIENT,,,1722.75,689.1,UC HEALTH,UC HEALTH COMMERCIAL,1498.7925,87,,,OTHER,1292.06,1688.3,PERCENT OF TOTAL BILLED CHARGES
PLT  EA UNIT,P9019,HCPCS,390,RC,,INPATIENT,,,272,108.8,UC HEALTH,UC HEALTH COMMERCIAL,236.64,87,,,OTHER,204,266.56,PERCENT OF TOTAL BILLED CHARGES
CROSSMATCH LEUKO REDUCED,86920,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
"BLOOD LEUKO REDUCED,IRRADIATED",P9040,HCPCS,390,RC,,INPATIENT,,,929.25,371.7,UC HEALTH,UC HEALTH COMMERCIAL,808.4475,87,,,OTHER,696.94,910.67,PERCENT OF TOTAL BILLED CHARGES
IRRADIATION OF BLOOD PROD (EA),86945,CPT,300,RC,,OUTPATIENT,,,366.5,146.6,UC HEALTH,UC HEALTH COMMERCIAL,318.855,87,,,OTHER,274.88,359.17,PERCENT OF TOTAL BILLED CHARGES
PLTPH LR    IRR     APHERESIS,P9037,HCPCS,390,RC,,INPATIENT,,,1875.5,750.2,UC HEALTH,UC HEALTH COMMERCIAL,1631.685,87,,,OTHER,1406.63,1837.99,PERCENT OF TOTAL BILLED CHARGES
SPLITTING OF BLD OR BLD PRODTS,86985,CPT,300,RC,,OUTPATIENT,,,297.3,118.92,UC HEALTH,UC HEALTH COMMERCIAL,258.651,87,,,OTHER,89.63,117.11,PERCENT OF TOTAL BILLED CHARGES
ANTIGEN SCREENING,86906,CPT,300,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
"PRBC TRANSFUSED,LEUKO REDUCED",P9016,HCPCS,390,RC,,INPATIENT,,,545.25,218.1,UC HEALTH,UC HEALTH COMMERCIAL,474.3675,87,,,OTHER,408.94,534.35,PERCENT OF TOTAL BILLED CHARGES
PLASMA  FRESH FROZEN SD,P9017,HCPCS,390,RC,,INPATIENT,,,225.5,90.2,UC HEALTH,UC HEALTH COMMERCIAL,196.185,87,,,OTHER,169.13,220.99,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS BLOOD OP SALVAGE,86891,CPT,300,RC,,OUTPATIENT,,,1307.81,523.124,UC HEALTH,UC HEALTH COMMERCIAL,1137.7947,87,,,OTHER,97.88,127.89,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (0-1HRS),36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UC HEALTH,UC HEALTH COMMERCIAL,913.2825,87,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (1-2HRS),36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UC HEALTH,UC HEALTH COMMERCIAL,1000.2825,87,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (2-4HRS),36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UC HEALTH,UC HEALTH COMMERCIAL,1087.2825,87,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
BLOOD ADM ONC (4-8HRS),36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UC HEALTH,UC HEALTH COMMERCIAL,1261.2825,87,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM SGL LT,77053LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,UC HEALTH,UC HEALTH COMMERCIAL,655.3275,87,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM MULT LT,77054LT,CPT,401,RC,LT,OUTPATIENT,,,753.25,301.3,UC HEALTH,UC HEALTH COMMERCIAL,655.3275,87,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 3RD RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 4TH RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
STEREO CORE BX RT,19081RT,CPT,401,RC,RT,OUTPATIENT,,,2904.5,1161.8,UC HEALTH,UC HEALTH COMMERCIAL,2526.915,87,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT,77031RT,CPT,320,RC,RT,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC CORE BX GUIDANCE,77031,CPT,320,RC,,OUTPATIENT,,,1744.75,697.9,UC HEALTH,UC HEALTH COMMERCIAL,1517.9325,87,,,OTHER,1308.56,1709.86,PERCENT OF TOTAL BILLED CHARGES
STERO 3RD LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
STERO 2ND LESION LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY LT,19103LT,CPT,361,RC,LT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
VAC ASSIST,19103,CPT,361,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
MAMMOTOME BIOPSY 2ND LESION RT,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT,19290RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,UC HEALTH,UC HEALTH COMMERCIAL,1093.59,87,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
STEREO 2ND LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT 2ND,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREO 3RD LESION RT,19082RT,CPT,401,RC,RT,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC RT 3RD,77031RT59,CPT,320,RC,RT59,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC LT,19290LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,UC HEALTH,UC HEALTH COMMERCIAL,1093.59,87,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
STEREO 2ND LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC (LT) 2ND,77031LT59,CPT,320,RC,LT59,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
STEREO 3RD LESION LT,19082LT,CPT,402,RC,LT,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC (LT) 3RD,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
MAMM SPECIMEN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,UC HEALTH,UC HEALTH COMMERCIAL,837.3576,87,,,OTHER,466.31,609.32,PERCENT OF TOTAL BILLED CHARGES
MAMMOGRAPHY GUIDANCE,77032,CPT,320,RC,,OUTPATIENT,,,419,167.6,UC HEALTH,UC HEALTH COMMERCIAL,364.53,87,,,OTHER,314.25,410.62,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,1257,502.8,UC HEALTH,UC HEALTH COMMERCIAL,1093.59,87,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 2ND LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 4TH LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STRTCTC,19081,CPT,401,RC,,OUTPATIENT,,,2904.5,1161.8,UC HEALTH,UC HEALTH COMMERCIAL,2526.915,87,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STRTCTC,19082,CPT,401,RC,,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
US MAM UNILATERAL LT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
US MAM UNILATERAL RT SCREENING,77055,CPT,320,RC,,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM BILATERAL DIAG,77066,CPT,401,RC,,OUTPATIENT,,,244.58,97.832,UC HEALTH,UC HEALTH COMMERCIAL,212.7846,87,,,OTHER,176.63,230.79,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI SCREEN CAD,7706752,CPT,,,52,OUTPATIENT,,,20.75,8.3,UC HEALTH,UC HEALTH COMMERCIAL,18.0525,87,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM BILAT SCREENING,77067,CPT,403,RC,,OUTPATIENT,,,217.5,87,UC HEALTH,UC HEALTH COMMERCIAL,189.225,87,,,OTHER,163.13,213.15,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM SCREENING CAD,77067,CPT,403,RC,,OUTPATIENT,,,20.75,8.3,UC HEALTH,UC HEALTH COMMERCIAL,18.0525,87,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM UNILAT RT DIAG,77065RT,CPT,401,RC,RT,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAMM UNILAT LT DIAG,77065LT,CPT,401,RC,LT,OUTPATIENT,,,193,77.2,UC HEALTH,UC HEALTH COMMERCIAL,167.91,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI RT SCREEN,77067RT52,CPT,403,RC,RT52,OUTPATIENT,,,202.2,80.88,UC HEALTH,UC HEALTH COMMERCIAL,175.914,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM UNI LT SCREEN,77067LT52,CPT,403,RC,LT52,OUTPATIENT,,,202.2,80.88,UC HEALTH,UC HEALTH COMMERCIAL,175.914,87,,,OTHER,144.75,189.14,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2846.75,1138.7,UC HEALTH,UC HEALTH COMMERCIAL,2476.6725,87,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2846.75,1138.7,UC HEALTH,UC HEALTH COMMERCIAL,2476.6725,87,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO RT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UC HEALTH,UC HEALTH COMMERCIAL,2456.6625,87,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO LT,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UC HEALTH,UC HEALTH COMMERCIAL,2456.6625,87,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO RT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UC HEALTH,UC HEALTH COMMERCIAL,1791.33,87,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO LT,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UC HEALTH,UC HEALTH COMMERCIAL,1791.33,87,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
INJECTION FOR BREAST XRAY,19030,CPT,401,RC,,OUTPATIENT,,,396.25,158.5,UC HEALTH,UC HEALTH COMMERCIAL,344.7375,87,,,OTHER,297.19,388.33,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE RT,19282RT,CPT,320,RC,RT,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE LT,19282LT,CPT,361,RC,LT,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO BI,1908350,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO BI,1908450,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST 1ST BI,1928150,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEVICE BREAST EA IMAGE,1928250,CPT,401,RC,50,OUTPATIENT,,,2350.25,940.1,UC HEALTH,UC HEALTH COMMERCIAL,2044.7175,87,,,OTHER,1762.69,2303.25,PERCENT OF TOTAL BILLED CHARGES
PERQ DEV BREAST 1ST BI,1928350,CPT,401,RC,50,OUTPATIENT,,,2846.75,1138.7,UC HEALTH,UC HEALTH COMMERCIAL,2476.6725,87,,,OTHER,2135.06,2789.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION STEREO BI,1908150,CPT,401,RC,50,OUTPATIENT,,,5808.75,2323.5,UC HEALTH,UC HEALTH COMMERCIAL,5053.6125,87,,,OTHER,4356.56,5692.58,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION STEREO BI,1908250,CPT,401,RC,50,OUTPATIENT,,,2569,1027.6,UC HEALTH,UC HEALTH COMMERCIAL,2235.03,87,,,OTHER,1926.75,2517.62,PERCENT OF TOTAL BILLED CHARGES
DIAG DIGI BREAST TOMO UNI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
DIGITAL MAM SCREENING CAD,77065,CPT,,,,OUTPATIENT,,,20.75,8.3,UC HEALTH,UC HEALTH COMMERCIAL,18.0525,87,,,OTHER,15.56,20.34,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMOSYNTHESIS BI,G0279,HCPCS,401,RC,,BOTH,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 1ST RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1257,502.8,UC HEALTH,UC HEALTH COMMERCIAL,1093.59,87,,,OTHER,942.75,1231.86,PERCENT OF TOTAL BILLED CHARGES
NEEDLE PLACEMENT 2ND RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM SGL RT,77053RT,CPT,320,RC,RT,OUTPATIENT,,,753.25,301.3,UC HEALTH,UC HEALTH COMMERCIAL,655.3275,87,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
MAMM DUCTOGRAM MULT RT,77054RT,CPT,401,RC,RT,OUTPATIENT,,,753.25,301.3,UC HEALTH,UC HEALTH COMMERCIAL,655.3275,87,,,OTHER,564.94,738.19,PERCENT OF TOTAL BILLED CHARGES
STEREO CORE BX LT,19081LT,CPT,401,RC,LT,OUTPATIENT,,,2904.5,1161.8,UC HEALTH,UC HEALTH COMMERCIAL,2526.915,87,,,OTHER,2178.38,2846.41,PERCENT OF TOTAL BILLED CHARGES
STEREOTACTIC NDLE LOC LT,77031LT,CPT,320,RC,LT,OUTPATIENT,,,1733.75,693.5,UC HEALTH,UC HEALTH COMMERCIAL,1508.3625,87,,,OTHER,1300.31,1699.08,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BILATERAL 1EA,4020004,CDM,,,,INPATIENT,,,4117.5,1647,UC HEALTH,UC HEALTH COMMERCIAL,3582.225,87,,,OTHER,3088.13,4035.15,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 1ST LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 2ND LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDED 2ND NEEDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 1ST LESION,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT LT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UC HEALTH,UC HEALTH COMMERCIAL,1399.395,87,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT BI,7694250,CPT,402,RC,50,OUTPATIENT,,,1608.5,643.4,UC HEALTH,UC HEALTH COMMERCIAL,1399.395,87,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 2 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST LT 3 SEP LSNS,19102LT,CPT,361,RC,LT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY LIVER,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,UC HEALTH,UC HEALTH COMMERCIAL,1534.68,87,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 2ND PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US THYROID FNA,10005,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UC HEALTH,UC HEALTH COMMERCIAL,1607.5425,87,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
US OB AFI/PLACENTA/HR/POS/E.G.,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 1 LESION,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 2 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST RT 3 SEP LSNS,19102RT,CPT,361,RC,RT,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US OB VERSION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US OB CERVIX LENGTH,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 3RD PLCM,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BI 3RD LESION,19102,CPT,361,RC,,OUTPATIENT,,,1358,543.2,UC HEALTH,UC HEALTH COMMERCIAL,1181.46,87,,,OTHER,1018.5,1330.84,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY MUSCLE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US ABCESS DRAINAGE W/CATH,75989,CPT,350,RC,,OUTPATIENT,,,744,297.6,UC HEALTH,UC HEALTH COMMERCIAL,647.28,87,,,OTHER,558,729.12,PERCENT OF TOTAL BILLED CHARGES
ABCESS DRAINAGE - ABDOMEN,49406,CPT,361,RC,,OUTPATIENT,,,3982,1592.8,UC HEALTH,UC HEALTH COMMERCIAL,3464.34,87,,,OTHER,2986.5,3902.36,PERCENT OF TOTAL BILLED CHARGES
US BREAST ASPIRATION LT2 SITES,19001LT,CPT,361,RC,LT,OUTPATIENT,,,768,307.2,UC HEALTH,UC HEALTH COMMERCIAL,668.16,87,,,OTHER,576,752.64,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY RENAL,76942,CPT,402,RC,,OUTPATIENT,,,1764,705.6,UC HEALTH,UC HEALTH COMMERCIAL,1534.68,87,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US RENAL CORE BX,50200,CPT,361,RC,,OUTPATIENT,,,1700.5,680.2,UC HEALTH,UC HEALTH COMMERCIAL,1479.435,87,,,OTHER,1275.38,1666.49,PERCENT OF TOTAL BILLED CHARGES
US RENAL FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UC HEALTH,UC HEALTH COMMERCIAL,1534.68,87,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
LEVEL II,20206,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UC HEALTH,UC HEALTH COMMERCIAL,1607.5425,87,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY PELVIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US LUNG/MEDIASTINUM CORE BX,32405,CPT,350,RC,,OUTPATIENT,,,1531,612.4,UC HEALTH,UC HEALTH COMMERCIAL,1331.97,87,,,OTHER,1148.25,1500.38,PERCENT OF TOTAL BILLED CHARGES
US LUNG/MEDIASTINUM FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,2680.75,1072.3,UC HEALTH,UC HEALTH COMMERCIAL,2332.2525,87,,,OTHER,2010.56,2627.14,PERCENT OF TOTAL BILLED CHARGES
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,426.5,170.6,UC HEALTH,UC HEALTH COMMERCIAL,371.055,87,,,OTHER,319.88,417.97,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED LT,76642LT,CPT,402,RC,LT,OUTPATIENT,,,196.25,78.5,UC HEALTH,UC HEALTH COMMERCIAL,170.7375,87,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED RT,76642RT,CPT,402,RC,RT,OUTPATIENT,,,196.25,78.5,UC HEALTH,UC HEALTH COMMERCIAL,170.7375,87,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
BREAST LIMITED BILATERAL,7664250,CPT,402,RC,50,OUTPATIENT,,,392,156.8,UC HEALTH,UC HEALTH COMMERCIAL,341.04,87,,,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE LT,76641LT,CPT,402,RC,LT,OUTPATIENT,,,293.5,117.4,UC HEALTH,UC HEALTH COMMERCIAL,255.345,87,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE RT,76641RT,CPT,402,RC,RT,OUTPATIENT,,,293.5,117.4,UC HEALTH,UC HEALTH COMMERCIAL,255.345,87,,,OTHER,220.13,287.63,PERCENT OF TOTAL BILLED CHARGES
BREAST COMPLETE BILATERAL,7664150,CPT,402,RC,50,OUTPATIENT,,,586.5,234.6,UC HEALTH,UC HEALTH COMMERCIAL,510.255,87,,,OTHER,439.88,574.77,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY THYROID,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US THYROID,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UC HEALTH,UC HEALTH COMMERCIAL,691.65,87,,,OTHER,596.25,779.1,PERCENT OF TOTAL BILLED CHARGES
US CORE BIOPSY OF THYROID,60100,CPT,350,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,631.88,825.65,PERCENT OF TOTAL BILLED CHARGES
MID LINE PLACEMENT W/US GUIDAN,36410,CPT,320,RC,,OUTPATIENT,,,488,195.2,UC HEALTH,UC HEALTH COMMERCIAL,424.56,87,,,OTHER,366,478.2,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UC HEALTH,UC HEALTH COMMERCIAL,1709.55,87,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
FNA BX W/US GDN 1ST LES OTHER,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UC HEALTH,UC HEALTH COMMERCIAL,1534.68,87,,,OTHER,1323,1728.7,PERCENT OF TOTAL BILLED CHARGES
US THORACENTESIS,32421,CPT,361,RC,,OUTPATIENT,,,1049,419.6,UC HEALTH,UC HEALTH COMMERCIAL,912.63,87,,,OTHER,786.75,1028.02,PERCENT OF TOTAL BILLED CHARGES
US ABDOMINAL COMPLETE,76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,UC HEALTH,UC HEALTH COMMERCIAL,526.785,87,,,OTHER,454.13,593.39,PERCENT OF TOTAL BILLED CHARGES
PARACENTESIS W/IMAGE GUIDANCE,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE FOR AMNIOCENTESIS,76946,CPT,402,RC,,OUTPATIENT,,,1081.25,432.5,UC HEALTH,UC HEALTH COMMERCIAL,940.6875,87,,,OTHER,810.94,1059.63,PERCENT OF TOTAL BILLED CHARGES
US AMNIOCENTESIS,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,UC HEALTH,UC HEALTH COMMERCIAL,1098.3663,87,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION LT 1 SITE,19000LT,CPT,361,RC,LT,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 1 SITE,19000RT,CPT,402,RC,RT,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
US GUIDED NEEDLE PLACEMENT RT,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UC HEALTH,UC HEALTH COMMERCIAL,1399.395,87,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US GUIDED 2ND NEEDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION RT 2 SITES,19001RT,CPT,361,RC,RT,OUTPATIENT,,,768,307.2,UC HEALTH,UC HEALTH COMMERCIAL,668.16,87,,,OTHER,576,752.64,PERCENT OF TOTAL BILLED CHARGES
US BREAST/BILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,UC HEALTH,UC HEALTH COMMERCIAL,537.66,87,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 1 SITE,1900050,CPT,402,RC,50,OUTPATIENT,,,1299.75,519.9,UC HEALTH,UC HEALTH COMMERCIAL,1130.7825,87,,,OTHER,974.81,1273.76,PERCENT OF TOTAL BILLED CHARGES
BREAST ASPIRATION BIL 2 SITES,1900150,CPT,402,RC,50,OUTPATIENT,,,1535.5,614.2,UC HEALTH,UC HEALTH COMMERCIAL,1335.885,87,,,OTHER,1151.63,1504.79,PERCENT OF TOTAL BILLED CHARGES
US BREAST/UNILATERAL,76645,CPT,402,RC,,OUTPATIENT,,,618,247.2,UC HEALTH,UC HEALTH COMMERCIAL,537.66,87,,,OTHER,463.5,605.64,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,19281LT,CPT,402,RC,LT,OUTPATIENT,,,2173.25,869.3,UC HEALTH,UC HEALTH COMMERCIAL,1890.7275,87,,,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC LT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,19281RT,CPT,402,RC,RT,OUTPATIENT,,,2173.25,869.3,UC HEALTH,UC HEALTH COMMERCIAL,1890.7275,87,,,OTHER,1629.94,2129.79,PERCENT OF TOTAL BILLED CHARGES
BREAST NEEDLE LOC RT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US CHEST BSCAN INC MEDIASTINUM,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,UC HEALTH,UC HEALTH COMMERCIAL,346.695,87,,,OTHER,298.88,390.53,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US CYST ASPIRATION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
US SKIN LESION BIOPSY,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,UC HEALTH,UC HEALTH COMMERCIAL,375.1875,87,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR,76881,CPT,402,RC,,OUTPATIENT,,,798.75,319.5,UC HEALTH,UC HEALTH COMMERCIAL,694.9125,87,,,OTHER,599.06,782.78,PERCENT OF TOTAL BILLED CHARGES
EXTREMITY NON VASCULAR LIMITED,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
AXILLA ULTRASOUND,76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
FOLLOW UP (NOT FOR OB),76970,CPT,402,RC,,OUTPATIENT,,,264.5,105.8,UC HEALTH,UC HEALTH COMMERCIAL,230.115,87,,,OTHER,198.38,259.21,PERCENT OF TOTAL BILLED CHARGES
US SURGICAL SPECIMAN,76098,CPT,320,RC,,OUTPATIENT,,,962.48,384.992,UC HEALTH,UC HEALTH COMMERCIAL,837.3576,87,,,OTHER,466.31,609.32,PERCENT OF TOTAL BILLED CHARGES
VASCULAR STUDY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UC HEALTH,UC HEALTH COMMERCIAL,399.0516,87,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
US TESTICULAR,76870,CPT,402,RC,,OUTPATIENT,,,732,292.8,UC HEALTH,UC HEALTH COMMERCIAL,636.84,87,,,OTHER,549,717.36,PERCENT OF TOTAL BILLED CHARGES
US HEAD/NECK SOFT TISSUE,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UC HEALTH,UC HEALTH COMMERCIAL,691.65,87,,,OTHER,457.69,598.05,PERCENT OF TOTAL BILLED CHARGES
US SONOHYSTOGRAPHY,76831,CPT,402,RC,,OUTPATIENT,,,1027.25,410.9,UC HEALTH,UC HEALTH COMMERCIAL,893.7075,87,,,OTHER,770.44,1006.71,PERCENT OF TOTAL BILLED CHARGES
US HIPS INFANT,76885,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,UC HEALTH,UC HEALTH COMMERCIAL,330.8175,87,,,OTHER,285.19,372.65,PERCENT OF TOTAL BILLED CHARGES
US GUIDED BIOPSY,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US MARKING FOR NEEDLE PLACEMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE NEEDLE PLACEMENT,36573,CPT,320,RC,,OUTPATIENT,,,545.5,218.2,UC HEALTH,UC HEALTH COMMERCIAL,474.585,87,,,OTHER,409.13,534.59,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT RT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE 3RD NDLE PLCMNT LT,7694259,CPT,402,RC,59,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE BI NEEDLE 1ST PLCM,76942,CPT,402,RC,,OUTPATIENT,,,1608.5,643.4,UC HEALTH,UC HEALTH COMMERCIAL,1399.395,87,,,OTHER,1206.38,1576.33,PERCENT OF TOTAL BILLED CHARGES
US HEAD NEONATAL,76506,CPT,402,RC,,OUTPATIENT,,,525.5,210.2,UC HEALTH,UC HEALTH COMMERCIAL,457.185,87,,,OTHER,394.13,514.99,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB>14 WKS DETAILED,76805,CPT,402,RC,,OUTPATIENT,,,770.75,308.3,UC HEALTH,UC HEALTH COMMERCIAL,670.5525,87,,,OTHER,578.06,755.34,PERCENT OF TOTAL BILLED CHARGES
US OB TRAB 14-20 WKS EA GEST,76810,CPT,402,RC,,OUTPATIENT,,,328.25,131.3,UC HEALTH,UC HEALTH COMMERCIAL,285.5775,87,,,OTHER,246.19,321.69,PERCENT OF TOTAL BILLED CHARGES
US OB AFI/PLACENTA/HR/POSITION,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL OB,76817,CPT,402,RC,,OUTPATIENT,,,616.25,246.5,UC HEALTH,UC HEALTH COMMERCIAL,536.1375,87,,,OTHER,462.19,603.93,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS,76801,CPT,402,RC,,OUTPATIENT,,,682.25,272.9,UC HEALTH,UC HEALTH COMMERCIAL,593.5575,87,,,OTHER,511.69,668.61,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB <14 WKS E/GEST,76802,CPT,402,RC,,OUTPATIENT,,,274.75,109.9,UC HEALTH,UC HEALTH COMMERCIAL,239.0325,87,,,OTHER,206.06,269.26,PERCENT OF TOTAL BILLED CHARGES
US PELVIC,76856,CPT,402,RC,,OUTPATIENT,,,854,341.6,UC HEALTH,UC HEALTH COMMERCIAL,742.98,87,,,OTHER,640.5,836.92,PERCENT OF TOTAL BILLED CHARGES
PELVIS LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,UC HEALTH,UC HEALTH COMMERCIAL,556.1475,87,,,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
US RENAL,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,UC HEALTH,UC HEALTH COMMERCIAL,814.1025,87,,,OTHER,701.81,917.04,PERCENT OF TOTAL BILLED CHARGES
US AORTA,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UC HEALTH,UC HEALTH COMMERCIAL,485.895,87,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
US AAA SCREENING,76706,CPT,402,RC,,OUTPATIENT,,,344.25,137.7,UC HEALTH,UC HEALTH COMMERCIAL,299.4975,87,,,OTHER,258.19,337.37,PERCENT OF TOTAL BILLED CHARGES
OB FOLLOW UP TWIN,76816,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
US RENAL TRANSPLANT,76776,CPT,402,RC,,OUTPATIENT,,,484.75,193.9,UC HEALTH,UC HEALTH COMMERCIAL,421.7325,87,,,OTHER,363.56,475.06,PERCENT OF TOTAL BILLED CHARGES
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,OUTPATIENT,,,489.75,195.9,UC HEALTH,UC HEALTH COMMERCIAL,426.0825,87,,,OTHER,367.31,479.96,PERCENT OF TOTAL BILLED CHARGES
OB US LIMITED FETUS(S),76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US RETROPERITONEAL LIMITED,76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UC HEALTH,UC HEALTH COMMERCIAL,485.895,87,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
US TRANSVAGINAL,76830,CPT,402,RC,,OUTPATIENT,,,380.25,152.1,UC HEALTH,UC HEALTH COMMERCIAL,330.8175,87,,,OTHER,285.19,372.65,PERCENT OF TOTAL BILLED CHARGES
US CHEST LIMITED,76604,CPT,402,RC,,OUTPATIENT,,,217.19,86.876,UC HEALTH,UC HEALTH COMMERCIAL,188.9553,87,,,OTHER,141.75,185.22,PERCENT OF TOTAL BILLED CHARGES
US ABDOMINAL  LIMITED,76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UC HEALTH,UC HEALTH COMMERCIAL,410.205,87,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
US OB LIMITED SIZE,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED TWINS,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
OB LIMITED POST PARTUM,76815,CPT,402,RC,,OUTPATIENT,,,418.75,167.5,UC HEALTH,UC HEALTH COMMERCIAL,364.3125,87,,,OTHER,314.06,410.38,PERCENT OF TOTAL BILLED CHARGES
US TRANSABD OB >14 WKS EA/GEST,76810,CPT,402,RC,,OUTPATIENT,,,296.5,118.6,UC HEALTH,UC HEALTH COMMERCIAL,257.955,87,,,OTHER,222.38,290.57,PERCENT OF TOTAL BILLED CHARGES
AXILLA MARKER PLACEMENT,10035,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,929.8,1214.9,PERCENT OF TOTAL BILLED CHARGES
US OB FETAL RE-EVAL SZ  FLUID,76816,CPT,402,RC,,OUTPATIENT,,,402.25,160.9,UC HEALTH,UC HEALTH COMMERCIAL,349.9575,87,,,OTHER,301.69,394.21,PERCENT OF TOTAL BILLED CHARGES
US PARACENTESIS,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US NEEDLE PLACEMENT PER LESION,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLACEMENT,19285,CPT,361,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,433.88,566.93,PERCENT OF TOTAL BILLED CHARGES
RETROPERITONEAL COMPLETE,76770,CPT,402,RC,,OUTPATIENT,,,935.75,374.3,UC HEALTH,UC HEALTH COMMERCIAL,814.1025,87,,,OTHER,701.81,917.04,PERCENT OF TOTAL BILLED CHARGES
US BREAST MARKER PLCMT ADD'L,19286,CPT,402,RC,,OUTPATIENT,,,231.75,92.7,UC HEALTH,UC HEALTH COMMERCIAL,201.6225,87,,,OTHER,173.81,227.12,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY BREAST BILATERAL 1EA,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,UC HEALTH,UC HEALTH COMMERCIAL,3411.9225,87,,,OTHER,2941.31,3843.32,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UC HEALTH,UC HEALTH COMMERCIAL,2456.6625,87,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
US BRST BX VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2823.75,1129.5,UC HEALTH,UC HEALTH COMMERCIAL,2456.6625,87,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 1 SITE,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST R 2 SITES,19103RT,CPT,361,RC,RT,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST L2 SITES,19084,CPT,402,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2,1908350,CPT,401,RC,50,OUTPATIENT,,,5137.75,2055.1,UC HEALTH,UC HEALTH COMMERCIAL,4469.8425,87,,,OTHER,3853.31,5035,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 1ST,19083,CPT,401,RC,,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
BX BREAST VAC ASSIST BIL 2ND,1908450,CPT,401,RC,50,OUTPATIENT,,,2027.75,811.1,UC HEALTH,UC HEALTH COMMERCIAL,1764.1425,87,,,OTHER,1520.81,1987.2,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST 1ST LESION,19083,CPT,401,RC,,OUTPATIENT,,,1960.75,784.3,UC HEALTH,UC HEALTH COMMERCIAL,1705.8525,87,,,OTHER,1470.56,1921.54,PERCENT OF TOTAL BILLED CHARGES
US BX BREAST ADD LESION,19084,CPT,402,RC,,OUTPATIENT,,,2059,823.6,UC HEALTH,UC HEALTH COMMERCIAL,1791.33,87,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
US LIVER FNA BX,10005,CPT,361,RC,,OUTPATIENT,,,1764,705.6,UC HEALTH,UC HEALTH COMMERCIAL,1534.68,87,,,OTHER,1323,1728.72,PERCENT OF TOTAL BILLED CHARGES
US LIVER CORE BX,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,UC HEALTH,UC HEALTH COMMERCIAL,1328.2725,87,,,OTHER,1145.06,1496.22,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,UC HEALTH,UC HEALTH COMMERCIAL,1791.33,87,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19083,CPT,401,RC,,OUTPATIENT,,,2059,823.6,UC HEALTH,UC HEALTH COMMERCIAL,1791.33,87,,,OTHER,1544.25,2017.82,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION RT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,UC HEALTH,UC HEALTH COMMERCIAL,1199.0775,87,,,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION LT,19084,CPT,402,RC,,OUTPATIENT,,,1378.25,551.3,UC HEALTH,UC HEALTH COMMERCIAL,1199.0775,87,,,OTHER,1033.69,1350.69,PERCENT OF TOTAL BILLED CHARGES
CATHETER FOR HYSTEROGRAPHY,58340,CPT,320,RC,,OUTPATIENT,,,447.5,179,UC HEALTH,UC HEALTH COMMERCIAL,389.325,87,,,OTHER,335.63,438.55,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,3921.75,1568.7,UC HEALTH,UC HEALTH COMMERCIAL,3411.9225,87,,,OTHER,2941.31,3843.32,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION BI,19084,CPT,402,RC,,OUTPATIENT,,,787.5,315,UC HEALTH,UC HEALTH COMMERCIAL,685.125,87,,,OTHER,590.63,771.75,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,19083,CPT,401,RC,,OUTPATIENT,,,4117.5,1647,UC HEALTH,UC HEALTH COMMERCIAL,3582.225,87,,,OTHER,3088.13,4035.15,PERCENT OF TOTAL BILLED CHARGES
US MUSCLE CORE BX,20206,CPT,361,RC,,OUTPATIENT,,,1248,499.2,UC HEALTH,UC HEALTH COMMERCIAL,1085.76,87,,,OTHER,936,1223.04,PERCENT OF TOTAL BILLED CHARGES
US BIOPSY LYMPH SUPERFICIAL,38505,CPT,361,RC,,OUTPATIENT,,,1847.75,739.1,UC HEALTH,UC HEALTH COMMERCIAL,1607.5425,87,,,OTHER,1385.81,1810.8,PERCENT OF TOTAL BILLED CHARGES
HEMATOMA/SEROMA/FLUID DRAIN,10140,CPT,402,RC,,OUTPATIENT,,,427.5,171,UC HEALTH,UC HEALTH COMMERCIAL,371.925,87,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
FLUID DRAIN W/CATH,10030,CPT,350,RC,,OUTPATIENT,,,1343.5,537.4,UC HEALTH,UC HEALTH COMMERCIAL,1168.845,87,,,OTHER,1007.63,1316.63,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY WITH DOPPLER,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,UC HEALTH,UC HEALTH COMMERCIAL,508.08,87,,,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
RENAL ARTERY DOPPLER COMPLETE,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UC HEALTH,UC HEALTH COMMERCIAL,399.0516,87,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
DUPLEX PELVIC OUTFLOW,93976QQ,CPT,,,QQ,OUTPATIENT,,,529.5,211.8,UC HEALTH,UC HEALTH COMMERCIAL,460.665,87,,,OTHER,397.13,518.91,PERCENT OF TOTAL BILLED CHARGES
BREAST MARKER PLACEMENT,19281,CPT,402,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,409.13,534.59,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS BILATERAL,3255550,CPT,402,RC,50,OUTPATIENT,,,3200,1280,UC HEALTH,UC HEALTH COMMERCIAL,2784,87,,,OTHER,2400,3136,PERCENT OF TOTAL BILLED CHARGES
IMAGE CATH FLUID COLXN VISC US,49405,CPT,350,RC,,OUTPATIENT,,,2843.64,1137.456,UC HEALTH,UC HEALTH COMMERCIAL,2473.9668,87,,,OTHER,2132.7,2786.8,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL CORD DOPPLER,76820,CPT,402,RC,,OUTPATIENT,,,215.38,86.152,UC HEALTH,UC HEALTH COMMERCIAL,187.3806,87,,,OTHER,161.5,211.1,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,UC HEALTH,UC HEALTH COMMERCIAL,1097.2875,87,,,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
US PICC LINE ONLY,36573,CPT,320,RC,,OUTPATIENT,,,2578.5,1031.4,UC HEALTH,UC HEALTH COMMERCIAL,2243.295,87,,,OTHER,1933.88,2526.93,PERCENT OF TOTAL BILLED CHARGES
US SPINAL CANAL,76800,CPT,402,RC,,OUTPATIENT,,,526.75,210.7,UC HEALTH,UC HEALTH COMMERCIAL,458.2725,87,,,OTHER,395.06,516.22,PERCENT OF TOTAL BILLED CHARGES
US PSEUDOANEURYSM REPAIR,76936,CPT,402,RC,,OUTPATIENT,,,527.09,210.836,UC HEALTH,UC HEALTH COMMERCIAL,458.5683,87,,,OTHER,319.88,417.97,PERCENT OF TOTAL BILLED CHARGES
US SOFT TISSUE MISC,76999,CPT,402,RC,,OUTPATIENT,,,334.5,133.8,UC HEALTH,UC HEALTH COMMERCIAL,291.015,87,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
FOLLICLE STUDY,7685752,CPT,402,RC,52,OUTPATIENT,,,217.19,86.876,UC HEALTH,UC HEALTH COMMERCIAL,188.9553,87,,,OTHER,89.81,117.36,PERCENT OF TOTAL BILLED CHARGES
DIGITAL BREAST TOMO SCRN BIL,77063,CPT,403,RC,,OUTPATIENT,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI RT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
BREAST TOMO SCRN UNI LT,7706352,CPT,403,RC,52,OUTPATIENT,,,87,34.8,UC HEALTH,UC HEALTH COMMERCIAL,75.69,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
AEROSOL DAILY,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT 1ST HR,94644,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
CONT MED AEROSOL TRMT ADD'L HR,94645,CPT,410,RC,,OUTPATIENT,,,176.5,70.6,UC HEALTH,UC HEALTH COMMERCIAL,153.555,87,,,OTHER,132.38,172.97,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON-VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,57.75,75.46,PERCENT OF TOTAL BILLED CHARGES
IPPB SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES  INITIAL,G0238,HCPCS,410,RC,,INPATIENT,,,117,46.8,UC HEALTH,UC HEALTH COMMERCIAL,101.79,87,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
CPT PD SUBSEQUENT,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL SUBSEQ,94668,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,83.44,109.03,PERCENT OF TOTAL BILLED CHARGES
MANIPULATION CHEST WALL INITL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
IPPB INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
SPUTUM INDUCTION,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
HYPERINFLATION SYSTEM VENTLAB,1613908,CDM,,,,INPATIENT,,,80,32,UC HEALTH,UC HEALTH COMMERCIAL,69.6,87,,,OTHER,60,78.4,PERCENT OF TOTAL BILLED CHARGES
VENTILATOR SUBSEQUENT DAY,94003,CPT,410,RC,,OUTPATIENT,,,2087.75,835.1,UC HEALTH,UC HEALTH COMMERCIAL,1816.3425,87,,,OTHER,1565.81,2046,PERCENT OF TOTAL BILLED CHARGES
VENTILATOR FIRST DAY,94002,CPT,410,RC,,OUTPATIENT,,,2575.5,1030.2,UC HEALTH,UC HEALTH COMMERCIAL,2240.685,87,,,OTHER,1931.63,2523.99,PERCENT OF TOTAL BILLED CHARGES
WEANING PARAMETERS,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,UC HEALTH,UC HEALTH COMMERCIAL,241.9905,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
CPT PD INITIAL,94667,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
BREATHING EXERCISES,G0238,HCPCS,410,RC,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
CPAP INITIAL DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UC HEALTH,UC HEALTH COMMERCIAL,573.33,87,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
CPAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UC HEALTH,UC HEALTH COMMERCIAL,573.33,87,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
SUCTION ENDOTRACHEAL NON VENT,31720,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,80.81,105.6,PERCENT OF TOTAL BILLED CHARGES
ABG PUNCTURE,36600,CPT,410,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,55.69,72.77,PERCENT OF TOTAL BILLED CHARGES
HHN MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE ED,97112GP,CPT,420,RC,GP,OUTPATIENT,,,142,56.8,UC HEALTH,UC HEALTH COMMERCIAL,123.54,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY,97140GP,CPT,420,RC,GP,OUTPATIENT,,,144.38,57.752,UC HEALTH,UC HEALTH COMMERCIAL,125.6106,87,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACT,97530GP,CPT,420,RC,GP,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,UC HEALTH,UC HEALTH COMMERCIAL,50.1294,87,,,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,57.62,23.048,UC HEALTH,UC HEALTH COMMERCIAL,50.1294,87,,,OTHER,43.2,56.5,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE >20CM,97598GP,CPT,420,RC,GP,OUTPATIENT,,,155.75,62.3,UC HEALTH,UC HEALTH COMMERCIAL,135.5025,87,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MAJOR,97606,CPT,,,,OUTPATIENT,,,751.82,300.728,UC HEALTH,UC HEALTH COMMERCIAL,654.0834,87,,,OTHER,563.9,736.8,PERCENT OF TOTAL BILLED CHARGES
WOUND VAC MINOR,97605,CPT,,,,OUTPATIENT,,,363.92,145.568,UC HEALTH,UC HEALTH COMMERCIAL,316.6104,87,,,OTHER,272.9,356.6,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - GROUP,97150GP,CPT,423,RC,GP,OUTPATIENT,,,91.25,36.5,UC HEALTH,UC HEALTH COMMERCIAL,79.3875,87,,,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY - INDIV/15 MN,97113GP,CPT,420,RC,GP,OUTPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
ELEC STIMULATION ATTENDED/15 M,97032GP,CPT,420,RC,GP,OUTPATIENT,,,133.25,53.3,UC HEALTH,UC HEALTH COMMERCIAL,115.9275,87,,,OTHER,99.94,130.59,PERCENT OF TOTAL BILLED CHARGES
ELEC STIM UNATTENDED/VISIT,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
ELECT STIM UNATTENDED,G0283GP,HCPCS,421,RC,GP,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
PREEMPLOYMENT SCREEN BASIC,4210052,CDM,,,,INPATIENT,,,150,60,UC HEALTH,UC HEALTH COMMERCIAL,130.5,87,,,OTHER,112.5,147,PERCENT OF TOTAL BILLED CHARGES
PREEMPLOYMENT SCREEN/INTER,4210053,CDM,,,,INPATIENT,,,300,120,UC HEALTH,UC HEALTH COMMERCIAL,261,87,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVAL MODERATE COMP,97162GP,CPT,424,RC,GP,OUTPATIENT,,,349,139.6,UC HEALTH,UC HEALTH COMMERCIAL,303.63,87,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVALHIGH COMPLEXITY,97163GP,CPT,424,RC,GP,OUTPATIENT,,,394,157.6,UC HEALTH,UC HEALTH COMMERCIAL,342.78,87,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
PT REASSESSMENT,97164GP,CPT,424,RC,GP,OUTPATIENT,,,142.26,56.904,UC HEALTH,UC HEALTH COMMERCIAL,123.7662,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
PT THERAPY EVAL LOW COMPLEXITY,97161GP,CPT,424,RC,GP,OUTPATIENT,,,303,121.2,UC HEALTH,UC HEALTH COMMERCIAL,263.61,87,,,OTHER,134.81,176.16,PERCENT OF TOTAL BILLED CHARGES
GAIT TRAINING / 15 MIN,97116GP,CPT,420,RC,GP,OUTPATIENT,,,131.45,52.58,UC HEALTH,UC HEALTH COMMERCIAL,114.3615,87,,,OTHER,76.13,99.47,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GP,CPT,420,RC,GP,OUTPATIENT,,,139,55.6,UC HEALTH,UC HEALTH COMMERCIAL,120.93,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GP,CPT,420,RC,GP,OUTPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
MASSAGE THERAPY 15 MINS,97124GP,CPT,420,RC,GP,OUTPATIENT,,,120.75,48.3,UC HEALTH,UC HEALTH COMMERCIAL,105.0525,87,,,OTHER,90.56,118.34,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST 15 M,97750GP,CPT,420,RC,GP,OUTPATIENT,,,148,59.2,UC HEALTH,UC HEALTH COMMERCIAL,128.76,87,,,OTHER,111,145.04,PERCENT OF TOTAL BILLED CHARGES
MOIST HEAT THERAPY,97010GP,CPT,420,RC,GP,OUTPATIENT,,,65.5,26.2,UC HEALTH,UC HEALTH COMMERCIAL,56.985,87,,,OTHER,49.13,64.19,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FITTING 15 MINS,97760GP,CPT,420,RC,GP,OUTPATIENT,,,117.75,47.1,UC HEALTH,UC HEALTH COMMERCIAL,102.4425,87,,,OTHER,88.31,115.4,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH,97018GP,CPT,420,RC,GP,OUTPATIENT,,,72.5,29,UC HEALTH,UC HEALTH COMMERCIAL,63.075,87,,,OTHER,54.38,71.05,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISE 15 MINS,97110GP,CPT,420,RC,GP,OUTPATIENT,,,146.94,58.776,UC HEALTH,UC HEALTH COMMERCIAL,127.8378,87,,,OTHER,85.13,111.23,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXCLUDE HANDS,95833GP,CPT,420,RC,GP,OUTPATIENT,,,79.5,31.8,UC HEALTH,UC HEALTH COMMERCIAL,69.165,87,,,OTHER,59.63,77.91,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING INCLUDE HANDS,95834GP,CPT,420,RC,GP,OUTPATIENT,,,106,42.4,UC HEALTH,UC HEALTH COMMERCIAL,92.22,87,,,OTHER,79.5,103.88,PERCENT OF TOTAL BILLED CHARGES
TRACTION - MECHANICAL,97012GP,CPT,420,RC,GP,OUTPATIENT,,,91.25,36.5,UC HEALTH,UC HEALTH COMMERCIAL,79.3875,87,,,OTHER,68.44,89.43,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GP,CPT,420,RC,GP,OUTPATIENT,,,32,12.8,UC HEALTH,UC HEALTH COMMERCIAL,27.84,87,,,OTHER,24,31.36,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GP,CPT,420,RC,GP,OUTPATIENT,,,113.9,45.56,UC HEALTH,UC HEALTH COMMERCIAL,99.093,87,,,OTHER,63.38,82.81,PERCENT OF TOTAL BILLED CHARGES
WHIRLPOOL,97022GP,CPT,420,RC,GP,OUTPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
WOUND CARE NON SELECTIVE,97602GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,155.06,202.62,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE <20CM,97597GP,CPT,420,RC,GP,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,402,RC,,OUTPATIENT,,,233.98,93.592,UC HEALTH,UC HEALTH COMMERCIAL,203.5626,87,,,OTHER,175.5,229.3,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING EXTREMITY,95831GP,CPT,420,RC,GP,OUTPATIENT,,,54.25,21.7,UC HEALTH,UC HEALTH COMMERCIAL,47.1975,87,,,OTHER,40.69,53.17,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING-HAND,95832GP,CPT,420,RC,GP,OUTPATIENT,,,118.25,47.3,UC HEALTH,UC HEALTH COMMERCIAL,102.8775,87,,,OTHER,88.69,115.89,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GP,CPT,420,RC,GP,OUTPATIENT,,,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CANALITH REPOSITIONING,95992,CPT,420,RC,,OUTPATIENT,,,148.75,59.5,UC HEALTH,UC HEALTH COMMERCIAL,129.4125,87,,,OTHER,111.56,145.78,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY/WORK REINTEGRATION,97537,CPT,420,RC,,OUTPATIENT,,,117,46.8,UC HEALTH,UC HEALTH COMMERCIAL,101.79,87,,,OTHER,87.75,114.66,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING,97761,CPT,420,RC,,OUTPATIENT,,,123.75,49.5,UC HEALTH,UC HEALTH COMMERCIAL,107.6625,87,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
C/O FOR ORTHOTIC/PROSTH USE,97763GP,CPT,420,RC,GP,OUTPATIENT,,,123.75,49.5,UC HEALTH,UC HEALTH COMMERCIAL,107.6625,87,,,OTHER,92.81,121.28,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES,97530GP,CPT,420,RC,GP,OUTPATIENT,,,113.75,45.5,UC HEALTH,UC HEALTH COMMERCIAL,98.9625,87,,,OTHER,85.31,111.48,PERCENT OF TOTAL BILLED CHARGES
MANUAL THERAPY OT,97140GO,CPT,430,RC,GO,OUTPATIENT,,,102.75,41.1,UC HEALTH,UC HEALTH COMMERCIAL,89.3925,87,,,OTHER,77.06,100.7,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,UC HEALTH,UC HEALTH COMMERCIAL,42.7866,87,,,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,940,RC,,OUTPATIENT,,,49.18,19.672,UC HEALTH,UC HEALTH COMMERCIAL,42.7866,87,,,OTHER,36.9,48.2,PERCENT OF TOTAL BILLED CHARGES
APPLICATION CAST FINGER,29086,CPT,,,,OUTPATIENT,,,281.4,112.56,UC HEALTH,UC HEALTH COMMERCIAL,244.818,87,,,OTHER,211.1,275.8,PERCENT OF TOTAL BILLED CHARGES
ULTRASOUND THERAPY 15 MINS,97035GO,CPT,430,RC,GO,OUTPATIENT,,,80.25,32.1,UC HEALTH,UC HEALTH COMMERCIAL,69.8175,87,,,OTHER,60.19,78.65,PERCENT OF TOTAL BILLED CHARGES
RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,UC HEALTH,UC HEALTH COMMERCIAL,100.05,87,,,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
ELE STIMULATION ATTENDED 15MIN,97032GO,CPT,430,RC,GO,OUTPATIENT,,,90.5,36.2,UC HEALTH,UC HEALTH COMMERCIAL,78.735,87,,,OTHER,67.88,88.69,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EXERCISES/15 MIN,97110GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,UC HEALTH,UC HEALTH COMMERCIAL,93.96,87,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - LOW COMPLEXITY,97165GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UC HEALTH,UC HEALTH COMMERCIAL,174.7482,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - MODERATE COMPLEXITY,97166GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UC HEALTH,UC HEALTH COMMERCIAL,174.7482,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT EVAL - HIGH COMPLEXITY,97167GO,CPT,434,RC,GO,OUTPATIENT,,,200.86,80.344,UC HEALTH,UC HEALTH COMMERCIAL,174.7482,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
OT RE-EVALUATION,97168GO,CPT,434,RC,GO,OUTPATIENT,,,115,46,UC HEALTH,UC HEALTH COMMERCIAL,100.05,87,,,OTHER,86.25,112.7,PERCENT OF TOTAL BILLED CHARGES
IONTOPHORESIS 15 MINS,97033GO,CPT,430,RC,GO,OUTPATIENT,,,129.25,51.7,UC HEALTH,UC HEALTH COMMERCIAL,112.4475,87,,,OTHER,96.94,126.67,PERCENT OF TOTAL BILLED CHARGES
MUSCLE TESTING MANUAL HAND,95832GO,CPT,430,RC,GO,OUTPATIENT,,,112.5,45,UC HEALTH,UC HEALTH COMMERCIAL,97.875,87,,,OTHER,84.38,110.25,PERCENT OF TOTAL BILLED CHARGES
NEUROMUSCULAR RE-EDUC/15 MIN,97112GO,CPT,430,RC,GO,OUTPATIENT,,,108,43.2,UC HEALTH,UC HEALTH COMMERCIAL,93.96,87,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
INFRARED THERAPY,97026GO,CPT,430,RC,GO,OUTPATIENT,,,30.25,12.1,UC HEALTH,UC HEALTH COMMERCIAL,26.3175,87,,,OTHER,22.69,29.65,PERCENT OF TOTAL BILLED CHARGES
AQUATIC THERAPY / 15 MIN,97113GO,CPT,430,RC,GO,OUTPATIENT,,,88.25,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.7775,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PROC GROUP (VISIT),97150GO,CPT,433,RC,GO,OUTPATIENT,,,86.5,34.6,UC HEALTH,UC HEALTH COMMERCIAL,75.255,87,,,OTHER,64.88,84.77,PERCENT OF TOTAL BILLED CHARGES
ORTHOTICS FIT-TRAINING/15 MIN,97760GO,CPT,430,RC,GO,OUTPATIENT,,,275,110,UC HEALTH,UC HEALTH COMMERCIAL,239.25,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
PROSTHETIC TRAINING / 15 MIN,97761GO,CPT,430,RC,GO,OUTPATIENT,,,87.14,34.856,UC HEALTH,UC HEALTH COMMERCIAL,75.8118,87,,,OTHER,63,82.32,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC ACTIVITIES/15 MIN,97530GO,CPT,430,RC,GO,OUTPATIENT,,,108.25,43.3,UC HEALTH,UC HEALTH COMMERCIAL,94.1775,87,,,OTHER,81.19,106.09,PERCENT OF TOTAL BILLED CHARGES
SELF CARE MANAGEMENT/15 MIN,97535GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,UC HEALTH,UC HEALTH COMMERCIAL,65.685,87,,,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
COMMUNITY-WORK REINT TRN/15 MN,97537GO,CPT,430,RC,GO,OUTPATIENT,,,75.5,30.2,UC HEALTH,UC HEALTH COMMERCIAL,65.685,87,,,OTHER,56.63,73.99,PERCENT OF TOTAL BILLED CHARGES
WHEELCHAIR MANAGEMENT / 15 MIN,97542GO,CPT,430,RC,GO,OUTPATIENT,,,119,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.53,87,,,OTHER,89.25,116.62,PERCENT OF TOTAL BILLED CHARGES
ORHOTIC/PROSTHETIC CHECK/15 MN,97763GO,CPT,430,RC,GO,OUTPATIENT,,,250.54,100.216,UC HEALTH,UC HEALTH COMMERCIAL,217.9698,87,,,OTHER,40.31,52.68,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORM-CAP TEST/15MN,97750GO,CPT,430,RC,GO,OUTPATIENT,,,140.75,56.3,UC HEALTH,UC HEALTH COMMERCIAL,122.4525,87,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
DEVELOP COGNITIVE SKILLS/15 MN,G0515GO,HCPCS,430,RC,GO,BOTH,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
THER IVNTJ EA ADDL 15 MIN,97130,CPT,,,,OUTPATIENT,,,42,16.8,UC HEALTH,UC HEALTH COMMERCIAL,36.54,87,,,OTHER,31.5,41.2,PERCENT OF TOTAL BILLED CHARGES
EVALUATE SWALLOWING FUNCTION,92610,CPT,430,RC,,OUTPATIENT,,,436.5,174.6,UC HEALTH,UC HEALTH COMMERCIAL,379.755,87,,,OTHER,327.38,427.77,PERCENT OF TOTAL BILLED CHARGES
LIMB MUSCLE TESTING MANUAL,95831,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,UC HEALTH,UC HEALTH COMMERCIAL,111.1425,87,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIM,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,UC HEALTH,UC HEALTH COMMERCIAL,175.5225,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
PARAFFIN BATH THERAPY,97018,CPT,430,RC,,OUTPATIENT,,,101.25,40.5,UC HEALTH,UC HEALTH COMMERCIAL,88.0875,87,,,OTHER,75.94,99.23,PERCENT OF TOTAL BILLED CHARGES
SENSORY INTEGRATION,97533,CPT,430,RC,,OUTPATIENT,,,127.75,51.1,UC HEALTH,UC HEALTH COMMERCIAL,111.1425,87,,,OTHER,95.81,125.2,PERCENT OF TOTAL BILLED CHARGES
ASSISTIVE TECHNOLOGY ASSESS,97755,CPT,430,RC,,OUTPATIENT,,,121.5,48.6,UC HEALTH,UC HEALTH COMMERCIAL,105.705,87,,,OTHER,91.13,119.07,PERCENT OF TOTAL BILLED CHARGES
THER IVNTJ 1ST 15 MIN,97129,CPT,,,,OUTPATIENT,,,240,96,UC HEALTH,UC HEALTH COMMERCIAL,208.8,87,,,OTHER,180,235.2,PERCENT OF TOTAL BILLED CHARGES
ST COG FUNC PT ADD 15,97130,CPT,,,,OUTPATIENT,,,220.3,88.12,UC HEALTH,UC HEALTH COMMERCIAL,191.661,87,,,OTHER,165.2,215.9,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE EVAL,92523GN,CPT,444,RC,GN,OUTPATIENT,,,261.33,104.532,UC HEALTH,UC HEALTH COMMERCIAL,227.3571,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
SPEECH/LANG/AUD/VOICE TX,92507GN,CPT,440,RC,GN,OUTPATIENT,,,316,126.4,UC HEALTH,UC HEALTH COMMERCIAL,274.92,87,,,OTHER,105.75,138.18,PERCENT OF TOTAL BILLED CHARGES
EVAL SWALLOWING FUNCTION,92610GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,UC HEALTH,UC HEALTH COMMERCIAL,266.22,87,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
SP SWALLOWING/ORAL TREATMENT,92526GN,CPT,440,RC,GN,OUTPATIENT,,,306,122.4,UC HEALTH,UC HEALTH COMMERCIAL,266.22,87,,,OTHER,229.5,299.88,PERCENT OF TOTAL BILLED CHARGES
ASSESSMENT OF APHASIA PER HR,96105GN,CPT,442,RC,GN,OUTPATIENT,,,291.25,116.5,UC HEALTH,UC HEALTH COMMERCIAL,253.3875,87,,,OTHER,218.44,285.43,PERCENT OF TOTAL BILLED CHARGES
COGNITIVE FNCT INTERVENTION,G0515GN,HCPCS,440,RC,GN,BOTH,,,59.25,23.7,UC HEALTH,UC HEALTH COMMERCIAL,51.5475,87,,,OTHER,44.44,58.07,PERCENT OF TOTAL BILLED CHARGES
VOICE PROSTHETIC EVA,92597GN,CPT,444,RC,GN,OUTPATIENT,,,167.25,66.9,UC HEALTH,UC HEALTH COMMERCIAL,145.5075,87,,,OTHER,125.44,163.91,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE 1 HR,92607GN,CPT,444,RC,GN,OUTPATIENT,,,260.32,104.128,UC HEALTH,UC HEALTH COMMERCIAL,226.4784,87,,,OTHER,175.5,229.32,PERCENT OF TOTAL BILLED CHARGES
EVAL FOR SPEECH DEVICE ADDL,92608GN,CPT,444,RC,GN,OUTPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
SPEECH GENERATING DEVICE SERV,92609GN,CPT,440,RC,GN,OUTPATIENT,,,242.25,96.9,UC HEALTH,UC HEALTH COMMERCIAL,210.7575,87,,,OTHER,181.69,237.41,PERCENT OF TOTAL BILLED CHARGES
DEVELOPMENTAL TEST LIMITED,96110,CPT,430,RC,,OUTPATIENT,,,201.75,80.7,UC HEALTH,UC HEALTH COMMERCIAL,175.5225,87,,,OTHER,151.31,197.72,PERCENT OF TOTAL BILLED CHARGES
PHYSICAL PERFORMANCE TEST,97750,CPT,440,RC,,OUTPATIENT,,,140.75,56.3,UC HEALTH,UC HEALTH COMMERCIAL,122.4525,87,,,OTHER,105.56,137.94,PERCENT OF TOTAL BILLED CHARGES
TRMT OF SWALLOWING DYSFUNCTION,92526GN,CPT,440,RC,GN,OUTPATIENT,,,175.92,70.368,UC HEALTH,UC HEALTH COMMERCIAL,153.0504,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
SPEECH GROUPS THERAPY,92508GN,CPT,443,RC,GN,OUTPATIENT,,,161.5,64.6,UC HEALTH,UC HEALTH COMMERCIAL,140.505,87,,,OTHER,121.13,158.27,PERCENT OF TOTAL BILLED CHARGES
STD COGNITIVE TEST PER HR,96125GN,CPT,444,RC,GN,OUTPATIENT,,,350.25,140.1,UC HEALTH,UC HEALTH COMMERCIAL,304.7175,87,,,OTHER,262.69,343.25,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH FLUENCY,92521GN,CPT,444,RC,GN,OUTPATIENT,,,277.46,110.984,UC HEALTH,UC HEALTH COMMERCIAL,241.3902,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH SOUND PROD,92522GN,CPT,444,RC,GN,OUTPATIENT,,,182,72.8,UC HEALTH,UC HEALTH COMMERCIAL,158.34,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
EVAL OF SPEECH SND W/EVAL LANG,92523GN,CPT,444,RC,GN,OUTPATIENT,,,477.2,190.88,UC HEALTH,UC HEALTH COMMERCIAL,415.164,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
BEHAVIORAL ANALYSIS OF VOICE,92524GN,CPT,444,RC,GN,OUTPATIENT,,,226.82,90.728,UC HEALTH,UC HEALTH COMMERCIAL,197.3334,87,,,OTHER,136.5,178.36,PERCENT OF TOTAL BILLED CHARGES
MOTION FLUOROSCOPY/SWALLOW,92611,CPT,,,,OUTPATIENT,,,534,213.6,UC HEALTH,UC HEALTH COMMERCIAL,464.58,87,,,OTHER,400.5,523.3,PERCENT OF TOTAL BILLED CHARGES
ENDOSCOPY SWALLOW (FEES) VID,92612,CPT,444,RC,,OUTPATIENT,,,531,212.4,UC HEALTH,UC HEALTH COMMERCIAL,461.97,87,,,OTHER,398.3,520.4,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 4-8 HR,36430,CPT,391,RC,,OUTPATIENT,,,1449.75,579.9,UC HEALTH,UC HEALTH COMMERCIAL,1261.2825,87,,,OTHER,1087.3,1420.8,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 1,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,UC HEALTH,UC HEALTH COMMERCIAL,244.6875,87,,,OTHER,210.94,275.63,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 2,9928225,CPT,450,RC,25,OUTPATIENT,,,371.25,148.5,UC HEALTH,UC HEALTH COMMERCIAL,322.9875,87,,,OTHER,278.44,363.83,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 3,9928325,CPT,450,RC,25,OUTPATIENT,,,461.62,184.648,UC HEALTH,UC HEALTH COMMERCIAL,401.6094,87,,,OTHER,325.88,425.81,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 4,9928425,CPT,450,RC,25,OUTPATIENT,,,820.25,328.1,UC HEALTH,UC HEALTH COMMERCIAL,713.6175,87,,,OTHER,615.19,803.85,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 5,9928525,CPT,450,RC,25,OUTPATIENT,,,1448.5,579.4,UC HEALTH,UC HEALTH COMMERCIAL,1260.195,87,,,OTHER,1086.38,1419.53,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE,99291,CPT,450,RC,,OUTPATIENT,,,1571,628.4,UC HEALTH,UC HEALTH COMMERCIAL,1366.77,87,,,OTHER,1178.25,1539.58,PERCENT OF TOTAL BILLED CHARGES
CRITICAL CARE ADD'L 30 MIN,99292,CPT,450,RC,,OUTPATIENT,,,271.25,108.5,UC HEALTH,UC HEALTH COMMERCIAL,235.9875,87,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
NEBULIZER INITIAL TREATMENT,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
TRAUMA TEAM ACTIVATION,G0390,HCPCS,684,RC,,INPATIENT,,,2695.25,1078.1,UC HEALTH,UC HEALTH COMMERCIAL,2344.8675,87,,,OTHER,2021.44,2641.35,PERCENT OF TOTAL BILLED CHARGES
IV PUSH MED EA ADD'L,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION 1ST,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
IM/SQ VACCINATION EA ADD'L,90472,CPT,771,RC,,OUTPATIENT,,,91.75,36.7,UC HEALTH,UC HEALTH COMMERCIAL,79.8225,87,,,OTHER,68.81,89.92,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION >16 MINS INITIAL,96365,CPT,260,RC,,OUTPATIENT,,,475.75,190.3,UC HEALTH,UC HEALTH COMMERCIAL,413.9025,87,,,OTHER,356.81,466.24,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION CONCURRENT,96368,CPT,450,RC,,OUTPATIENT,,,183.5,73.4,UC HEALTH,UC HEALTH COMMERCIAL,159.645,87,,,OTHER,137.63,179.83,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION SEQUENTIAL,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
CORONARY THROMBOLYSIS,92977,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,UC HEALTH,UC HEALTH COMMERCIAL,1173.195,87,,,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
URINE DIP,81002,CPT,307,RC,,OUTPATIENT,,,38.25,15.3,UC HEALTH,UC HEALTH COMMERCIAL,33.2775,87,,,OTHER,28.69,37.49,PERCENT OF TOTAL BILLED CHARGES
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UC HEALTH,UC HEALTH COMMERCIAL,540.705,87,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
STRAIGHT CATHETER,51701,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER,51702,CPT,320,RC,,OUTPATIENT,,,343.75,137.5,UC HEALTH,UC HEALTH COMMERCIAL,299.0625,87,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHETER COMP,51703,CPT,320,RC,,OUTPATIENT,,,450.5,180.2,UC HEALTH,UC HEALTH COMMERCIAL,391.935,87,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CHEST TUBE ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
NG-OG TUBE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,UC HEALTH,UC HEALTH COMMERCIAL,458.5683,87,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
G-TUBE CHANGE,43762,CPT,450,RC,,OUTPATIENT,,,720.25,288.1,UC HEALTH,UC HEALTH COMMERCIAL,626.6175,87,,,OTHER,540.19,705.85,PERCENT OF TOTAL BILLED CHARGES
DEFIBRILLATION,92950,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,UC HEALTH,UC HEALTH COMMERCIAL,1288.905,87,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
TC PACING,92953,CPT,450,RC,,OUTPATIENT,,,1348.5,539.4,UC HEALTH,UC HEALTH COMMERCIAL,1173.195,87,,,OTHER,1011.38,1321.53,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE PLCMT ASSIST>5YRS,36556,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UC HEALTH,UC HEALTH COMMERCIAL,1770.2325,87,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST LG,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UC HEALTH,UC HEALTH COMMERCIAL,576.5925,87,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
THORACOTOMY ASSIST,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
I O INSERTION,36680,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,UC HEALTH,UC HEALTH COMMERCIAL,468.5733,87,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
SHORT ARM,29125,CPT,450,RC,,OUTPATIENT,,,330.75,132.3,UC HEALTH,UC HEALTH COMMERCIAL,287.7525,87,,,OTHER,248.06,324.14,PERCENT OF TOTAL BILLED CHARGES
SHORT LEG,29515,CPT,450,RC,,OUTPATIENT,,,361,144.4,UC HEALTH,UC HEALTH COMMERCIAL,314.07,87,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
LONG LEG,29505,CPT,450,RC,,OUTPATIENT,,,450.5,180.2,UC HEALTH,UC HEALTH COMMERCIAL,391.935,87,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,600.25,240.1,UC HEALTH,UC HEALTH COMMERCIAL,522.2175,87,,,OTHER,450.19,588.25,PERCENT OF TOTAL BILLED CHARGES
CYSTOSTOMY TUBE CHANGE COMPL,51710,CPT,320,RC,,OUTPATIENT,,,2566.75,1026.7,UC HEALTH,UC HEALTH COMMERCIAL,2233.0725,87,,,OTHER,1925.06,2515.42,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL/SUBS INTERV 15-30MN,G0396,HCPCS,450,RC,,INPATIENT,,,52.28,20.912,UC HEALTH,UC HEALTH COMMERCIAL,45.4836,87,,,OTHER,39.2,51.2,PERCENT OF TOTAL BILLED CHARGES
ALCOHOL/SUBS INTERV >30 MIN,G0397,HCPCS,450,RC,,INPATIENT,,,266.34,106.536,UC HEALTH,UC HEALTH COMMERCIAL,231.7158,87,,,OTHER,199.8,261,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 1-2 HR,36430,CPT,391,RC,,OUTPATIENT,,,1149.75,459.9,UC HEALTH,UC HEALTH COMMERCIAL,1000.2825,87,,,OTHER,862.3,1126.8,PERCENT OF TOTAL BILLED CHARGES
OXYGEN PER HOUR,2710040,CDM,,,,INPATIENT,,,63,25.2,UC HEALTH,UC HEALTH COMMERCIAL,54.81,87,,,OTHER,47.25,61.74,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL,96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,UC HEALTH,UC HEALTH COMMERCIAL,389.76,87,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
FNA W/O IMAGE,10021,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UC HEALTH,UC HEALTH COMMERCIAL,679.905,87,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
REMOVE NAIL PLATE ADD-ON,11732,CPT,450,RC,,OUTPATIENT,,,255,102,UC HEALTH,UC HEALTH COMMERCIAL,221.85,87,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
INTER REPAIR GENITIAL 2.6-7.5,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 20.1-30.0CM,12017,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCTION OF SHDLR ANES,23655,CPT,450,RC,,OUTPATIENT,,,1884.25,753.7,UC HEALTH,UC HEALTH COMMERCIAL,1639.2975,87,,,OTHER,1413.19,1846.57,PERCENT OF TOTAL BILLED CHARGES
CLOSED REDUCT SHLD W/O ANES BI,2365050,CPT,450,RC,50,OUTPATIENT,,,884.75,353.9,UC HEALTH,UC HEALTH COMMERCIAL,769.7325,87,,,OTHER,663.56,867.06,PERCENT OF TOTAL BILLED CHARGES
TRT OF ANKLE FRACTURE,45027816,CDM,,,,INPATIENT,,,619.25,247.7,UC HEALTH,UC HEALTH COMMERCIAL,538.7475,87,,,OTHER,464.44,606.87,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED POSTERIOR,30905,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DENTAL SURGERY PROCEDURE,41899,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
INC OF THROMBOSED HEMORRD EXT,46083,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF SCROTUM ABCESS,55100,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
I&D OF VULVA/PERINEUM,56405,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,UC HEALTH,UC HEALTH COMMERCIAL,488.0961,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
NJX INTERLAMINAR LMBR/SAC,62322,CPT,361,RC,,OUTPATIENT,,,1369.75,547.9,UC HEALTH,UC HEALTH COMMERCIAL,1191.6825,87,,,OTHER,1027.31,1342.36,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 2-4 HR,36430,CPT,391,RC,,OUTPATIENT,,,1249.75,499.9,UC HEALTH,UC HEALTH COMMERCIAL,1087.2825,87,,,OTHER,937.3,1224.8,PERCENT OF TOTAL BILLED CHARGES
REMOVAL IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UC HEALTH,UC HEALTH COMMERCIAL,246.4275,87,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
CATHETERIZATION FOR COLLECTION,P9612,HCPCS,300,RC,,INPATIENT,,,6,2.4,UC HEALTH,UC HEALTH COMMERCIAL,5.22,87,,,OTHER,4.5,5.9,PERCENT OF TOTAL BILLED CHARGES
ACNE SURGERY,10040,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS COMP/MULT,10061,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE PILONIDAL,10080,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
INCISION & DRAINAGE EPIDIDYMIS,54700,CPT,450,RC,,OUTPATIENT,,,975,390,UC HEALTH,UC HEALTH COMMERCIAL,848.25,87,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY SUB-Q SIMPLE,10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INC/REMOVAL FOREIGN BODY;COMPL,10121,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UC HEALTH,UC HEALTH COMMERCIAL,917.415,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE HEMOTOMA,10140,CPT,402,RC,,OUTPATIENT,,,1261.25,504.5,UC HEALTH,UC HEALTH COMMERCIAL,1097.2875,87,,,OTHER,945.94,1236.03,PERCENT OF TOTAL BILLED CHARGES
PUNCTURE ASPIRATE ABCESS SMPL,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,320.63,418.95,PERCENT OF TOTAL BILLED CHARGES
DBRDMT SKIN UP TO 10% OF BODY,11000,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT OPEN FX SUBQ ONLY,11010,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,UC HEALTH,UC HEALTH COMMERCIAL,2867.955,87,,,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SKIN SUBQ TISSUE,11011,CPT,450,RC,,OUTPATIENT,,,3296.5,1318.6,UC HEALTH,UC HEALTH COMMERCIAL,2867.955,87,,,OTHER,2472.38,3230.57,PERCENT OF TOTAL BILLED CHARGES
DEBRIDMENT SKIN PARTIAL THICK,4511040,CDM,,,,INPATIENT,,,470,188,UC HEALTH,UC HEALTH COMMERCIAL,408.9,87,,,OTHER,352.5,460.6,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SKIN FULL THICK,4511041,CDM,,,,INPATIENT,,,470,188,UC HEALTH,UC HEALTH COMMERCIAL,408.9,87,,,OTHER,352.5,460.6,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT SUBQ TISSUE 20 SQ,11042,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,UC HEALTH,UC HEALTH COMMERCIAL,810.405,87,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
DEB BONE 20 SQ CM OR LESS,11044,CPT,450,RC,,OUTPATIENT,,,931.5,372.6,UC HEALTH,UC HEALTH COMMERCIAL,810.405,87,,,OTHER,698.63,912.87,PERCENT OF TOTAL BILLED CHARGES
BIOPSY SKIN LESION,11100,CPT,402,RC,,OUTPATIENT,,,431.25,172.5,UC HEALTH,UC HEALTH COMMERCIAL,375.1875,87,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
INCISIONAL BIOPSY SINGLE LESN,11106,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,323.44,422.63,PERCENT OF TOTAL BILLED CHARGES
DEBRIDEMENT NAIL 1-5,11720,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
REMOVAL OF SKIN TAGS UP TO 15,11200,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
EXC TR-EXT B9+MART 0.6-ICM,11401,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
FLUID EXC H-F-NK-SP B9+MARG,11422,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,450,RC,,OUTPATIENT,,,605,242,UC HEALTH,UC HEALTH COMMERCIAL,526.35,87,,,OTHER,453.8,592.9,PERCENT OF TOTAL BILLED CHARGES
EXC MALIGN LESION INCL MARGINS,11606,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
TRIMMING OF FINGER/TOE NAIL(S),11719,CPT,450,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
AVULSION OF NAIL PLATE SINGLE,11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,191.25,249.9,PERCENT OF TOTAL BILLED CHARGES
EVACUATION SUBUNGAL HEMOTOMA,11740,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,161.25,210.7,PERCENT OF TOTAL BILLED CHARGES
EXCISION OF NAIL PERM RM,11750,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UC HEALTH,UC HEALTH COMMERCIAL,917.415,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF NAIL BED,11760,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,254.44,332.47,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF TENDON,4511754,CDM,,,,INPATIENT,,,1910.25,764.1,UC HEALTH,UC HEALTH COMMERCIAL,1661.9175,87,,,OTHER,1432.69,1872.05,PERCENT OF TOTAL BILLED CHARGES
WEDGE EXCISION OF SKIN OF NAIL,11765,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UC HEALTH,UC HEALTH COMMERCIAL,679.905,87,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
REMOVE PILONIDAL CYST SIMPLE,11770,CPT,450,RC,,OUTPATIENT,,,781.5,312.6,UC HEALTH,UC HEALTH COMMERCIAL,679.905,87,,,OTHER,586.13,765.87,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 2.5 CM OR LESS,12001,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 2.6CM TO 7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 7.6-12.5 CM,12004,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 12.6 TO 20 CM,12005,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 20.1 TO 30 CM,12006,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR > 30CM,12007,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE <2.5CM,12011,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE 2.6 - 5.0CM,12013,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR FACE 5.1-7.5CM,12014,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 7.6-12.5CM,12015,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR 12.6-20.0,12016,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
SIMPLE REPAIR OVER 30CM,12018,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,UC HEALTH,UC HEALTH COMMERCIAL,834.5475,87,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
TRMT OF SUPERFICIAL WND SIMPLE,12020,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR > 2.5 CM,12031,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.6-7.5CM,12032,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12034,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12035,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 20.1-30.0CM,12036,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0 CM,12037,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,UC HEALTH,UC HEALTH COMMERCIAL,2974.5213,87,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
INTER REPAIR GENITAL 2.5 CM<,12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.6-7.5CM,12042,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12044,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12045,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
REPAIR INTERMED 20.1-30.0CM,12046,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0 CM,12047,CPT,450,RC,,OUTPATIENT,,,3418.99,1367.596,UC HEALTH,UC HEALTH COMMERCIAL,2974.5213,87,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR < 2.5CM FACE,12051,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 2.5-5.0CM,12052,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 5.1-7.5CM,12053,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 7.6-12.5CM,12054,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 12.6-20.0CM,12055,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,277.88,363.09,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR 20.1-30.0CM,12056,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
INTERMED REPAIR OVER 30.0CM,12057,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,UC HEALTH,UC HEALTH COMMERCIAL,2774.43,87,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13100,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13101,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0CM,13102,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UC HEALTH,UC HEALTH COMMERCIAL,175.0875,87,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13120,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIRED SCALP/EXTREMI,13121,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0 CM,13122,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UC HEALTH,UC HEALTH COMMERCIAL,175.0875,87,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13131,CPT,450,RC,,OUTPATIENT,,,985.75,394.3,UC HEALTH,UC HEALTH COMMERCIAL,857.6025,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13132,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5.0CM,13133,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UC HEALTH,UC HEALTH COMMERCIAL,175.0875,87,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR > 1.0CM,13150,CPT,450,RC,,OUTPATIENT,,,3189,1275.6,UC HEALTH,UC HEALTH COMMERCIAL,2774.43,87,,,OTHER,2391.75,3125.22,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 1.1-2.5CM,13151,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR 2.6-7.5CM,13152,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,739.31,966.04,PERCENT OF TOTAL BILLED CHARGES
COMPLEX REPAIR EACH ADD 5CM,13153,CPT,450,RC,,OUTPATIENT,,,201.25,80.5,UC HEALTH,UC HEALTH COMMERCIAL,175.0875,87,,,OTHER,150.94,197.23,PERCENT OF TOTAL BILLED CHARGES
REMOVE SUTURES SAME SURGEON,15850,CPT,450,RC,,OUTPATIENT,,,1044.75,417.9,UC HEALTH,UC HEALTH COMMERCIAL,908.9325,87,,,OTHER,146.06,190.86,PERCENT OF TOTAL BILLED CHARGES
TRT 1ST DEGREE BURN LOCAL,16000,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,135.94,177.63,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRIDE SML BURN W/O ANE,16020,CPT,450,RC,,OUTPATIENT,,,361,144.4,UC HEALTH,UC HEALTH COMMERCIAL,314.07,87,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRISE MED BRN W/O ANE,16025,CPT,450,RC,,OUTPATIENT,,,495.25,198.1,UC HEALTH,UC HEALTH COMMERCIAL,430.8675,87,,,OTHER,371.44,485.35,PERCENT OF TOTAL BILLED CHARGES
DRESS/DEBRIDE LRG BURN W/O ANE,16030,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,472.88,617.89,PERCENT OF TOTAL BILLED CHARGES
CHEMICAL CAUTERIZATION,17250,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,65.25,85.26,PERCENT OF TOTAL BILLED CHARGES
SKIN TISSUE,17999,CPT,450,RC,,INPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
I&D ABSCESS,4520005,CDM,450,RC,,INPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
EXPLORE WOUND,20103,CPT,450,RC,,INPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY IN MUSCLE,20520,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UC HEALTH,UC HEALTH COMMERCIAL,917.415,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
INJ TENDONS/LIGAMENTS;SINGLE,20550,CPT,320,RC,,OUTPATIENT,,,561.25,224.5,UC HEALTH,UC HEALTH COMMERCIAL,488.2875,87,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
INJ SGL/MULT TRIGGER PTS 1OR2,20552,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,UC HEALTH,UC HEALTH COMMERCIAL,488.2875,87,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
INJ SGL/MULT TRIGGER PTS 3>,20553,CPT,361,RC,,OUTPATIENT,,,561.25,224.5,UC HEALTH,UC HEALTH COMMERCIAL,488.2875,87,,,OTHER,420.94,550.03,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST SM,20600,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
ARTHRO SM W/US GUIDANCE,20604,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
JOINT ARTHOCENTESIS ASSIST MED,20605,CPT,320,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
REMOVAL MJR JOINT OR BURSA,20610,CPT,320,RC,,OUTPATIENT,,,662.75,265.1,UC HEALTH,UC HEALTH COMMERCIAL,576.5925,87,,,OTHER,497.06,649.5,PERCENT OF TOTAL BILLED CHARGES
"ARTHRO,ASSIST LG W/US GUIDANCE",20611,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
ASPIRATE/INJ GAGLION,20612,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FIXATION DEVICE;SUPER,20670,CPT,450,RC,,OUTPATIENT,,,3136.96,1254.784,UC HEALTH,UC HEALTH COMMERCIAL,2729.1552,87,,,OTHER,2352.7,3074.2,PERCENT OF TOTAL BILLED CHARGES
FLUID PRESSURE MUSCLE,20950,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD NASAL BONE FRACTURE,21310,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLOSED TRMT OF NASAL BONE FX,21315,CPT,450,RC,,OUTPATIENT,,,1297.25,518.9,UC HEALTH,UC HEALTH COMMERCIAL,1128.6075,87,,,OTHER,972.94,1271.31,PERCENT OF TOTAL BILLED CHARGES
DISLOCATION CLOSED TREATMENT,21480,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RIB FRACTURE UNCOMP,21800,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
HIP DISLOCATION W/MANIPULATION,27257,CPT,450,RC,,OUTPATIENT,,,3282.25,1312.9,UC HEALTH,UC HEALTH COMMERCIAL,2855.5575,87,,,OTHER,2461.69,3216.61,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CLAVICULAR FRACTURE,23500,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PRX HUMERAL FX W/O,23600,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DISLOCATION CLOSED SHLD UNI,23650,CPT,450,RC,,OUTPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT SHLDER W/ANES BILA,23655,CPT,450,RC,,OUTPATIENT,,,2890.9,1156.36,UC HEALTH,UC HEALTH COMMERCIAL,2515.083,87,,,OTHER,2168.2,2833.1,PERCENT OF TOTAL BILLED CHARGES
CLSD REDUCT OF SHOULDER ANES,2365550,CPT,450,RC,50,OUTPATIENT,,,3768.5,1507.4,UC HEALTH,UC HEALTH COMMERCIAL,3278.595,87,,,OTHER,2826.38,3693.13,PERCENT OF TOTAL BILLED CHARGES
CLTX SHLD DISLC W/FX HUMERAL,23665,CPT,450,RC,,OUTPATIENT,,,1500,600,UC HEALTH,UC HEALTH COMMERCIAL,1305,87,,,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT SHLD DIS W/SURG,23675,CPT,450,RC,,OUTPATIENT,,,1500,600,UC HEALTH,UC HEALTH COMMERCIAL,1305,87,,,OTHER,1125,1470,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FB UPPER ARM/ELBOW SUB,24200,CPT,450,RC,,OUTPATIENT,,,675,270,UC HEALTH,UC HEALTH COMMERCIAL,587.25,87,,,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT HUMERAL FRACTURE,24535,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT HUMERAL FX,24565,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD ELBOW DISLOCATION,24600,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRMT CLOSED ELBOW DISLOCATION,24605,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD HD W/MANIPUL,24640,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD HD W/O MANIPULATION,24650,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT RAD HD OR NK FX W/MA,24655,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
EXCISE TENDON FOREARM/WRIST,25109,CPT,450,RC,,OUTPATIENT,,,1054.5,421.8,UC HEALTH,UC HEALTH COMMERCIAL,917.415,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REPAIR TENDON FLEXOR FA/WRIST,25260,CPT,450,RC,,OUTPATIENT,,,1910.25,764.1,UC HEALTH,UC HEALTH COMMERCIAL,1661.9175,87,,,OTHER,1432.69,1872.05,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD SHAFT FRCT W/O MA,25500,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RAD SHAFT FRCT W/MAN,25505,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT FRACTURE OF RADIUS,25520,CPT,450,RC,,OUTPATIENT,,,2814.98,1125.992,UC HEALTH,UC HEALTH COMMERCIAL,2449.0326,87,,,OTHER,2111.2,2758.7,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD ULNAR SH W/O MANIP,25530,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD RADIAL&ULNAR FX,4525560,CDM,,,,INPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT RAD/ULN SHAFT,25565,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD COLLES FX W/O MANIP,25600,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT DISTAL RADIAL FRACTU,25605,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF FINGER ABS/SIMPLE,26010,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF FINGER ABSCESS,26011,CPT,450,RC,,OUTPATIENT,,,773.5,309.4,UC HEALTH,UC HEALTH COMMERCIAL,672.945,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
DISTAL PHALANX OF FINGER,26236,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
REPAIR FINGER/HAND TENDON,26350,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UC HEALTH,UC HEALTH COMMERCIAL,1611.4575,87,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
"REPAIR EXT TENDON, FINGER",26418,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UC HEALTH,UC HEALTH COMMERCIAL,1611.4575,87,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MCAPRAL FX W/O MAN,26600,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
FRACTURE W/MANIPULATION,26605,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DISL THUMB W/MANIP,26641,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CMC FX THUMB W/MANIP,26645,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD CMC DISL EX THUMB W/M,26670,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MCP DISL W/MANIP,26700,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PHALANGEAL FX W/O MAN,26720,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD PHALANGEAL FX W/MANIP,26725,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER FRACTURE,26742,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DIST PHAL FX W/O MANI,26750,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD DIST PHAL FX W/MANIP,26755,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER FRACTURE EACH,26765,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,UC HEALTH,UC HEALTH COMMERCIAL,4979.4276,87,,,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
TREATMENT JOINT DISLOCATION,26770,CPT,450,RC,,OUTPATIENT,,,442.5,177,UC HEALTH,UC HEALTH COMMERCIAL,384.975,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
TREAT FINGER DISLOCATION,26775,CPT,450,RC,,OUTPATIENT,,,580,232,UC HEALTH,UC HEALTH COMMERCIAL,504.6,87,,,OTHER,435,568.4,PERCENT OF TOTAL BILLED CHARGES
AMPUTATION OF FINGER/THUMB,26951,CPT,450,RC,,OUTPATIENT,,,3417.75,1367.1,UC HEALTH,UC HEALTH COMMERCIAL,2973.4425,87,,,OTHER,2563.31,3349.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRT FEMO FX W/MANIP,27503,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD HIP DSLOC W/O ANESTH,27250,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT HIP,27252,CPT,450,RC,,OUTPATIENT,,,1852.25,740.9,UC HEALTH,UC HEALTH COMMERCIAL,1611.4575,87,,,OTHER,1389.19,1815.21,PERCENT OF TOTAL BILLED CHARGES
POST HIP ARTHROPLASTY DISLOCAT,27265,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT POST HIP ARTHRO,27266,CPT,450,RC,,OUTPATIENT,,,887.75,355.1,UC HEALTH,UC HEALTH COMMERCIAL,772.3425,87,,,OTHER,665.81,870,PERCENT OF TOTAL BILLED CHARGES
CLTX THIGH FX W/MNPJ,27268,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
DRAIN THIGH/KNEE LESION,27301,CPT,450,RC,,OUTPATIENT,,,4791.96,1916.784,UC HEALTH,UC HEALTH COMMERCIAL,4169.0052,87,,,OTHER,3594,4696.1,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY KNEE/THIGH,27372,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,UC HEALTH,UC HEALTH COMMERCIAL,2405.7675,87,,,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
SUTURE INFRAPATELLAR TENDON PR,27380,CPT,450,RC,,OUTPATIENT,,,892.5,357,UC HEALTH,UC HEALTH COMMERCIAL,776.475,87,,,OTHER,669.38,874.65,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD OF THIGH FRACTURE,27502,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.3,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD KNEE DISL W/O ANESTHE,27550,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREAT KNEECAP,27560,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLOSED TRMT OF PATELLAR DISC,27562,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD TIBIAL FX W/O MANIP,27750,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TREATMENT OF TIBIA FRACTURE,27752,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD MEDIAL MAL FX W/O MAN,27760,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT MED MALLCOLOURS FX,27762,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,UC HEALTH,UC HEALTH COMMERCIAL,2414.4066,87,,,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,OUTPATIENT,,,2775.18,1110.072,UC HEALTH,UC HEALTH COMMERCIAL,2414.4066,87,,,OTHER,2081.4,2719.7,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT DISTAL FIBULAR FX WO,27786,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX DISTAL FIBULA W/MA,27788,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT BIMALLEOLAR ANKLE FX,27810,CPT,450,RC,,OUTPATIENT,,,634,253.6,UC HEALTH,UC HEALTH COMMERCIAL,551.58,87,,,OTHER,475.5,621.32,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT TRIMALLCOLAR ANK FX,27818,CPT,450,RC,,OUTPATIENT,,,708.75,283.5,UC HEALTH,UC HEALTH COMMERCIAL,616.6125,87,,,OTHER,531.56,694.58,PERCENT OF TOTAL BILLED CHARGES
TREAT LOWER LEG FRACTURE,27825,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,UC HEALTH,UC HEALTH COMMERCIAL,505.905,87,,,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
CLOSED TX ANKLE DISLOCATION,27840,CPT,450,RC,,OUTPATIENT,,,581.5,232.6,UC HEALTH,UC HEALTH COMMERCIAL,505.905,87,,,OTHER,436.13,569.87,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,790.88,1033.41,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,,OUTPATIENT,,,2765.25,1106.1,UC HEALTH,UC HEALTH COMMERCIAL,2405.7675,87,,,OTHER,2073.94,2709.95,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY FOOT COMPLICA,28193,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,UC HEALTH,UC HEALTH COMMERCIAL,1494.8775,87,,,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
REPAIR OF FOOT TENDON EXTENSOR,28208,CPT,450,RC,,OUTPATIENT,,,5723.48,2289.392,UC HEALTH,UC HEALTH COMMERCIAL,4979.4276,87,,,OTHER,4292.6,5609,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX GREAT TOE W/O MANI,28490,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX GREAT TOE W/MANIP,28495,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX OTH PHALANX W/O MA,28510,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD FX OTH PHALANX W/MANI,28515,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLSD TRMT TARSAL BONE DISLOC,28545,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD TARSOMETAT DISL W/O A,28600,CPT,450,RC,,OUTPATIENT,,,575,230,UC HEALTH,UC HEALTH COMMERCIAL,500.25,87,,,OTHER,431.25,563.5,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD META JOINT DISL W/O A,28630,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
TRT CLSD INTPHAL JT DISL W/O A,28660,CPT,450,RC,,OUTPATIENT,,,430,172,UC HEALTH,UC HEALTH COMMERCIAL,374.1,87,,,OTHER,322.5,421.4,PERCENT OF TOTAL BILLED CHARGES
CLTX INTERPHALANGEAL JT,28665,CPT,450,RC,,OUTPATIENT,,,675,270,UC HEALTH,UC HEALTH COMMERCIAL,587.25,87,,,OTHER,506.25,661.5,PERCENT OF TOTAL BILLED CHARGES
LONG ARM CAST,29065,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,UC HEALTH,UC HEALTH COMMERCIAL,418.2003,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION SHORT ARM CAST,29075,CPT,450,RC,,OUTPATIENT,,,480.69,192.276,UC HEALTH,UC HEALTH COMMERCIAL,418.2003,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION HAND/FOREARM CAST,29085,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LONG ARM SPLINT,29105,CPT,450,RC,,OUTPATIENT,,,361,144.4,UC HEALTH,UC HEALTH COMMERCIAL,314.07,87,,,OTHER,270.75,353.78,PERCENT OF TOTAL BILLED CHARGES
APPLY FOREARM SPLINT,29126,CPT,450,RC,,OUTPATIENT,,,331,132.4,UC HEALTH,UC HEALTH COMMERCIAL,287.97,87,,,OTHER,248.3,324.4,PERCENT OF TOTAL BILLED CHARGES
FINGER SPLINT: STATIC,29130,CPT,450,RC,,OUTPATIENT,,,287.75,115.1,UC HEALTH,UC HEALTH COMMERCIAL,250.3425,87,,,OTHER,215.81,282,PERCENT OF TOTAL BILLED CHARGES
APPLICATION OF FINGER SPLINT,29131,CPT,450,RC,,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
STRAPPING THORAX,29200,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING OF SHOULDER,29240,CPT,450,RC,,OUTPATIENT,,,912,364.8,UC HEALTH,UC HEALTH COMMERCIAL,793.44,87,,,OTHER,684,893.8,PERCENT OF TOTAL BILLED CHARGES
STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING FINGER OR HAND,29280,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LONG LEG CAST,29345,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
APPLICATION SHORT LEG CAST,29405,CPT,450,RC,,OUTPATIENT,,,455.75,182.3,UC HEALTH,UC HEALTH COMMERCIAL,396.5025,87,,,OTHER,341.81,446.64,PERCENT OF TOTAL BILLED CHARGES
STRAPPING OF HIP,29520,CPT,450,RC,,OUTPATIENT,,,297,118.8,UC HEALTH,UC HEALTH COMMERCIAL,258.39,87,,,OTHER,222.8,291.1,PERCENT OF TOTAL BILLED CHARGES
STRAPPING KNEE,29530,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING ANKLE,29540,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING TOES,29550,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
STRAPPING UNNA BOOT,29580,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
REM OR BIVALV ARM/LEG CAST,29705,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
WINDOWING OF CAST,29730,CPT,450,RC,,OUTPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
REMOVAL NASAL FOREIGN,30300,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL NASAL HEMORRHAGE SIMPL,30901,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED SIMP BI,3090150,CPT,450,RC,50,OUTPATIENT,,,233.98,93.592,UC HEALTH,UC HEALTH COMMERCIAL,203.5626,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL NASAL HEMORRHAGE COMPL,30903,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
CONTROL OF NOSEBLEED COMPLEX,3090350,CPT,450,RC,50,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
NASAL SURGERY,30999,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
ENDOTRACHEAL INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UC HEALTH,UC HEALTH COMMERCIAL,687.0825,87,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
LARYNGOSCOPY FLEXIBLE DIAG,31575,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UC HEALTH,UC HEALTH COMMERCIAL,687.0825,87,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
TRACHEOSTOMY TRANSTRACHAEL,31603,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,UC HEALTH,UC HEALTH COMMERCIAL,2856.8625,87,,,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
"TRACHEOSTOMY, EME PROCEDURE",31605,CPT,450,RC,,OUTPATIENT,,,3283.75,1313.5,UC HEALTH,UC HEALTH COMMERCIAL,2856.8625,87,,,OTHER,2462.81,3218.08,PERCENT OF TOTAL BILLED CHARGES
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,OUTPATIENT,,,385.92,154.368,UC HEALTH,UC HEALTH COMMERCIAL,335.7504,87,,,OTHER,289.4,378.2,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS,32554,CPT,450,RC,,OUTPATIENT,,,1079.54,431.816,UC HEALTH,UC HEALTH COMMERCIAL,939.1998,87,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
TUBE THORACOSTOMY,32551,CPT,450,RC,,OUTPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
THORACENTESIS;W/IMAGING,32555,CPT,361,RC,,OUTPATIENT,,,1965,786,UC HEALTH,UC HEALTH COMMERCIAL,1709.55,87,,,OTHER,1473.75,1925.7,PERCENT OF TOTAL BILLED CHARGES
PERICARDIOCENTESIS INITIAL,33010,CPT,450,RC,,OUTPATIENT,,,959.25,383.7,UC HEALTH,UC HEALTH COMMERCIAL,834.5475,87,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
INSERT ELECTRD/PM CATH SNGL,33210,CPT,450,RC,,OUTPATIENT,,,16488.76,6595.504,UC HEALTH,UC HEALTH COMMERCIAL,14345.2212,87,,,OTHER,12366.6,16159,PERCENT OF TOTAL BILLED CHARGES
REPAIR BLOOD VESSEL UPPER EXT,35206,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,UC HEALTH,UC HEALTH COMMERCIAL,2762.4675,87,,,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
"RPR BLOOD VESSEL, HAND, FINGER",35207,CPT,450,RC,,OUTPATIENT,,,2625,1050,UC HEALTH,UC HEALTH COMMERCIAL,2283.75,87,,,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
REPAIR BLD VESSEL LOWER EXTREM,35226,CPT,450,RC,,OUTPATIENT,,,3175.25,1270.1,UC HEALTH,UC HEALTH COMMERCIAL,2762.4675,87,,,OTHER,2381.44,3111.75,PERCENT OF TOTAL BILLED CHARGES
BLOOD TRANSFUSION SERV 0-1 HR,36430,CPT,391,RC,,OUTPATIENT,,,1049.75,419.9,UC HEALTH,UC HEALTH COMMERCIAL,913.2825,87,,,OTHER,787.3,1028.8,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE PLCMT ASSIST<5YRS,36555,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UC HEALTH,UC HEALTH COMMERCIAL,1770.2325,87,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
INSERT NON-TUNNEL CV CATH,36556,CPT,450,RC,,OUTPATIENT,,,5703.74,2281.496,UC HEALTH,UC HEALTH COMMERCIAL,4962.2538,87,,,OTHER,4277.8,5589.7,PERCENT OF TOTAL BILLED CHARGES
INSERT TUNNELED CV CATH,36558,CPT,450,RC,,OUTPATIENT,,,2034.75,813.9,UC HEALTH,UC HEALTH COMMERCIAL,1770.2325,87,,,OTHER,1526.06,1994.06,PERCENT OF TOTAL BILLED CHARGES
INSERT PICC CATH,36569,CPT,361,RC,,OUTPATIENT,,,1672,668.8,UC HEALTH,UC HEALTH COMMERCIAL,1454.64,87,,,OTHER,1254,1638.56,PERCENT OF TOTAL BILLED CHARGES
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,287.5,115,UC HEALTH,UC HEALTH COMMERCIAL,250.125,87,,,OTHER,215.6,281.8,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,224,89.6,UC HEALTH,UC HEALTH COMMERCIAL,194.88,87,,,OTHER,168,219.5,PERCENT OF TOTAL BILLED CHARGES
ARTERIAL CATH; PERCUTANEOUS,36620,CPT,450,RC,,OUTPATIENT,,,550,220,UC HEALTH,UC HEALTH COMMERCIAL,478.5,87,,,OTHER,412.5,539,PERCENT OF TOTAL BILLED CHARGES
THROMBOLYTIC CEREBRAL IV INFUS,37195,CPT,450,RC,,OUTPATIENT,,,619.37,247.748,UC HEALTH,UC HEALTH COMMERCIAL,538.8519,87,,,OTHER,330.75,432.18,PERCENT OF TOTAL BILLED CHARGES
UNLIST PROCEDURE SUTURE VEIN,37799,CPT,450,RC,,OUTPATIENT,,,1718.25,687.3,UC HEALTH,UC HEALTH COMMERCIAL,1494.8775,87,,,OTHER,1288.69,1683.89,PERCENT OF TOTAL BILLED CHARGES
RPR LIP FULL THICKNESS VERMILI,40650,CPT,450,RC,,OUTPATIENT,,,901.62,360.648,UC HEALTH,UC HEALTH COMMERCIAL,784.4094,87,,,OTHER,676.2,883.6,PERCENT OF TOTAL BILLED CHARGES
RPR LIP FULL THKNS>ONE-HALF HE,40654,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.4,653.9,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF MOUTH,40800,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,OUTPATIENT,,,1663.6,665.44,UC HEALTH,UC HEALTH COMMERCIAL,1447.332,87,,,OTHER,1247.7,1630.3,PERCENT OF TOTAL BILLED CHARGES
RPR FLOOR MTH AND/OR TONGUE,41250,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
"TONGUE, FLOOR OF MOUTH UNLISTE",41599,CPT,450,RC,,OUTPATIENT,,,667.25,266.9,UC HEALTH,UC HEALTH COMMERCIAL,580.5075,87,,,OTHER,500.44,653.91,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF GUM,41800,CPT,450,RC,,OUTPATIENT,,,589,235.6,UC HEALTH,UC HEALTH COMMERCIAL,512.43,87,,,OTHER,441.75,577.22,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF TONSIL ABSCESS,42700,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY PHARYNX,42809,CPT,450,RC,,OUTPATIENT,,,538.59,215.436,UC HEALTH,UC HEALTH COMMERCIAL,468.5733,87,,,OTHER,331.88,433.65,PERCENT OF TOTAL BILLED CHARGES
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,UC HEALTH,UC HEALTH COMMERCIAL,1798.1421,87,,,OTHER,499.31,652.44,PERCENT OF TOTAL BILLED CHARGES
INCISION OF RECTAL,46040,CPT,450,RC,,OUTPATIENT,,,2066.83,826.732,UC HEALTH,UC HEALTH COMMERCIAL,1798.1421,87,,,OTHER,580.13,758.03,PERCENT OF TOTAL BILLED CHARGES
I&D PERIANAL ABSCESS SUPERFCL,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UC HEALTH,UC HEALTH COMMERCIAL,1376.2269,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REMOVE EXT HEM GROUPS 2+,46250,CPT,450,RC,,OUTPATIENT,,,5432.66,2173.064,UC HEALTH,UC HEALTH COMMERCIAL,4726.4142,87,,,OTHER,4074.5,5324,PERCENT OF TOTAL BILLED CHARGES
EXC OF THROMBOSED HEMORRD EXTR,46320,CPT,450,RC,,OUTPATIENT,,,2397.5,959,UC HEALTH,UC HEALTH COMMERCIAL,2085.825,87,,,OTHER,1798.13,2349.55,PERCENT OF TOTAL BILLED CHARGES
ANOSCOPY REMOVE FOR BODY,46608,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UC HEALTH,UC HEALTH COMMERCIAL,1376.2269,87,,,OTHER,750,980,PERCENT OF TOTAL BILLED CHARGES
ABD PARACENTESIS W/O IMAGING,49082,CPT,450,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
ABD PARACENTESIS W/IMAG GUIDAN,49083,CPT,361,RC,,OUTPATIENT,,,1613.66,645.464,UC HEALTH,UC HEALTH COMMERCIAL,1403.8842,87,,,OTHER,710.63,928.55,PERCENT OF TOTAL BILLED CHARGES
DRAIN BL W/CATH INSERTION,51102,CPT,350,RC,,OUTPATIENT,,,3738.02,1495.208,UC HEALTH,UC HEALTH COMMERCIAL,3252.0774,87,,,OTHER,2803.5,3663.3,PERCENT OF TOTAL BILLED CHARGES
US URINE CAPACITY MEASURE,51798,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UC HEALTH,UC HEALTH COMMERCIAL,540.705,87,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
INCISION AND DRAINAGE SCROTUM,54700,CPT,450,RC,,OUTPATIENT,,,975,390,UC HEALTH,UC HEALTH COMMERCIAL,848.25,87,,,OTHER,731.25,955.5,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF GLAND,56420,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
INTRO ANY HEMOSTATIC AGENT,57180,CPT,450,RC,,OUTPATIENT,,,577.5,231,UC HEALTH,UC HEALTH COMMERCIAL,502.425,87,,,OTHER,433.13,565.95,PERCENT OF TOTAL BILLED CHARGES
REPAIR VAGINA/PERINEUM,57210,CPT,450,RC,,OUTPATIENT,,,6049.04,2419.616,UC HEALTH,UC HEALTH COMMERCIAL,5262.6648,87,,,OTHER,4536.8,5928.1,PERCENT OF TOTAL BILLED CHARGES
REMOVE INTRAUTERINE DEVICE,58301,CPT,450,RC,,OUTPATIENT,,,561.03,224.412,UC HEALTH,UC HEALTH COMMERCIAL,488.0961,87,,,OTHER,282.38,368.97,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE SPINAL,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,687.75,898.66,PERCENT OF TOTAL BILLED CHARGES
"INJECTION, EPIDURAL PATCH",62273,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ TRIGEMINAL,64400,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ FACIAL,64402,CPT,450,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ OCCIPITAL,64405,CPT,361,RC,,OUTPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
BILATERAL N BLOCK INJ OCCIPITA,6445050,CPT,450,RC,50,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,801.75,1047.62,PERCENT OF TOTAL BILLED CHARGES
INJ ANES/SCIATIC NERVE SINGLE,64445,CPT,450,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
NJX AA&/STRD FEMORAL NERVE,64447,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,UC HEALTH,UC HEALTH COMMERCIAL,527.655,87,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,606.5,242.6,UC HEALTH,UC HEALTH COMMERCIAL,527.655,87,,,OTHER,454.88,594.37,PERCENT OF TOTAL BILLED CHARGES
N BLOCK INJ PERIPHERAL BILAT,64450,CPT,361,RC,,OUTPATIENT,,,1298.5,519.4,UC HEALTH,UC HEALTH COMMERCIAL,1129.695,87,,,OTHER,973.9,1272.5,PERCENT OF TOTAL BILLED CHARGES
NERVE BLOCK UNLISTED,64999,CPT,361,RC,,OUTPATIENT,,,528.02,211.208,UC HEALTH,UC HEALTH COMMERCIAL,459.3774,87,,,OTHER,396,517.5,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY EYE EXTERNAL,65205,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UC HEALTH,UC HEALTH COMMERCIAL,604.4325,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
REMOVAL FOREIGN BODY CORNEAL,65220,CPT,450,RC,,OUTPATIENT,,,707.75,283.1,UC HEALTH,UC HEALTH COMMERCIAL,615.7425,87,,,OTHER,530.81,693.6,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY CORNEAL W/SLI,65222,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UC HEALTH,UC HEALTH COMMERCIAL,604.4325,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
REMOVE FOREIGN BODY FROM EYE,65235,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UC HEALTH,UC HEALTH COMMERCIAL,604.4325,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF EYELID ABCESS,67700,CPT,450,RC,,OUTPATIENT,,,563.64,225.456,UC HEALTH,UC HEALTH COMMERCIAL,490.3668,87,,,OTHER,422.7,552.4,PERCENT OF TOTAL BILLED CHARGES
CANTHOTOMY,67715,CPT,450,RC,,OUTPATIENT,,,2205,882,UC HEALTH,UC HEALTH COMMERCIAL,1918.35,87,,,OTHER,1653.75,2160.9,PERCENT OF TOTAL BILLED CHARGES
REPAIR EYELID WOUND,67935,CPT,450,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
REMOVE FOREIGN BODY EYELID,67938,CPT,450,RC,,OUTPATIENT,,,694.75,277.9,UC HEALTH,UC HEALTH COMMERCIAL,604.4325,87,,,OTHER,521.06,680.86,PERCENT OF TOTAL BILLED CHARGES
DRAIN EXTERNAL EAR LESION,69000,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
REM FOREIGN BODY EAR,69200,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UC HEALTH,UC HEALTH COMMERCIAL,246.4275,87,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
FOREIGN BODY REMOVAL EAR W/GA,69205,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UC HEALTH,UC HEALTH COMMERCIAL,246.4275,87,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
REMOVE IMPACTED EAR WAX UNI,69209,CPT,450,RC,,OUTPATIENT,,,115.84,46.336,UC HEALTH,UC HEALTH COMMERCIAL,100.7808,87,,,OTHER,86.9,113.5,PERCENT OF TOTAL BILLED CHARGES
REM IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,283.25,113.3,UC HEALTH,UC HEALTH COMMERCIAL,246.4275,87,,,OTHER,212.44,277.59,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE ULTRASOUND OF THE EYES,7651250,CPT,450,RC,50,OUTPATIENT,,,943,377.2,UC HEALTH,UC HEALTH COMMERCIAL,820.41,87,,,OTHER,707.25,924.14,PERCENT OF TOTAL BILLED CHARGES
BEDSIDE ULTRASOUND OF THE EYE,76512,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UC HEALTH,UC HEALTH COMMERCIAL,410.205,87,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,OUTPATIENT,,,795,318,UC HEALTH,UC HEALTH COMMERCIAL,691.65,87,,,OTHER,457.69,598.05,PERCENT OF TOTAL BILLED CHARGES
US CHEST REAL TIME W/IMAGE DOC,76604,CPT,402,RC,,OUTPATIENT,,,398.5,159.4,UC HEALTH,UC HEALTH COMMERCIAL,346.695,87,,,OTHER,298.88,390.53,PERCENT OF TOTAL BILLED CHARGES
US BREAST LIMITED UNILAT,76642,CPT,402,RC,,OUTPATIENT,,,196.25,78.5,UC HEALTH,UC HEALTH COMMERCIAL,170.7375,87,,,OTHER,147.19,192.33,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US ABDOMEN, COMPLETE",76700,CPT,402,RC,,OUTPATIENT,,,605.5,242.2,UC HEALTH,UC HEALTH COMMERCIAL,526.785,87,,,OTHER,454.13,593.39,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE ABDOMEN, LIMITED",76705,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UC HEALTH,UC HEALTH COMMERCIAL,410.205,87,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
"US RETROPERITONEAL, LIMITED",76775,CPT,402,RC,,OUTPATIENT,,,558.5,223.4,UC HEALTH,UC HEALTH COMMERCIAL,485.895,87,,,OTHER,418.88,547.33,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US, PREGNANT UTERUS",76815,CPT,402,RC,,OUTPATIENT,,,471.5,188.6,UC HEALTH,UC HEALTH COMMERCIAL,410.205,87,,,OTHER,353.63,462.07,PERCENT OF TOTAL BILLED CHARGES
PELVIC LIMITED,76857,CPT,402,RC,,OUTPATIENT,,,639.25,255.7,UC HEALTH,UC HEALTH COMMERCIAL,556.1475,87,,,OTHER,479.44,626.47,PERCENT OF TOTAL BILLED CHARGES
"BEDSIDE US,LIMITED NONVAS EXTR",76882,CPT,402,RC,,OUTPATIENT,,,277.25,110.9,UC HEALTH,UC HEALTH COMMERCIAL,241.2075,87,,,OTHER,207.94,271.71,PERCENT OF TOTAL BILLED CHARGES
US GUIDANCE NEEDLE PLCMNT,76942,CPT,402,RC,,OUTPATIENT,,,916.75,366.7,UC HEALTH,UC HEALTH COMMERCIAL,797.5725,87,,,OTHER,687.56,898.42,PERCENT OF TOTAL BILLED CHARGES
BURN SUPPLIES,459002,CDM,,,,INPATIENT,,,1710.5,684.2,UC HEALTH,UC HEALTH COMMERCIAL,1488.135,87,,,OTHER,1282.88,1676.29,PERCENT OF TOTAL BILLED CHARGES
INJ INTER ARTERIAL,96373,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,137.06,179.1,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
INJ THER/PROPH/DIAG SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,157,62.8,UC HEALTH,UC HEALTH COMMERCIAL,136.59,87,,,OTHER,117.75,153.86,PERCENT OF TOTAL BILLED CHARGES
GASTRIC LAVAGE,43753,CPT,450,RC,,OUTPATIENT,,,527.09,210.836,UC HEALTH,UC HEALTH COMMERCIAL,458.5683,87,,,OTHER,273,356.72,PERCENT OF TOTAL BILLED CHARGES
OPHTHALMOLOGICAL EXAM AND EVAL,92002,CPT,450,RC,,OUTPATIENT,,,270,108,UC HEALTH,UC HEALTH COMMERCIAL,234.9,87,,,OTHER,202.5,264.6,PERCENT OF TOTAL BILLED CHARGES
DIAGNOSTIC NASOPHARYNGOSCOPY,92511,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UC HEALTH,UC HEALTH COMMERCIAL,687.0825,87,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
CARDIAC ARREST CPR,92950,CPT,450,RC,,OUTPATIENT,,,998,399.2,UC HEALTH,UC HEALTH COMMERCIAL,868.26,87,,,OTHER,748.5,978.04,PERCENT OF TOTAL BILLED CHARGES
CARDIOVERSION ELECTIVE,92960,CPT,450,RC,,OUTPATIENT,,,1481.5,592.6,UC HEALTH,UC HEALTH COMMERCIAL,1288.905,87,,,OTHER,1111.13,1451.87,PERCENT OF TOTAL BILLED CHARGES
"TRANSTHORACIC ECHO, LIMITED",93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UC HEALTH,UC HEALTH COMMERCIAL,418.905,87,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
US LE ART;UNILAT OR LIMITED,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,UC HEALTH,UC HEALTH COMMERCIAL,466.755,87,,,OTHER,402.38,525.77,PERCENT OF TOTAL BILLED CHARGES
US VENOUS LIMITED - BEDSIDE,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,UC HEALTH,UC HEALTH COMMERCIAL,807.795,87,,,OTHER,696.38,909.93,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SAME DRUG,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IRRIG DRUG DELIVERY DEVICE,96523,CPT,260,RC,,OUTPATIENT,,,172,68.8,UC HEALTH,UC HEALTH COMMERCIAL,149.64,87,,,OTHER,129,168.56,PERCENT OF TOTAL BILLED CHARGES
ACTIVE WOUND CARE <20CM,97597,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,168.75,220.5,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP <5 YRS,99151,CPT,450,RC,,OUTPATIENT,,,340,136,UC HEALTH,UC HEALTH COMMERCIAL,295.8,87,,,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP 5/>YRS,99152,CPT,761,RC,,OUTPATIENT,,,650,260,UC HEALTH,UC HEALTH COMMERCIAL,565.5,87,,,OTHER,487.5,637,PERCENT OF TOTAL BILLED CHARGES
MOD SED SAME PHYS/QHP EA,99153,CPT,761,RC,,OUTPATIENT,,,340,136,UC HEALTH,UC HEALTH COMMERCIAL,295.8,87,,,OTHER,255,333.2,PERCENT OF TOTAL BILLED CHARGES
MOD SED OTH PHYS/QHP 5>YRS,99156,CPT,450,RC,,OUTPATIENT,,,335,134,UC HEALTH,UC HEALTH COMMERCIAL,291.45,87,,,OTHER,251.3,328.3,PERCENT OF TOTAL BILLED CHARGES
MOD SED OTHER PHYS/QHP EA,99157,CPT,450,RC,,OUTPATIENT,,,189.5,75.8,UC HEALTH,UC HEALTH COMMERCIAL,164.865,87,,,OTHER,142.1,185.7,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 1 W/O MODIFIER,99281,CPT,450,RC,,OUTPATIENT,,,281.25,112.5,UC HEALTH,UC HEALTH COMMERCIAL,244.6875,87,,,OTHER,210.94,275.63,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 2 W/O MODIFIER,99282,CPT,450,RC,,OUTPATIENT,,,371.25,148.5,UC HEALTH,UC HEALTH COMMERCIAL,322.9875,87,,,OTHER,278.44,363.83,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 3 W/O MODIFIER,99283,CPT,450,RC,,OUTPATIENT,,,461.62,184.648,UC HEALTH,UC HEALTH COMMERCIAL,401.6094,87,,,OTHER,325.88,425.81,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 4 W/O MODIFIER,99284,CPT,450,RC,,OUTPATIENT,,,820.25,328.1,UC HEALTH,UC HEALTH COMMERCIAL,713.6175,87,,,OTHER,615.19,803.85,PERCENT OF TOTAL BILLED CHARGES
ER ACUITY 5 W/O MODIFIER,99285,CPT,450,RC,,OUTPATIENT,,,1448.5,579.4,UC HEALTH,UC HEALTH COMMERCIAL,1260.195,87,,,OTHER,1086.38,1419.53,PERCENT OF TOTAL BILLED CHARGES
BI-PAP SUBSEQUENT DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UC HEALTH,UC HEALTH COMMERCIAL,573.33,87,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
ETCO2 FIRST DAY,94770,CPT,460,RC,,OUTPATIENT,,,222.75,89.1,UC HEALTH,UC HEALTH COMMERCIAL,193.7925,87,,,OTHER,167.06,218.3,PERCENT OF TOTAL BILLED CHARGES
BI-PAP FIRST DAY,94660,CPT,460,RC,,OUTPATIENT,,,659,263.6,UC HEALTH,UC HEALTH COMMERCIAL,573.33,87,,,OTHER,494.25,645.82,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY ONCE DAILY,94760,CPT,460,RC,,OUTPATIENT,,,96.25,38.5,UC HEALTH,UC HEALTH COMMERCIAL,83.7375,87,,,OTHER,72.19,94.33,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY MULTIPLES DAILY,94761,CPT,460,RC,,OUTPATIENT,,,275.5,110.2,UC HEALTH,UC HEALTH COMMERCIAL,239.685,87,,,OTHER,206.63,269.99,PERCENT OF TOTAL BILLED CHARGES
PEAK FLOW MONITORING,4600043,CDM,270,RC,,INPATIENT,,,124.5,49.8,UC HEALTH,UC HEALTH COMMERCIAL,108.315,87,,,OTHER,93.38,122.01,PERCENT OF TOTAL BILLED CHARGES
PFT  SPIROMETRY  PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UC HEALTH,UC HEALTH COMMERCIAL,281.88,87,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UC HEALTH,UC HEALTH COMMERCIAL,281.88,87,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
SPIROMETRY PRE/POST BRDIAL,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
PFT SPIROMETRY PRE/POST BRDIA,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSPASM PROVOCATION EVAL,94070,CPT,460,RC,,OUTPATIENT,,,874.25,349.7,UC HEALTH,UC HEALTH COMMERCIAL,760.5975,87,,,OTHER,655.69,856.77,PERCENT OF TOTAL BILLED CHARGES
PFT  LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,UC HEALTH,UC HEALTH COMMERCIAL,581.595,87,,,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
PFT  DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,UC HEALTH,UC HEALTH COMMERCIAL,292.755,87,,,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
VITALOR SCREENING,94150,CPT,460,RC,,OUTPATIENT,,,278.15,111.26,UC HEALTH,UC HEALTH COMMERCIAL,241.9905,87,,,OTHER,107.44,140.39,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY NOCTURNAL STUDY,94762,CPT,460,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,160.31,209.48,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY WITH AMBULATION,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,UC HEALTH,UC HEALTH COMMERCIAL,167.475,87,,,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.5,315.8,UC HEALTH,UC HEALTH COMMERCIAL,686.865,87,,,OTHER,592.13,773.71,PERCENT OF TOTAL BILLED CHARGES
CARDIOPULMONARY RESUSCITATION,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,UC HEALTH,UC HEALTH COMMERCIAL,867.825,87,,,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
CARDIAC EVENT MONITER SETUP,93270,CPT,480,RC,,OUTPATIENT,,,412,164.8,UC HEALTH,UC HEALTH COMMERCIAL,358.44,87,,,OTHER,309,403.76,PERCENT OF TOTAL BILLED CHARGES
VENTILATION RESCUE BREATHING,92950,CPT,450,RC,,OUTPATIENT,,,997.5,399,UC HEALTH,UC HEALTH COMMERCIAL,867.825,87,,,OTHER,748.13,977.55,PERCENT OF TOTAL BILLED CHARGES
ECHO 3D/M MODE & COLOR DOPPLER,C8929,HCPCS,480,RC,,INPATIENT,,,2595.5,1038.2,UC HEALTH,UC HEALTH COMMERCIAL,2258.085,87,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
GRADED EXERCISE BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UC HEALTH,UC HEALTH COMMERCIAL,1010.2875,87,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
GRADED EXERCISE TEST,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UC HEALTH,UC HEALTH COMMERCIAL,1010.2875,87,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
GXT STD THREADMILL WALKING,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UC HEALTH,UC HEALTH COMMERCIAL,1010.2875,87,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
PHARM STRESS TEST BUNDLE,93017,CPT,482,RC,,OUTPATIENT,,,1161.25,464.5,UC HEALTH,UC HEALTH COMMERCIAL,1010.2875,87,,,OTHER,870.94,1138.03,PERCENT OF TOTAL BILLED CHARGES
PULMONARY STRESS TESTING 6 MIN,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,UC HEALTH,UC HEALTH COMMERCIAL,2258.085,87,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
AE PFT SPIROMETRY PRE/POST BRD,94060,CPT,460,RC,,OUTPATIENT,,,600,240,UC HEALTH,UC HEALTH COMMERCIAL,522,87,,,OTHER,450,588,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE&COLOR DOP W/C,C8929,HCPCS,480,RC,,BOTH,,,2595.5,1038.2,UC HEALTH,UC HEALTH COMMERCIAL,2258.085,87,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
AE MDI INHALER TX INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
AE MDI INHALER TX SUBSEQUENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,UC HEALTH,UC HEALTH COMMERCIAL,1566.6525,87,,,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE LIMITED,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UC HEALTH,UC HEALTH COMMERCIAL,418.905,87,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE & COLOR DOPPLER,93306,CPT,480,RC,,OUTPATIENT,,,2595.5,1038.2,UC HEALTH,UC HEALTH COMMERCIAL,2258.085,87,,,OTHER,1946.63,2543.59,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE NO DOPPLER,93307,CPT,480,RC,,OUTPATIENT,,,1800.75,720.3,UC HEALTH,UC HEALTH COMMERCIAL,1566.6525,87,,,OTHER,1350.56,1764.74,PERCENT OF TOTAL BILLED CHARGES
ECHO 2D/M MODE LIMITED STUDY,93308,CPT,480,RC,,OUTPATIENT,,,481.5,192.6,UC HEALTH,UC HEALTH COMMERCIAL,418.905,87,,,OTHER,361.13,471.87,PERCENT OF TOTAL BILLED CHARGES
STRESS ECHO TECHNICAL,93350,CPT,480,RC,,OUTPATIENT,,,1572.25,628.9,UC HEALTH,UC HEALTH COMMERCIAL,1367.8575,87,,,OTHER,1179.19,1540.81,PERCENT OF TOTAL BILLED CHARGES
AE NEB MED AEROSOL INITIAL,94664,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,103.31,135,PERCENT OF TOTAL BILLED CHARGES
AE NEB SUBSEQUENT MED AEROSOL,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
AE PEAK FLOW MONITORING,4830104,CDM,270,RC,,INPATIENT,,,124.5,49.8,UC HEALTH,UC HEALTH COMMERCIAL,108.315,87,,,OTHER,93.38,122.01,PERCENT OF TOTAL BILLED CHARGES
AE PFT SPIROMETRY PRE ONLY,94010,CPT,460,RC,,OUTPATIENT,,,324,129.6,UC HEALTH,UC HEALTH COMMERCIAL,281.88,87,,,OTHER,243,317.52,PERCENT OF TOTAL BILLED CHARGES
AE PFT LUNG VOLUMES,94726,CPT,460,RC,,OUTPATIENT,,,668.5,267.4,UC HEALTH,UC HEALTH COMMERCIAL,581.595,87,,,OTHER,501.38,655.13,PERCENT OF TOTAL BILLED CHARGES
AE PFT DIFFUSION CAPACITY,94729,CPT,460,RC,,OUTPATIENT,,,336.5,134.6,UC HEALTH,UC HEALTH COMMERCIAL,292.755,87,,,OTHER,252.38,329.77,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION EA ADD'L HOUR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL I,96360,CPT,450,RC,,OUTPATIENT,,,590.5,236.2,UC HEALTH,UC HEALTH COMMERCIAL,513.735,87,,,OTHER,442.88,578.69,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL II,96360,CPT,450,RC,,OUTPATIENT,,,522.5,209,UC HEALTH,UC HEALTH COMMERCIAL,454.575,87,,,OTHER,391.88,512.05,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION INITIAL LEVEL III,96360,CPT,450,RC,,OUTPATIENT,,,532.25,212.9,UC HEALTH,UC HEALTH COMMERCIAL,463.0575,87,,,OTHER,399.19,521.61,PERCENT OF TOTAL BILLED CHARGES
MINOR EXCISION SETUP,5100040,CDM,,,,INPATIENT,,,193.75,77.5,UC HEALTH,UC HEALTH COMMERCIAL,168.5625,87,,,OTHER,145.31,189.88,PERCENT OF TOTAL BILLED CHARGES
MINOR WOUND DEBRIDEMENT,5100050,CDM,,,,INPATIENT,,,177.5,71,UC HEALTH,UC HEALTH COMMERCIAL,154.425,87,,,OTHER,133.13,173.95,PERCENT OF TOTAL BILLED CHARGES
PICC LINE INSERTION,36489,CPT,361,RC,,OUTPATIENT,,,839.5,335.8,UC HEALTH,UC HEALTH COMMERCIAL,730.365,87,,,OTHER,629.63,822.71,PERCENT OF TOTAL BILLED CHARGES
STERILE DRESSING,5100080,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
EVAL & MGMT CLINICAL VISIT,G0463,HCPCS,510,RC,,BOTH,,,232,92.8,UC HEALTH,UC HEALTH COMMERCIAL,201.84,87,,,OTHER,126.94,165.87,PERCENT OF TOTAL BILLED CHARGES
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,INPATIENT,,,15,6,UC HEALTH,UC HEALTH COMMERCIAL,13.05,87,,,OTHER,11.3,14.7,PERCENT OF TOTAL BILLED CHARGES
SCHOOL/CAMP PHY LEVEL 1,P99901,HCPCS,516,RC,,OUTPATIENT,,,35,14,UC HEALTH,UC HEALTH COMMERCIAL,30.45,87,,,OTHER,26.25,34.3,PERCENT OF TOTAL BILLED CHARGES
DOT PHYSICAL,P99904,HCPCS,516,RC,,OUTPATIENT,,,170,68,UC HEALTH,UC HEALTH COMMERCIAL,147.9,87,,,OTHER,127.5,166.6,PERCENT OF TOTAL BILLED CHARGES
"CLINDAMYCIN PHOSP, 300MG INJ",S0077,HCPCS,,,,OUTPATIENT,,,22,8.8,UC HEALTH,UC HEALTH COMMERCIAL,19.14,87,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG,S0119,HCPCS,,,,OUTPATIENT,,,39,15.6,UC HEALTH,UC HEALTH COMMERCIAL,33.93,87,,,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
SPLINT DIGIT,S8450,HCPCS,516,RC,,OUTPATIENT,,,5,2,UC HEALTH,UC HEALTH COMMERCIAL,4.35,87,,,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 1 MG,Q0162,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL IPRATROP NON-COMP,J7620,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
"ALBUTEROL, INHALATION SOLUTION",J7613,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
PR PREDNISONE IMMEDIATE RELEAS,J7512,HCPCS,516,RC,,OUTPATIENT,,,0.05,0.02,UC HEALTH,UC HEALTH COMMERCIAL,0.0435,87,,,OTHER,0.04,0.05,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE ORAL,J7506,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 250CC BAG,J7050,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
NORMAL SALINE 1000CC BAG,J7030,HCPCS,516,RC,,OUTPATIENT,,,5,2,UC HEALTH,UC HEALTH COMMERCIAL,4.35,87,,,OTHER,3.75,4.9,PERCENT OF TOTAL BILLED CHARGES
TRIAMCINOLONE ACETONIDE INJ,J3301,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,UC HEALTH,UC HEALTH COMMERCIAL,3.48,87,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2930,HCPCS,516,RC,,OUTPATIENT,,,9,3.6,UC HEALTH,UC HEALTH COMMERCIAL,7.83,87,,,OTHER,6.75,8.82,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE INJECTION,J2920,HCPCS,516,RC,,OUTPATIENT,,,6,2.4,UC HEALTH,UC HEALTH COMMERCIAL,5.22,87,,,OTHER,4.5,5.88,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE HCL INJECTION,J2550,HCPCS,516,RC,,OUTPATIENT,,,4,1.6,UC HEALTH,UC HEALTH COMMERCIAL,3.48,87,,,OTHER,3,3.92,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON HCL INJECTION,J2405,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC TROMETHAMINE INJ,J1885,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UC HEALTH,UC HEALTH COMMERCIAL,1.74,87,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE HCL INJECTIO,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UC HEALTH,UC HEALTH COMMERCIAL,1.74,87,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE SODIUM PHOS,J1100,HCPCS,516,RC,,OUTPATIENT,,,1,0.4,UC HEALTH,UC HEALTH COMMERCIAL,0.87,87,,,OTHER,0.75,0.98,PERCENT OF TOTAL BILLED CHARGES
ROCEPHIN INJ,J0696,HCPCS,516,RC,,OUTPATIENT,,,2,0.8,UC HEALTH,UC HEALTH COMMERCIAL,1.74,87,,,OTHER,1.5,1.96,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G BENZATHINE INJ,J0561,HCPCS,516,RC,,OUTPATIENT,,,20,8,UC HEALTH,UC HEALTH COMMERCIAL,17.4,87,,,OTHER,15,19.6,PERCENT OF TOTAL BILLED CHARGES
PENG BENZATHINE/PROCAINE INJ,J0558,HCPCS,516,RC,,OUTPATIENT,,,15,6,UC HEALTH,UC HEALTH COMMERCIAL,13.05,87,,,OTHER,11.25,14.7,PERCENT OF TOTAL BILLED CHARGES
"REMOVE FOREIGN BODY, SIM",10120,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,294,384.16,PERCENT OF TOTAL BILLED CHARGES
PUNCTURE DRAINAGE OF LESION,10160,CPT,350,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,251.25,328.3,PERCENT OF TOTAL BILLED CHARGES
"REMOVAL OF NAIL PLATE, SINGLE",11730,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,189.75,247.94,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND TR 2.5CM/<,12001,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,172.5,225.4,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND TRNK 2.6-7.5CM,12002,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,210.75,275.38,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUND FA 2.5 CM/<,12011,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,211.5,276.36,PERCENT OF TOTAL BILLED CHARGES
RPR SF WOUNDS FA 5.1-7.5 CM,12014,CPT,450,RC,,OUTPATIENT,,,365,146,UC HEALTH,UC HEALTH COMMERCIAL,317.55,87,,,OTHER,273.75,357.7,PERCENT OF TOTAL BILLED CHARGES
"LAYER CLOSURE OF WOUNDS, HAND",12041,CPT,450,RC,,OUTPATIENT,,,689.31,275.724,UC HEALTH,UC HEALTH COMMERCIAL,599.6997,87,,,OTHER,464.25,606.62,PERCENT OF TOTAL BILLED CHARGES
"BURN TREATMENT W/O ANES, SM",16020,CPT,450,RC,,OUTPATIENT,,,357.87,143.148,UC HEALTH,UC HEALTH COMMERCIAL,311.3469,87,,,OTHER,158.25,206.78,PERCENT OF TOTAL BILLED CHARGES
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,450,RC,,OUTPATIENT,,,1239.69,495.876,UC HEALTH,UC HEALTH COMMERCIAL,1078.5303,87,,,OTHER,503.25,657.58,PERCENT OF TOTAL BILLED CHARGES
APPLY FOREARM SPLINT,29125,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,124.5,162.68,PERCENT OF TOTAL BILLED CHARGES
APPLICATION OF FINGER SPLINT,29130,CPT,450,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,78.75,102.9,PERCENT OF TOTAL BILLED CHARGES
APPLICATION LOWER LEG SPLINT,29515,CPT,450,RC,,OUTPATIENT,,,281.39,112.556,UC HEALTH,UC HEALTH COMMERCIAL,244.8093,87,,,OTHER,139.5,182.28,PERCENT OF TOTAL BILLED CHARGES
ROUTINE VENIPUNCTURE,36415,CPT,300,RC,,OUTPATIENT,,,8,3.2,UC HEALTH,UC HEALTH COMMERCIAL,6.96,87,,,OTHER,6,7.84,PERCENT OF TOTAL BILLED CHARGES
DRAINAGE OF ANAL ABSCESS,46050,CPT,450,RC,,OUTPATIENT,,,1581.87,632.748,UC HEALTH,UC HEALTH COMMERCIAL,1376.2269,87,,,OTHER,393,513.52,PERCENT OF TOTAL BILLED CHARGES
INCISE EXTERNAL HEMORRHOID,46083,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,UC HEALTH,UC HEALTH COMMERCIAL,461.5002,87,,,OTHER,342,446.88,PERCENT OF TOTAL BILLED CHARGES
INJ NERVE BLOCK PERIPHERAL,64450,CPT,361,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,155.25,202.86,PERCENT OF TOTAL BILLED CHARGES
CLEAR OUTER EAR CANAL,69200,CPT,450,RC,,OUTPATIENT,,,318,127.2,UC HEALTH,UC HEALTH COMMERCIAL,276.66,87,,,OTHER,238.5,311.64,PERCENT OF TOTAL BILLED CHARGES
REMOVE IMPACTED EAR WAX,69210,CPT,450,RC,,OUTPATIENT,,,127,50.8,UC HEALTH,UC HEALTH COMMERCIAL,110.49,87,,,OTHER,95.25,124.46,PERCENT OF TOTAL BILLED CHARGES
DRUG TEST PRSMV DIR OPT OBS,80305,CPT,300,RC,,OUTPATIENT,,,17.92,7.168,UC HEALTH,UC HEALTH COMMERCIAL,15.5904,87,,,OTHER,13.4,17.6,PERCENT OF TOTAL BILLED CHARGES
URINALYSIS COMPLETE,81001,CPT,307,RC,,OUTPATIENT,,,9,3.6,UC HEALTH,UC HEALTH COMMERCIAL,7.83,87,,,OTHER,6.8,8.8,PERCENT OF TOTAL BILLED CHARGES
"URINALYSIS, NON AUTOMATED",81002,CPT,307,RC,,OUTPATIENT,,,9,3.6,UC HEALTH,UC HEALTH COMMERCIAL,7.83,87,,,OTHER,6.75,8.82,PERCENT OF TOTAL BILLED CHARGES
URINE PREGNANCY TEST,81025,CPT,300,RC,,OUTPATIENT,,,22,8.8,UC HEALTH,UC HEALTH COMMERCIAL,19.14,87,,,OTHER,16.5,21.56,PERCENT OF TOTAL BILLED CHARGES
UR ALBUMIN SEMIQUANTITATIVE,82044,CPT,,,,OUTPATIENT,,,16,6.4,UC HEALTH,UC HEALTH COMMERCIAL,13.92,87,,,OTHER,12,15.7,PERCENT OF TOTAL BILLED CHARGES
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,OUTPATIENT,,,11,4.4,UC HEALTH,UC HEALTH COMMERCIAL,9.57,87,,,OTHER,8.3,10.8,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE TEST,82950,CPT,301,RC,,OUTPATIENT,,,16,6.4,UC HEALTH,UC HEALTH COMMERCIAL,13.92,87,,,OTHER,12,15.7,PERCENT OF TOTAL BILLED CHARGES
GLUCOSE BLOOD TEST,82962,CPT,300,RC,,OUTPATIENT,,,6.56,2.624,UC HEALTH,UC HEALTH COMMERCIAL,5.7072,87,,,OTHER,4.5,5.88,PERCENT OF TOTAL BILLED CHARGES
HEMOGLOBIN HGB (A1C),83036,CPT,301,RC,,OUTPATIENT,,,33,13.2,UC HEALTH,UC HEALTH COMMERCIAL,28.71,87,,,OTHER,24.8,32.3,PERCENT OF TOTAL BILLED CHARGES
PROTHROMBIN TIME,85610,CPT,300,RC,,OUTPATIENT,,,13,5.2,UC HEALTH,UC HEALTH COMMERCIAL,11.31,87,,,OTHER,9.8,12.7,PERCENT OF TOTAL BILLED CHARGES
SMEAR WET MOUNT SALINE/INK,87210,CPT,300,RC,,OUTPATIENT,,,15,6,UC HEALTH,UC HEALTH COMMERCIAL,13.05,87,,,OTHER,11.3,14.7,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA DNA AMP PROBE,87502,CPT,306,RC,,OUTPATIENT,,,117,46.8,UC HEALTH,UC HEALTH COMMERCIAL,101.79,87,,,OTHER,87.8,114.7,PERCENT OF TOTAL BILLED CHARGES
RSV DNA/RNA AMP PROBE,87634,CPT,300,RC,,OUTPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.8,95.1,PERCENT OF TOTAL BILLED CHARGES
COVID19 SARS2 RNA QUAL RT PCR,87635,CPT,300,RC,,OUTPATIENT,,,100.2,40.08,UC HEALTH,UC HEALTH COMMERCIAL,87.174,87,,,OTHER,75.2,98.2,PERCENT OF TOTAL BILLED CHARGES
STREP A DNA AMP PROBE,87651,CPT,300,RC,,OUTPATIENT,,,54,21.6,UC HEALTH,UC HEALTH COMMERCIAL,46.98,87,,,OTHER,40.5,52.9,PERCENT OF TOTAL BILLED CHARGES
DETECT AGNT MULT DNA AMPLI,87801,CPT,300,RC,,OUTPATIENT,,,98,39.2,UC HEALTH,UC HEALTH COMMERCIAL,85.26,87,,,OTHER,73.5,96,PERCENT OF TOTAL BILLED CHARGES
"INFCT ANTIGEN, INFLUENZA",87804,CPT,300,RC,,OUTPATIENT,,,41,16.4,UC HEALTH,UC HEALTH COMMERCIAL,35.67,87,,,OTHER,30.75,40.18,PERCENT OF TOTAL BILLED CHARGES
"INFCTS ANTIGN, STREPTOCOCCUS A",87880,CPT,300,RC,,OUTPATIENT,,,47,18.8,UC HEALTH,UC HEALTH COMMERCIAL,40.89,87,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
"IMMUN ADMIN 1 VAC, SNGL/COMBO",90471,CPT,761,RC,,OUTPATIENT,,,123.52,49.408,UC HEALTH,UC HEALTH COMMERCIAL,107.4624,87,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
TD VACCINE NO PRSRV 7/> IM,90714,CPT,516,RC,,OUTPATIENT,,,53,21.2,UC HEALTH,UC HEALTH COMMERCIAL,46.11,87,,,OTHER,39.75,51.94,PERCENT OF TOTAL BILLED CHARGES
TDAP IMMUNIZATION,90715,CPT,516,RC,,OUTPATIENT,,,79,31.6,UC HEALTH,UC HEALTH COMMERCIAL,68.73,87,,,OTHER,59.25,77.42,PERCENT OF TOTAL BILLED CHARGES
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,OUTPATIENT,,,22,8.8,UC HEALTH,UC HEALTH COMMERCIAL,19.14,87,,,OTHER,16.5,21.6,PERCENT OF TOTAL BILLED CHARGES
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,35.25,46.06,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION INITIAL;31-60 MINS,96360,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,110.25,144.06,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION EA ADDT'L HR,96361,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,UC HEALTH,UC HEALTH COMMERCIAL,69.3651,87,,,OTHER,29.25,38.22,PERCENT OF TOTAL BILLED CHARGES
"INJ, THERAPEUTIC OR DIAGNOSTIC",96372,CPT,260,RC,,OUTPATIENT,,,123.52,49.408,UC HEALTH,UC HEALTH COMMERCIAL,107.4624,87,,,OTHER,48,62.72,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SINGLE OR INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,405.61,162.244,UC HEALTH,UC HEALTH COMMERCIAL,352.8807,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
IV PUSH EA NEW ADDT'L DRUGS,96375,CPT,450,RC,,OUTPATIENT,,,79.73,31.892,UC HEALTH,UC HEALTH COMMERCIAL,69.3651,87,,,OTHER,42.75,55.86,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW",99201,CPT,516,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
OFFICE/OP VISIT NEW,99202,CPT,516,RC,,OUTPATIENT,,,190,76,UC HEALTH,UC HEALTH COMMERCIAL,165.3,87,,,OTHER,142.5,186.2,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99203,CPT,516,RC,,OUTPATIENT,,,277,110.8,UC HEALTH,UC HEALTH COMMERCIAL,240.99,87,,,OTHER,207.75,271.46,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, NEW, MOD",99204,CPT,516,RC,,OUTPATIENT,,,421,168.4,UC HEALTH,UC HEALTH COMMERCIAL,366.27,87,,,OTHER,315.75,412.58,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MIN",99211,CPT,510,RC,,OUTPATIENT,,,51,20.4,UC HEALTH,UC HEALTH COMMERCIAL,44.37,87,,,OTHER,38.25,49.98,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT EST, LOW",99212,CPT,510,RC,,OUTPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.76,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST MOD",99213,CPT,510,RC,,OUTPATIENT,,,185,74,UC HEALTH,UC HEALTH COMMERCIAL,160.95,87,,,OTHER,138.75,181.3,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, MOD",99214,CPT,510,RC,,OUTPATIENT,,,274,109.6,UC HEALTH,UC HEALTH COMMERCIAL,238.38,87,,,OTHER,205.5,268.52,PERCENT OF TOTAL BILLED CHARGES
"OFFICE/OP VISIT, EST, HIGH",99215,CPT,510,RC,,OUTPATIENT,,,371,148.4,UC HEALTH,UC HEALTH COMMERCIAL,322.77,87,,,OTHER,278.25,363.58,PERCENT OF TOTAL BILLED CHARGES
SLEEP STAGING <6 YRS,95782,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,UC HEALTH,UC HEALTH COMMERCIAL,3392.565,87,,,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
"SS, CPAP STAGING <6 YRS",95783,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UC HEALTH,UC HEALTH COMMERCIAL,3740.13,87,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
MULTI SLEEP LATENCY TEST,95805,CPT,740,RC,,OUTPATIENT,,,4094.5,1637.8,UC HEALTH,UC HEALTH COMMERCIAL,3562.215,87,,,OTHER,3070.88,4012.61,PERCENT OF TOTAL BILLED CHARGES
SLEEP STUDY UNATTENDED,95806,CPT,740,RC,,OUTPATIENT,,,278.15,111.26,UC HEALTH,UC HEALTH COMMERCIAL,241.9905,87,,,OTHER,206.25,269.5,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM STAGING,95810,CPT,740,RC,,OUTPATIENT,,,3899.5,1559.8,UC HEALTH,UC HEALTH COMMERCIAL,3392.565,87,,,OTHER,2924.63,3821.51,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM CPAP-STAGING,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UC HEALTH,UC HEALTH COMMERCIAL,3740.13,87,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
POLYSOMNOGRAM W/CPAP,95811,CPT,740,RC,,OUTPATIENT,,,4299,1719.6,UC HEALTH,UC HEALTH COMMERCIAL,3740.13,87,,,OTHER,3224.25,4213.02,PERCENT OF TOTAL BILLED CHARGES
ELECTROENCEPHALOGRAM,95816,CPT,740,RC,,OUTPATIENT,,,1063,425.2,UC HEALTH,UC HEALTH COMMERCIAL,924.81,87,,,OTHER,797.25,1041.74,PERCENT OF TOTAL BILLED CHARGES
EEG ALL NIGHT RECORDING,95827,CPT,740,RC,,OUTPATIENT,,,3742.25,1496.9,UC HEALTH,UC HEALTH COMMERCIAL,3255.7575,87,,,OTHER,2806.69,3667.41,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,UC HEALTH,UC HEALTH COMMERCIAL,2921.46,87,,,OTHER,2518.5,3290.84,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST LT W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,UC HEALTH,UC HEALTH COMMERCIAL,2512.125,87,,,OTHER,2165.63,2829.75,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST RT  W/WO,C8905,HCPCS,610,RC,,INPATIENT,,,2887.5,1155,UC HEALTH,UC HEALTH COMMERCIAL,2512.125,87,,,OTHER,2165.63,2829.75,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST BILATERAL W/WO,C8908,HCPCS,610,RC,,BOTH,,,4059.25,1623.7,UC HEALTH,UC HEALTH COMMERCIAL,3531.5475,87,,,OTHER,3044.44,3978.07,PERCENT OF TOTAL BILLED CHARGES
MRI BREAST BILAT W/O CONTRAST,77047,CPT,610,RC,,OUTPATIENT,,,3180,1272,UC HEALTH,UC HEALTH COMMERCIAL,2766.6,87,,,OTHER,2385,3116.4,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB W/WO BILATERAL,7371850,CPT,610,RC,50,OUTPATIENT,,,3675,1470,UC HEALTH,UC HEALTH COMMERCIAL,3197.25,87,,,OTHER,2756.25,3601.5,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
BRACHIAL PLEXUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL W/WO,7372050,CPT,610,RC,50,OUTPATIENT,,,4811.25,1924.5,UC HEALTH,UC HEALTH COMMERCIAL,4185.7875,87,,,OTHER,3608.44,4715.03,PERCENT OF TOTAL BILLED CHARGES
FEMUR BILATERAL W/O,7371850,CPT,610,RC,50,OUTPATIENT,,,3526,1410.4,UC HEALTH,UC HEALTH COMMERCIAL,3067.62,87,,,OTHER,2644.5,3455.48,PERCENT OF TOTAL BILLED CHARGES
TIB/FIB BILATERAL W/O,7372050,CPT,610,RC,50,OUTPATIENT,,,3400,1360,UC HEALTH,UC HEALTH COMMERCIAL,2958,87,,,OTHER,2550,3332,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/O CONTRAST,71550,CPT,610,RC,,OUTPATIENT,,,3358,1343.2,UC HEALTH,UC HEALTH COMMERCIAL,2921.46,87,,,OTHER,2518.5,3290.84,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/WO CONTRT,72156,CPT,610,RC,,OUTPATIENT,,,3765.75,1506.3,UC HEALTH,UC HEALTH COMMERCIAL,3276.2025,87,,,OTHER,2824.31,3690.44,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/CONTRAST,72142,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI CERVICAL SPINE W/O CONTRST,72141,CPT,610,RC,,OUTPATIENT,,,2808.25,1123.3,UC HEALTH,UC HEALTH COMMERCIAL,2443.1775,87,,,OTHER,2106.19,2752.09,PERCENT OF TOTAL BILLED CHARGES
MRI FACE NECK ORBIT W CONTRAST,70542,CPT,610,RC,,OUTPATIENT,,,3577.75,1431.1,UC HEALTH,UC HEALTH COMMERCIAL,3112.6425,87,,,OTHER,2683.31,3506.2,PERCENT OF TOTAL BILLED CHARGES
MR GUIDANCE FOR NEEDLE PLACE,77021,CPT,610,RC,,OUTPATIENT,,,2378.75,951.5,UC HEALTH,UC HEALTH COMMERCIAL,2069.5125,87,,,OTHER,1784.06,2331.18,PERCENT OF TOTAL BILLED CHARGES
MRI FACE/NECK/OR WO CONTRAST,70540,CPT,610,RC,,OUTPATIENT,,,3169.5,1267.8,UC HEALTH,UC HEALTH COMMERCIAL,2757.465,87,,,OTHER,2377.13,3106.11,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2800,1120,UC HEALTH,UC HEALTH COMMERCIAL,2436,87,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,2800,1120,UC HEALTH,UC HEALTH COMMERCIAL,2436,87,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/WO CONT RT,73720,CPT,610,RC,,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR WO CONT RT,73718,CPT,610,RC,,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/O CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/CONT RT,73722RT,CPT,610,RC,RT,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/O CONT RT,73721RT,CPT,610,RC,RT,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/CONT RT,73722,CPT,610,RC,,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/WO CONT RT,73723RT,CPT,610,RC,RT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO CONT RT,73721,CPT,610,RC,,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS WO/CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST BILATERAL W/WO,7322350,CPT,610,RC,50,OUTPATIENT,,,5700,2280,UC HEALTH,UC HEALTH COMMERCIAL,4959,87,,,OTHER,4275,5586,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/CONT RT,73222,CPT,610,RC,,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/WO CONT RT,73223,CPT,610,RC,,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER WO CONT RT,73221,CPT,610,RC,,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/WO CONT RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HAND WO CONT RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
HAND W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6504.75,2601.9,UC HEALTH,UC HEALTH COMMERCIAL,5659.1325,87,,,OTHER,4878.56,6374.66,PERCENT OF TOTAL BILLED CHARGES
HAND W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,5402.25,2160.9,UC HEALTH,UC HEALTH COMMERCIAL,4699.9575,87,,,OTHER,4051.69,5294.21,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/WO CONTRAST,70553,CPT,610,RC,,OUTPATIENT,,,3674.75,1469.9,UC HEALTH,UC HEALTH COMMERCIAL,3197.0325,87,,,OTHER,2756.06,3601.26,PERCENT OF TOTAL BILLED CHARGES
BONE MARROW,77084,CPT,610,RC,,OUTPATIENT,,,2587.5,1035,UC HEALTH,UC HEALTH COMMERCIAL,2251.125,87,,,OTHER,1940.63,2535.75,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,3071.75,1228.7,UC HEALTH,UC HEALTH COMMERCIAL,2672.4225,87,,,OTHER,2303.81,3010.32,PERCENT OF TOTAL BILLED CHARGES
MRI HEAD W/O CONTRAST,70551,CPT,610,RC,,OUTPATIENT,,,2888.5,1155.4,UC HEALTH,UC HEALTH COMMERCIAL,2512.995,87,,,OTHER,2166.38,2830.73,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI ANKLE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI ELBOW W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/CONT RT,73719,CPT,610,RC,,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI FOREARM W/WO LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT WO CONT BI,7371850,CPT,610,RC,50,OUTPATIENT,,,5046,2018.4,UC HEALTH,UC HEALTH COMMERCIAL,4390.02,87,,,OTHER,3784.5,4945.08,PERCENT OF TOTAL BILLED CHARGES
MRI FOOT W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
FOOT W/WO CONT BI,7372050,CPT,610,RC,50,OUTPATIENT,,,6848.75,2739.5,UC HEALTH,UC HEALTH COMMERCIAL,5958.4125,87,,,OTHER,5136.56,6711.78,PERCENT OF TOTAL BILLED CHARGES
MRI FEMUR W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HAND WO CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HAND W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI HIP WO CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI HIP W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/CONT LT,73219LT,CPT,610,RC,LT,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS WO/CONT LT,73218LT,CPT,610,RC,LT,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI HUMERUS W/WO CONT LT,73220LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/CONT LT,73722LT,CPT,610,RC,LT,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/O CONT LT,73721LT,CPT,610,RC,LT,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRI KNEE W/WO CONT LT,73723LT,CPT,610,RC,LT,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/CONTRAST,73722QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364.5,945.8,UC HEALTH,UC HEALTH COMMERCIAL,2057.115,87,,,OTHER,1773.38,2317.21,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/WO CONT LT,73723LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/O CONT LT,73718RTQQ,CPT,610,RC,RTQQ,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/CONT LT,73719LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/O CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/WO CONT LT,73720LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/O CONTRAST,73721QQ,CPT,610,RC,QQ,OUTPATIENT,,,2154.5,861.8,UC HEALTH,UC HEALTH COMMERCIAL,1874.415,87,,,OTHER,1615.88,2111.41,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/CONT LT,C8912LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/O CONT LT,C8913LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/WO CONT LT,C8914LT,HCPCS,610,RC,LT,INPATIENT,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER WO CONT LT,73221LT,CPT,610,RC,LT,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI SHOULDER W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/CONT LT,73719LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,UC HEALTH,UC HEALTH COMMERCIAL,2436,87,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB WO CONT LT,73718LT,CPT,610,RC,LT,OUTPATIENT,,,2523,1009.2,UC HEALTH,UC HEALTH COMMERCIAL,2195.01,87,,,OTHER,1892.25,2472.54,PERCENT OF TOTAL BILLED CHARGES
MRI TIB/FIB W/WO CONT LT,73720LT,CPT,610,RC,LT,OUTPATIENT,,,2800,1120,UC HEALTH,UC HEALTH COMMERCIAL,2436,87,,,OTHER,2100,2744,PERCENT OF TOTAL BILLED CHARGES
MRI WHOLE BODY LIM 1-4 AREAS,76498,CPT,610,RC,,OUTPATIENT,,,3496,1398.4,UC HEALTH,UC HEALTH COMMERCIAL,3041.52,87,,,OTHER,2622,3426.1,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/WO CONTRAST,72158,CPT,610,RC,,OUTPATIENT,,,3560.75,1424.3,UC HEALTH,UC HEALTH COMMERCIAL,3097.8525,87,,,OTHER,2670.56,3489.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/CONT LT,C8934LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/O CONT LT,C8935LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/WO CONT LT,C8936LT,HCPCS,610,RC,LT,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/CONT LT,73222LT,CPT,610,RC,LT,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/CONTRAST,72149,CPT,610,RC,,OUTPATIENT,,,3350.75,1340.3,UC HEALTH,UC HEALTH COMMERCIAL,2915.1525,87,,,OTHER,2513.06,3283.74,PERCENT OF TOTAL BILLED CHARGES
MRI WRIST W/WO CONT LT,73223LT,CPT,610,RC,LT,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI LUMBAR SPINE W/O CONTRAST,72148,CPT,610,RC,,OUTPATIENT,,,2931.5,1172.6,UC HEALTH,UC HEALTH COMMERCIAL,2550.405,87,,,OTHER,2198.63,2872.87,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/O CONTRAST,70544,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,UC HEALTH,UC HEALTH COMMERCIAL,2516.2575,87,,,OTHER,2169.19,2834.41,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/CONT RT,C8912,HCPCS,610,RC,,BOTH,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/WO RT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI SCAPULA W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MR ANGIO PELVIS W/O & W/DYE,72198,CPT,610,RC,,OUTPATIENT,,,2625,1050,UC HEALTH,UC HEALTH COMMERCIAL,2283.75,87,,,OTHER,1968.75,2572.5,PERCENT OF TOTAL BILLED CHARGES
MRA ANG LWR EXT W OR W/O DYE,73725,CPT,610,RC,,OUTPATIENT,,,1837.5,735,UC HEALTH,UC HEALTH COMMERCIAL,1598.625,87,,,OTHER,1378.13,1800.75,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABDOMEN W/WO CONTRST,C8902,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UC HEALTH,UC HEALTH COMMERCIAL,2011.44,87,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/O CONTRAST,70547,CPT,610,RC,,OUTPATIENT,,,2223,889.2,UC HEALTH,UC HEALTH COMMERCIAL,1934.01,87,,,OTHER,1667.25,2178.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/CONTRAST,70548,CPT,610,RC,,OUTPATIENT,,,2434.25,973.7,UC HEALTH,UC HEALTH COMMERCIAL,2117.7975,87,,,OTHER,1825.69,2385.57,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO NECK W/WO CONTRAST,70549,CPT,610,RC,,OUTPATIENT,,,2892.25,1156.9,UC HEALTH,UC HEALTH COMMERCIAL,2516.2575,87,,,OTHER,2169.19,2834.41,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,UC HEALTH,UC HEALTH COMMERCIAL,3355.8075,87,,,OTHER,2892.94,3780.11,PERCENT OF TOTAL BILLED CHARGES
MRI TMJ W/O CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,UC HEALTH,UC HEALTH COMMERCIAL,2929.0725,87,,,OTHER,2525.06,3299.42,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/WO CONTRT,72157,CPT,610,RC,,OUTPATIENT,,,3352.25,1340.9,UC HEALTH,UC HEALTH COMMERCIAL,2916.4575,87,,,OTHER,2514.19,3285.21,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/CONTRAST,72147,CPT,610,RC,,OUTPATIENT,,,3108,1243.2,UC HEALTH,UC HEALTH COMMERCIAL,2703.96,87,,,OTHER,2331,3045.84,PERCENT OF TOTAL BILLED CHARGES
MRI THORACIC SPINE W/O CONTRST,72146,CPT,610,RC,,OUTPATIENT,,,2931,1172.4,UC HEALTH,UC HEALTH COMMERCIAL,2549.97,87,,,OTHER,2198.25,2872.38,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT RT,73222QQ,CPT,610,RC,QQ,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/CONT LT,73222LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2720.5,1088.2,UC HEALTH,UC HEALTH COMMERCIAL,2366.835,87,,,OTHER,2040.38,2666.09,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT RT,73221QQ,CPT,610,RC,QQ,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/O CONT LT,73221LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2364,945.6,UC HEALTH,UC HEALTH COMMERCIAL,2056.68,87,,,OTHER,1773,2316.72,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/CONTRAST,70545,CPT,610,RC,,OUTPATIENT,,,3099,1239.6,UC HEALTH,UC HEALTH COMMERCIAL,2696.13,87,,,OTHER,2324.25,3037.02,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO HEAD W/WO CONTRAST,70546,CPT,610,RC,,OUTPATIENT,,,3173,1269.2,UC HEALTH,UC HEALTH COMMERCIAL,2760.51,87,,,OTHER,2379.75,3109.54,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/CONTRAST,71551,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,UC HEALTH,UC HEALTH COMMERCIAL,3280.1175,87,,,OTHER,2827.69,3694.85,PERCENT OF TOTAL BILLED CHARGES
MRI CHEST W/WO CONTRAST,71552,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,UC HEALTH,UC HEALTH COMMERCIAL,3454.5525,87,,,OTHER,2978.06,3891.34,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT JT W/WO CONT RT,73723QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,UC HEALTH,UC HEALTH COMMERCIAL,3027.6,87,,,OTHER,2610,3410.4,PERCENT OF TOTAL BILLED CHARGES
MRI PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,UC HEALTH,UC HEALTH COMMERCIAL,4271.9175,87,,,OTHER,3682.69,4812.05,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/O CONT RT,73218QQ,CPT,610,RC,QQ,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/O CONT LT,73218LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/CONT RT,73219QQ,CPT,610,RC,QQ,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/CONT LT,73219LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT RT,73220QQ,CPT,610,RC,QQ,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT NON JT W/WO CONT LT,73220LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT RT,73223QQ,CPT,610,RC,QQ,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI UPEXT JT W/WO CONT LT,73223LTQQ,CPT,610,RC,LTQQ,OUTPATIENT,,,3382,1352.8,UC HEALTH,UC HEALTH COMMERCIAL,2942.34,87,,,OTHER,2536.5,3314.36,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/CONTRAST,74182,CPT,610,RC,,OUTPATIENT,,,3770.25,1508.1,UC HEALTH,UC HEALTH COMMERCIAL,3280.1175,87,,,OTHER,2827.69,3694.85,PERCENT OF TOTAL BILLED CHARGES
MRI ABDOMEN W/WO CONTRAST,74183,CPT,610,RC,,OUTPATIENT,,,3970.75,1588.3,UC HEALTH,UC HEALTH COMMERCIAL,3454.5525,87,,,OTHER,2978.06,3891.34,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION RT,19085RT,CPT,610,RC,RT,OUTPATIENT,,,3207.25,1282.9,UC HEALTH,UC HEALTH COMMERCIAL,2790.3075,87,,,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION LT,19085LT,CPT,610,RC,LT,OUTPATIENT,,,3207.25,1282.9,UC HEALTH,UC HEALTH COMMERCIAL,2790.3075,87,,,OTHER,2405.44,3143.11,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION RT,19086RT,CPT,610,RC,RT,OUTPATIENT,,,2441.25,976.5,UC HEALTH,UC HEALTH COMMERCIAL,2123.8875,87,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION LT,19086LT,CPT,610,RC,LT,OUTPATIENT,,,2441.25,976.5,UC HEALTH,UC HEALTH COMMERCIAL,2123.8875,87,,,OTHER,1830.94,2392.43,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION BI,1908550,CPT,610,RC,50,OUTPATIENT,,,3589.75,1435.9,UC HEALTH,UC HEALTH COMMERCIAL,3123.0825,87,,,OTHER,2692.31,3517.96,PERCENT OF TOTAL BILLED CHARGES
BX BREAST ADD LESION BI,1908650,CPT,610,RC,50,OUTPATIENT,,,2823.75,1129.5,UC HEALTH,UC HEALTH COMMERCIAL,2456.6625,87,,,OTHER,2117.81,2767.28,PERCENT OF TOTAL BILLED CHARGES
BX BREAST 1ST LESION UNI,19085,CPT,610,RC,,OUTPATIENT,,,4345,1738,UC HEALTH,UC HEALTH COMMERCIAL,3780.15,87,,,OTHER,3258.75,4258.1,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/O RT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/O LT,73218,CPT,610,RC,,OUTPATIENT,,,2752.5,1101,UC HEALTH,UC HEALTH COMMERCIAL,2394.675,87,,,OTHER,2064.38,2697.45,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/WO RT,73218,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/WO LT,73220,CPT,610,RC,,OUTPATIENT,,,3350.5,1340.2,UC HEALTH,UC HEALTH COMMERCIAL,2914.935,87,,,OTHER,2512.88,3283.49,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT RT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
MRI CLAVICLE W/CONT LT,73219,CPT,610,RC,,OUTPATIENT,,,3140,1256,UC HEALTH,UC HEALTH COMMERCIAL,2731.8,87,,,OTHER,2355,3077.2,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UC HEALTH,UC HEALTH COMMERCIAL,3748.395,87,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
ANKLE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UC HEALTH,UC HEALTH COMMERCIAL,5829.6525,87,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
KNEE W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UC HEALTH,UC HEALTH COMMERCIAL,3748.395,87,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
KNEE W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UC HEALTH,UC HEALTH COMMERCIAL,5829.6525,87,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
HIP W/O BILATERAL,7372150,CPT,610,RC,50,OUTPATIENT,,,4308.5,1723.4,UC HEALTH,UC HEALTH COMMERCIAL,3748.395,87,,,OTHER,3231.38,4222.33,PERCENT OF TOTAL BILLED CHARGES
HIP W/WO BILATERAL,7372350,CPT,610,RC,50,OUTPATIENT,,,6700.75,2680.3,UC HEALTH,UC HEALTH COMMERCIAL,5829.6525,87,,,OTHER,5025.56,6566.74,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/O BILATERAL,7322150,CPT,610,RC,50,OUTPATIENT,,,4727.5,1891,UC HEALTH,UC HEALTH COMMERCIAL,4112.925,87,,,OTHER,3545.63,4632.95,PERCENT OF TOTAL BILLED CHARGES
SHOULDER W/WO BILATERAL,7322350,CPT,610,RC,50,OUTPATIENT,,,6763.25,2705.3,UC HEALTH,UC HEALTH COMMERCIAL,5884.0275,87,,,OTHER,5072.44,6627.99,PERCENT OF TOTAL BILLED CHARGES
WRIST BILAT W/O MRI,73221,CPT,610,RC,,OUTPATIENT,,,3408.64,1363.456,UC HEALTH,UC HEALTH COMMERCIAL,2965.5168,87,,,OTHER,2556.5,3340.5,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/CONT RT,C8934,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/WO CONT RT,C8936,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABD W/O CONTRAST,C8901,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UC HEALTH,UC HEALTH COMMERCIAL,2011.44,87,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO ABD W/CONTRAST,C8900,HCPCS,610,RC,,INPATIENT,,,2312,924.8,UC HEALTH,UC HEALTH COMMERCIAL,2011.44,87,,,OTHER,1734,2265.76,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/CONTRAST,C8909,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UC HEALTH,UC HEALTH COMMERCIAL,1591.8825,87,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/WO CONTRAST,C8911,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UC HEALTH,UC HEALTH COMMERCIAL,1591.8825,87,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/O CONT RT,C8913,HCPCS,610,RC,,BOTH,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
MRI TMJ W/WO CONTRAST,70336QQ,CPT,610,RC,QQ,OUTPATIENT,,,3366.75,1346.7,UC HEALTH,UC HEALTH COMMERCIAL,2929.0725,87,,,OTHER,2525.06,3299.42,PERCENT OF TOTAL BILLED CHARGES
MRI ST NECK W/CONTRAST,70542QQ,CPT,610,RC,QQ,OUTPATIENT,,,3914.5,1565.8,UC HEALTH,UC HEALTH COMMERCIAL,3405.615,87,,,OTHER,2935.88,3836.21,PERCENT OF TOTAL BILLED CHARGES
MRI FACE/NECK/ORBIT W/WO,70543,CPT,610,RC,,OUTPATIENT,,,4389.75,1755.9,UC HEALTH,UC HEALTH COMMERCIAL,3819.0825,87,,,OTHER,3292.31,4301.96,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/CONTRAST,70552,CPT,610,RC,,OUTPATIENT,,,4124.5,1649.8,UC HEALTH,UC HEALTH COMMERCIAL,3588.315,87,,,OTHER,3093.38,4042.01,PERCENT OF TOTAL BILLED CHARGES
MRI PITUITARY/IAC W/WO CONTRST,70553,CPT,610,RC,,OUTPATIENT,,,5173,2069.2,UC HEALTH,UC HEALTH COMMERCIAL,4500.51,87,,,OTHER,3879.75,5069.54,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO CHEST W/O CONTRAST,C8910,HCPCS,610,RC,,INPATIENT,,,1829.75,731.9,UC HEALTH,UC HEALTH COMMERCIAL,1591.8825,87,,,OTHER,1372.31,1793.16,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/O CONTRAST,72195,CPT,610,RC,,OUTPATIENT,,,3480,1392,UC HEALTH,UC HEALTH COMMERCIAL,3027.6,87,,,OTHER,2610,3410.4,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/CONTRAST,72196,CPT,610,RC,,OUTPATIENT,,,3857.25,1542.9,UC HEALTH,UC HEALTH COMMERCIAL,3355.8075,87,,,OTHER,2892.94,3780.11,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO PELVIS W/WO CONTRAST,72197,CPT,610,RC,,OUTPATIENT,,,4910.25,1964.1,UC HEALTH,UC HEALTH COMMERCIAL,4271.9175,87,,,OTHER,3682.69,4812.05,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO UPEXT W/O CONT RT,C8935,HCPCS,610,RC,,INPATIENT,,,3662.25,1464.9,UC HEALTH,UC HEALTH COMMERCIAL,3186.1575,87,,,OTHER,2746.69,3589.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/WO CONT RT,73718QQ,CPT,610,RC,QQ,OUTPATIENT,,,3424.5,1369.8,UC HEALTH,UC HEALTH COMMERCIAL,2979.315,87,,,OTHER,2568.38,3356.01,PERCENT OF TOTAL BILLED CHARGES
MRI LOEXT NON JT W/CONT RT,73719QQ,CPT,610,RC,QQ,OUTPATIENT,,,2837.5,1135,UC HEALTH,UC HEALTH COMMERCIAL,2468.625,87,,,OTHER,2128.13,2780.75,PERCENT OF TOTAL BILLED CHARGES
MRA ANGIO LOEXT W/WO CONT RT,C8914,HCPCS,610,RC,,INPATIENT,,,1864.75,745.9,UC HEALTH,UC HEALTH COMMERCIAL,1622.3325,87,,,OTHER,1398.56,1827.46,PERCENT OF TOTAL BILLED CHARGES
LOCM (180 MG IODINE),Q9946,HCPCS,636,RC,,INPATIENT,,,103,41.2,UC HEALTH,UC HEALTH COMMERCIAL,89.61,87,,,OTHER,77.25,100.94,PERCENT OF TOTAL BILLED CHARGES
LOCM (320 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,379.25,151.7,UC HEALTH,UC HEALTH COMMERCIAL,329.9475,87,,,OTHER,284.44,371.67,PERCENT OF TOTAL BILLED CHARGES
LOCM (350 MG IODINE),Q9967,HCPCS,636,RC,,INPATIENT,,,103,41.2,UC HEALTH,UC HEALTH COMMERCIAL,89.61,87,,,OTHER,77.25,100.94,PERCENT OF TOTAL BILLED CHARGES
TECHNETIUM TC99M MEDRONATE,A9503,HCPCS,343,RC,,INPATIENT,,,196.25,78.5,UC HEALTH,UC HEALTH COMMERCIAL,170.7375,87,,,OTHER,147.2,192.3,PERCENT OF TOTAL BILLED CHARGES
GLADOLINIUM,A9579,HCPCS,636,RC,,INPATIENT,,,271.25,108.5,UC HEALTH,UC HEALTH COMMERCIAL,235.9875,87,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
FDG F-18 INITIAL,A9552PI,HCPCS,343,RC,PI,INPATIENT,,,1320.75,528.3,UC HEALTH,UC HEALTH COMMERCIAL,1149.0525,87,,,OTHER,990.56,1294.34,PERCENT OF TOTAL BILLED CHARGES
FDG F-18 SUB,A9552PS,HCPCS,343,RC,PS,INPATIENT,,,1320.75,528.3,UC HEALTH,UC HEALTH COMMERCIAL,1149.0525,87,,,OTHER,990.56,1294.34,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM + .5 HR,7100010,CDM,,,,INPATIENT,,,150.75,60.3,UC HEALTH,UC HEALTH COMMERCIAL,131.1525,87,,,OTHER,113.06,147.74,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-GENERAL,7100070,CDM,,,,INPATIENT,,,860,344,UC HEALTH,UC HEALTH COMMERCIAL,748.2,87,,,OTHER,645,842.8,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-LOCAL,7100080,CDM,,,,INPATIENT,,,439,175.6,UC HEALTH,UC HEALTH COMMERCIAL,381.93,87,,,OTHER,329.25,430.22,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM-REGIONAL,7100090,CDM,,,,INPATIENT,,,553,221.2,UC HEALTH,UC HEALTH COMMERCIAL,481.11,87,,,OTHER,414.75,541.94,PERCENT OF TOTAL BILLED CHARGES
DELIVERY/RECOVERY 1,7200010,CDM,,,,INPATIENT,,,1865,746,UC HEALTH,UC HEALTH COMMERCIAL,1622.55,87,,,OTHER,1398.75,1827.7,PERCENT OF TOTAL BILLED CHARGES
DELIVERY/RECOVERY 2,7200012,CDM,,,,INPATIENT,,,3997.75,1599.1,UC HEALTH,UC HEALTH COMMERCIAL,3478.0425,87,,,OTHER,2998.31,3917.8,PERCENT OF TOTAL BILLED CHARGES
PRECIP DELIVERY,7200014,CDM,,,,INPATIENT,,,896.25,358.5,UC HEALTH,UC HEALTH COMMERCIAL,779.7375,87,,,OTHER,672.19,878.33,PERCENT OF TOTAL BILLED CHARGES
CS PREOP,7200016,CDM,,,,INPATIENT,,,297.25,118.9,UC HEALTH,UC HEALTH COMMERCIAL,258.6075,87,,,OTHER,222.94,291.31,PERCENT OF TOTAL BILLED CHARGES
OB DOPPLER,7200018,CDM,,,,INPATIENT,,,204.5,81.8,UC HEALTH,UC HEALTH COMMERCIAL,177.915,87,,,OTHER,153.38,200.41,PERCENT OF TOTAL BILLED CHARGES
EFM/PER DAY,7200020,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
BABY CHECK AND EVAL,99211,CPT,510,RC,,OUTPATIENT,,,102,40.8,UC HEALTH,UC HEALTH COMMERCIAL,88.74,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
FHM INTERNAL FSE,7200030,CDM,,,,INPATIENT,,,394.75,157.9,UC HEALTH,UC HEALTH COMMERCIAL,343.4325,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
INFUSION THERAPY,96365,CPT,260,RC,,OUTPATIENT,,,496.25,198.5,UC HEALTH,UC HEALTH COMMERCIAL,431.7375,87,,,OTHER,372.19,486.33,PERCENT OF TOTAL BILLED CHARGES
NIPPLE STIM (INCLUDES EFM),7200034,CDM,,,,INPATIENT,,,424.25,169.7,UC HEALTH,UC HEALTH COMMERCIAL,369.0975,87,,,OTHER,318.19,415.77,PERCENT OF TOTAL BILLED CHARGES
OCT (INCLUDES EFM),59020,CPT,720,RC,,OUTPATIENT,,,670,268,UC HEALTH,UC HEALTH COMMERCIAL,582.9,87,,,OTHER,502.5,656.6,PERCENT OF TOTAL BILLED CHARGES
VERSION (INCLUDES EFM),59412,CPT,720,RC,,OUTPATIENT,,,2396,958.4,UC HEALTH,UC HEALTH COMMERCIAL,2084.52,87,,,OTHER,1797,2348.08,PERCENT OF TOTAL BILLED CHARGES
IUPC,7200042,CDM,,,,INPATIENT,,,739.25,295.7,UC HEALTH,UC HEALTH COMMERCIAL,643.1475,87,,,OTHER,554.44,724.47,PERCENT OF TOTAL BILLED CHARGES
INJ THER/PROPH/DIAG  SQ/IM,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,UC HEALTH,UC HEALTH COMMERCIAL,165.735,87,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
INJECTION PROCEDURE,96372,CPT,260,RC,,OUTPATIENT,,,190.5,76.2,UC HEALTH,UC HEALTH COMMERCIAL,165.735,87,,,OTHER,142.88,186.69,PERCENT OF TOTAL BILLED CHARGES
NST/EFM,59025,CPT,720,RC,,OUTPATIENT,,,445.25,178.1,UC HEALTH,UC HEALTH COMMERCIAL,387.3675,87,,,OTHER,333.94,436.35,PERCENT OF TOTAL BILLED CHARGES
NURSE ATTENDED TRANSFER,7200120,CDM,,,,INPATIENT,,,334.5,133.8,UC HEALTH,UC HEALTH COMMERCIAL,291.015,87,,,OTHER,250.88,327.81,PERCENT OF TOTAL BILLED CHARGES
AUTOLOGOUS SALVAGING SERVICE,86891,CPT,300,RC,,OUTPATIENT,,,2927.25,1170.9,UC HEALTH,UC HEALTH COMMERCIAL,2546.7075,87,,,OTHER,2195.44,2868.71,PERCENT OF TOTAL BILLED CHARGES
INFUSION THERAPY EA ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
OB IM/SQ VACCINE,90471,CPT,761,RC,,OUTPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.1,PERCENT OF TOTAL BILLED CHARGES
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,OUTPATIENT,,,5697.98,2279.192,UC HEALTH,UC HEALTH COMMERCIAL,4957.2426,87,,,OTHER,4273.5,5584,PERCENT OF TOTAL BILLED CHARGES
IV PUSH NEW MED ADDON,96375,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV PUSH SAME MED ADDON,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION (INITIAL),96360,CPT,450,RC,,OUTPATIENT,,,448,179.2,UC HEALTH,UC HEALTH COMMERCIAL,389.76,87,,,OTHER,336,439.04,PERCENT OF TOTAL BILLED CHARGES
SEQUENTIAL MEDICATED INF,96367,CPT,450,RC,,OUTPATIENT,,,137.5,55,UC HEALTH,UC HEALTH COMMERCIAL,119.625,87,,,OTHER,103.13,134.75,PERCENT OF TOTAL BILLED CHARGES
IV HYDRATION ADD'L HR,96361,CPT,450,RC,,OUTPATIENT,,,118,47.2,UC HEALTH,UC HEALTH COMMERCIAL,102.66,87,,,OTHER,88.5,115.64,PERCENT OF TOTAL BILLED CHARGES
OB THER/DIAG CONCURRENT INF,96368,CPT,450,RC,,OUTPATIENT,,,132.25,52.9,UC HEALTH,UC HEALTH COMMERCIAL,115.0575,87,,,OTHER,99.2,129.6,PERCENT OF TOTAL BILLED CHARGES
IV PUSH INITIAL,96374,CPT,450,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.1,214.4,PERCENT OF TOTAL BILLED CHARGES
LABOR,7210002,CDM,,,,INPATIENT,,,1247.25,498.9,UC HEALTH,UC HEALTH COMMERCIAL,1085.1075,87,,,OTHER,935.44,1222.31,PERCENT OF TOTAL BILLED CHARGES
MATERNAL RESUSCITATION,7210010,CDM,,,,INPATIENT,,,399.75,159.9,UC HEALTH,UC HEALTH COMMERCIAL,347.7825,87,,,OTHER,299.81,391.76,PERCENT OF TOTAL BILLED CHARGES
AMNIOCENTESIS PROCEDURE,59000,CPT,361,RC,,OUTPATIENT,,,1262.49,504.996,UC HEALTH,UC HEALTH COMMERCIAL,1098.3663,87,,,OTHER,446.25,583.1,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,UC HEALTH,UC HEALTH COMMERCIAL,711.66,87,,,OTHER,613.5,801.64,PERCENT OF TOTAL BILLED CHARGES
BAG/MASK PROCEDURE,7210014,CDM,,,,INPATIENT,,,124.25,49.7,UC HEALTH,UC HEALTH COMMERCIAL,108.0975,87,,,OTHER,93.19,121.77,PERCENT OF TOTAL BILLED CHARGES
OB C-SECTION,7210015,CDM,,,,INPATIENT,,,1540.75,616.3,UC HEALTH,UC HEALTH COMMERCIAL,1340.4525,87,,,OTHER,1155.56,1509.94,PERCENT OF TOTAL BILLED CHARGES
FOLEY CATHERTERIZATION PROC,7210018,CDM,,,,INPATIENT,,,135.75,54.3,UC HEALTH,UC HEALTH COMMERCIAL,118.1025,87,,,OTHER,101.81,133.04,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 1,7210020,CDM,,,,INPATIENT,,,99,39.6,UC HEALTH,UC HEALTH COMMERCIAL,86.13,87,,,OTHER,74.25,97.02,PERCENT OF TOTAL BILLED CHARGES
CARDIAC MONITOR,7210022,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 2,7210030,CDM,,,,INPATIENT,,,155.75,62.3,UC HEALTH,UC HEALTH COMMERCIAL,135.5025,87,,,OTHER,116.81,152.64,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 3,7210040,CDM,,,,INPATIENT,,,285.75,114.3,UC HEALTH,UC HEALTH COMMERCIAL,248.6025,87,,,OTHER,214.31,280.04,PERCENT OF TOTAL BILLED CHARGES
OB CARE LEVEL 4,7210050,CDM,,,,INPATIENT,,,660.5,264.2,UC HEALTH,UC HEALTH COMMERCIAL,574.635,87,,,OTHER,495.38,647.29,PERCENT OF TOTAL BILLED CHARGES
INTERNAL FM,7210060,CDM,,,,INPATIENT,,,394.75,157.9,UC HEALTH,UC HEALTH COMMERCIAL,343.4325,87,,,OTHER,296.06,386.86,PERCENT OF TOTAL BILLED CHARGES
LOCAL/PUDENDAL PROCEDURE,7210062,CDM,,,,INPATIENT,,,117.5,47,UC HEALTH,UC HEALTH COMMERCIAL,102.225,87,,,OTHER,88.13,115.15,PERCENT OF TOTAL BILLED CHARGES
NRS ATTENDED TRANSPORT,7210068,CDM,,,,INPATIENT,,,633.25,253.3,UC HEALTH,UC HEALTH COMMERCIAL,550.9275,87,,,OTHER,474.94,620.59,PERCENT OF TOTAL BILLED CHARGES
PELVIC EXAM PROCEDURE,7210070,CDM,,,,INPATIENT,,,256.5,102.6,UC HEALTH,UC HEALTH COMMERCIAL,223.155,87,,,OTHER,192.38,251.37,PERCENT OF TOTAL BILLED CHARGES
SITZ BATH,7210072,CDM,,,,INPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
STAPLE/SUTURE REMOVAL,7210074,CDM,,,,INPATIENT,,,43,17.2,UC HEALTH,UC HEALTH COMMERCIAL,37.41,87,,,OTHER,32.25,42.14,PERCENT OF TOTAL BILLED CHARGES
TEDS,7210076,CDM,,,,INPATIENT,,,56.5,22.6,UC HEALTH,UC HEALTH COMMERCIAL,49.155,87,,,OTHER,42.38,55.37,PERCENT OF TOTAL BILLED CHARGES
URINE CATH/IN & OUT,7210078,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
VACUUM EXTRACTION,7210080,CDM,,,,INPATIENT,,,474.25,189.7,UC HEALTH,UC HEALTH COMMERCIAL,412.5975,87,,,OTHER,355.69,464.77,PERCENT OF TOTAL BILLED CHARGES
BLADDER IRRIGATION,51700,CPT,450,RC,,OUTPATIENT,,,621.5,248.6,UC HEALTH,UC HEALTH COMMERCIAL,540.705,87,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
HEARING SCREEN,92586,CPT,470,RC,,OUTPATIENT,,,289.75,115.9,UC HEALTH,UC HEALTH COMMERCIAL,252.0825,87,,,OTHER,217.31,283.96,PERCENT OF TOTAL BILLED CHARGES
AMNIOINFUSION PROCEDURE,7210013,CDM,,,,INPATIENT,,,818,327.2,UC HEALTH,UC HEALTH COMMERCIAL,711.66,87,,,OTHER,613.5,801.64,PERCENT OF TOTAL BILLED CHARGES
PHOTOTHERAPY,7220012,CDM,,,,INPATIENT,,,514.25,205.7,UC HEALTH,UC HEALTH COMMERCIAL,447.3975,87,,,OTHER,385.69,503.97,PERCENT OF TOTAL BILLED CHARGES
HABERMAN FEEDER/SOFT FEEDER,7220018,CDM,,,,INPATIENT,,,76.75,30.7,UC HEALTH,UC HEALTH COMMERCIAL,66.7725,87,,,OTHER,57.56,75.22,PERCENT OF TOTAL BILLED CHARGES
LUMBAR PUNCTURE,7220020,CDM,,,,INPATIENT,,,290.75,116.3,UC HEALTH,UC HEALTH COMMERCIAL,252.9525,87,,,OTHER,218.06,284.94,PERCENT OF TOTAL BILLED CHARGES
SUCTION PROCEDURE,7220022,CDM,,,,INPATIENT,,,92.75,37.1,UC HEALTH,UC HEALTH COMMERCIAL,80.6925,87,,,OTHER,69.56,90.9,PERCENT OF TOTAL BILLED CHARGES
UMBILICAL CATH PROCEDURE,36510,CPT,360,RC,,OUTPATIENT,,,548.25,219.3,UC HEALTH,UC HEALTH COMMERCIAL,476.9775,87,,,OTHER,411.19,537.29,PERCENT OF TOTAL BILLED CHARGES
WARMER ISOLETTE,7220026,CDM,,,,INPATIENT,,,161.25,64.5,UC HEALTH,UC HEALTH COMMERCIAL,140.2875,87,,,OTHER,120.94,158.03,PERCENT OF TOTAL BILLED CHARGES
IV ACCESS/VOLUTROL/BURETTE,7220028,CDM,,,,INPATIENT,,,159.5,63.8,UC HEALTH,UC HEALTH COMMERCIAL,138.765,87,,,OTHER,119.63,156.31,PERCENT OF TOTAL BILLED CHARGES
MATERNAL SUCTION SETUP,7220030,CDM,,,,INPATIENT,,,97,38.8,UC HEALTH,UC HEALTH COMMERCIAL,84.39,87,,,OTHER,72.75,95.06,PERCENT OF TOTAL BILLED CHARGES
INFANT INTUBATION,31500,CPT,450,RC,,OUTPATIENT,,,789.75,315.9,UC HEALTH,UC HEALTH COMMERCIAL,687.0825,87,,,OTHER,592.31,773.96,PERCENT OF TOTAL BILLED CHARGES
TRANSCUTANEOUS BILIRUBIN,88720,CPT,300,RC,,OUTPATIENT,,,28.75,11.5,UC HEALTH,UC HEALTH COMMERCIAL,25.0125,87,,,OTHER,21.56,28.18,PERCENT OF TOTAL BILLED CHARGES
BANKED BREASTMILK PER OUNCE,7220036,CDM,,,,INPATIENT,,,6.25,2.5,UC HEALTH,UC HEALTH COMMERCIAL,5.4375,87,,,OTHER,4.69,6.13,PERCENT OF TOTAL BILLED CHARGES
CIRCUMCISION,54150,CPT,360,RC,,OUTPATIENT,,,1304.5,521.8,UC HEALTH,UC HEALTH COMMERCIAL,1134.915,87,,,OTHER,978.38,1278.41,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY EVALUATION REPEAT(NSY,94760,CPT,460,RC,,OUTPATIENT,,,96.75,38.7,UC HEALTH,UC HEALTH COMMERCIAL,84.1725,87,,,OTHER,72.56,94.82,PERCENT OF TOTAL BILLED CHARGES
OXIMETRY/PER DAY,94761,CPT,460,RC,,OUTPATIENT,,,192.5,77,UC HEALTH,UC HEALTH COMMERCIAL,167.475,87,,,OTHER,144.38,188.65,PERCENT OF TOTAL BILLED CHARGES
DELIVER PLACENTA,59414,CPT,722,RC,,OUTPATIENT,,,5228.48,2091.392,UC HEALTH,UC HEALTH COMMERCIAL,4548.7776,87,,,OTHER,3921.4,5123.9,PERCENT OF TOTAL BILLED CHARGES
DX LMBR SPI PNXR,62270,CPT,320,RC,,OUTPATIENT,,,1264.84,505.936,UC HEALTH,UC HEALTH COMMERCIAL,1100.4108,87,,,OTHER,948.6,1239.5,PERCENT OF TOTAL BILLED CHARGES
OB US LIMITED FETUS(S) BEDSIDE,76815,CPT,402,RC,,OUTPATIENT,,,217.2,86.88,UC HEALTH,UC HEALTH COMMERCIAL,188.964,87,,,OTHER,162.9,212.9,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 1, EST",G0463,HCPCS,510,RC,,INPATIENT,,,51,20.4,UC HEALTH,UC HEALTH COMMERCIAL,44.37,87,,,OTHER,38.3,50,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 2, EST",G0463,HCPCS,510,RC,,INPATIENT,,,112,44.8,UC HEALTH,UC HEALTH COMMERCIAL,97.44,87,,,OTHER,84,109.8,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 3, EST",G0463,HCPCS,510,RC,,INPATIENT,,,185,74,UC HEALTH,UC HEALTH COMMERCIAL,160.95,87,,,OTHER,138.8,181.3,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 4, EST",G0463,HCPCS,510,RC,,INPATIENT,,,274,109.6,UC HEALTH,UC HEALTH COMMERCIAL,238.38,87,,,OTHER,205.5,268.5,PERCENT OF TOTAL BILLED CHARGES
"OP VISIT LEVEL 5, EST",G0463,HCPCS,510,RC,,INPATIENT,,,371,148.4,UC HEALTH,UC HEALTH COMMERCIAL,322.77,87,,,OTHER,278.3,363.6,PERCENT OF TOTAL BILLED CHARGES
EKG,93005,CPT,730,RC,,OUTPATIENT,,,362.25,144.9,UC HEALTH,UC HEALTH COMMERCIAL,315.1575,87,,,OTHER,271.69,355.01,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
RHYTHM STRIP TRACING ONLY,93041,CPT,730,RC,,OUTPATIENT,,,110.94,44.376,UC HEALTH,UC HEALTH COMMERCIAL,96.5178,87,,,OTHER,76.5,99.96,PERCENT OF TOTAL BILLED CHARGES
HOLTER MONITOR RECORDING/SETUP,93225,CPT,731,RC,,OUTPATIENT,,,327.75,131.1,UC HEALTH,UC HEALTH COMMERCIAL,285.1425,87,,,OTHER,245.81,321.2,PERCENT OF TOTAL BILLED CHARGES
BRONCHOSCOPY PROCEDURE,7310025,CDM,,,,INPATIENT,,,2996.25,1198.5,UC HEALTH,UC HEALTH COMMERCIAL,2606.7375,87,,,OTHER,2247.19,2936.33,PERCENT OF TOTAL BILLED CHARGES
CATHETERIZE FRO URINE SPEC,P9612,HCPCS,300,RC,,INPATIENT,,,152.5,61,UC HEALTH,UC HEALTH COMMERCIAL,132.675,87,,,OTHER,114.4,149.5,PERCENT OF TOTAL BILLED CHARGES
OBSERVATION OB,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,UC HEALTH,UC HEALTH COMMERCIAL,68.0775,87,,,OTHER,58.69,76.69,PERCENT OF TOTAL BILLED CHARGES
OBSERVATION ROOM,G0378,HCPCS,762,RC,,INPATIENT,,,78.25,31.3,UC HEALTH,UC HEALTH COMMERCIAL,68.0775,87,,,OTHER,58.69,76.69,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC/DIAG INJ LEVEL I,96372,CPT,260,RC,,OUTPATIENT,,,272.5,109,UC HEALTH,UC HEALTH COMMERCIAL,237.075,87,,,OTHER,204.38,267.05,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC/DIAG INJ LEVEL II,96372,CPT,260,RC,,OUTPATIENT,,,162.25,64.9,UC HEALTH,UC HEALTH COMMERCIAL,141.1575,87,,,OTHER,121.69,159.01,PERCENT OF TOTAL BILLED CHARGES
IM VACCINATION <18 YRS OLD,90460,CPT,761,RC,,OUTPATIENT,,,137,54.8,UC HEALTH,UC HEALTH COMMERCIAL,119.19,87,,,OTHER,102.75,134.26,PERCENT OF TOTAL BILLED CHARGES
COLL OF BLOOD BY VENI PUNCTUR,36415,CPT,300,RC,,OUTPATIENT,,,26,10.4,UC HEALTH,UC HEALTH COMMERCIAL,22.62,87,,,OTHER,19.5,25.48,PERCENT OF TOTAL BILLED CHARGES
CENTRAL LINE FLUSH/DRAW,90784,CPT,361,RC,,OUTPATIENT,,,110.25,44.1,UC HEALTH,UC HEALTH COMMERCIAL,95.9175,87,,,OTHER,82.69,108.05,PERCENT OF TOTAL BILLED CHARGES
INCIS/DRAIN ABCESS SIMPLE,10060,CPT,450,RC,,INPATIENT,,,534.5,213.8,UC HEALTH,UC HEALTH COMMERCIAL,465.015,87,,,OTHER,400.88,523.81,PERCENT OF TOTAL BILLED CHARGES
IV INFUS THERAPY INIT LVL I,96365,CPT,260,RC,,OUTPATIENT,,,618.25,247.3,UC HEALTH,UC HEALTH COMMERCIAL,537.8775,87,,,OTHER,463.69,605.89,PERCENT OF TOTAL BILLED CHARGES
IV INFUS THERAPY INIT LVL II,96365,CPT,260,RC,,OUTPATIENT,,,550.25,220.1,UC HEALTH,UC HEALTH COMMERCIAL,478.7175,87,,,OTHER,412.69,539.25,PERCENT OF TOTAL BILLED CHARGES
IV INFUSION THERAPY ADD'L HR,96366,CPT,450,RC,,OUTPATIENT,,,98.25,39.3,UC HEALTH,UC HEALTH COMMERCIAL,85.4775,87,,,OTHER,73.69,96.29,PERCENT OF TOTAL BILLED CHARGES
IV INFU THERAPY INIT LVL III,96365,CPT,260,RC,,OUTPATIENT,,,562.75,225.1,UC HEALTH,UC HEALTH COMMERCIAL,489.5925,87,,,OTHER,422.06,551.5,PERCENT OF TOTAL BILLED CHARGES
INITIATION OF INFUSION PUMP,96416,CPT,335,RC,,OUTPATIENT,,,830.75,332.3,UC HEALTH,UC HEALTH COMMERCIAL,722.7525,87,,,OTHER,623.06,814.14,PERCENT OF TOTAL BILLED CHARGES
OSTOMY CARE VISIT,G0463,HCPCS,510,RC,,INPATIENT,,,104,41.6,UC HEALTH,UC HEALTH COMMERCIAL,90.48,87,,,OTHER,78,101.92,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAIN NECK/CHEST,21501,CPT,761,RC,,OUTPATIENT,,,3972.25,1588.9,UC HEALTH,UC HEALTH COMMERCIAL,3455.8575,87,,,OTHER,2979.19,3892.81,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC EA ADD'L IVP,96376,CPT,260,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
OBS IM/SQ VACCINE,90471,CPT,761,RC,,INPATIENT,,,144,57.6,UC HEALTH,UC HEALTH COMMERCIAL,125.28,87,,,OTHER,108,141.12,PERCENT OF TOTAL BILLED CHARGES
OBS STRAIGHT BLADDER CATHETER,51701,CPT,450,RC,,INPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,108.75,142.1,PERCENT OF TOTAL BILLED CHARGES
"OBS FOLEY CATHETER, SIMPLE",51702,CPT,320,RC,,INPATIENT,,,343.75,137.5,UC HEALTH,UC HEALTH COMMERCIAL,299.0625,87,,,OTHER,257.81,336.88,PERCENT OF TOTAL BILLED CHARGES
"OBS FOLEY CATHETER, COMPLEX",51703,CPT,320,RC,,INPATIENT,,,450.5,180.2,UC HEALTH,UC HEALTH COMMERCIAL,391.935,87,,,OTHER,337.88,441.49,PERCENT OF TOTAL BILLED CHARGES
"OBS CONCURRENT MEDICATED, INF",96368,CPT,450,RC,,INPATIENT,,,132.25,52.9,UC HEALTH,UC HEALTH COMMERCIAL,115.0575,87,,,OTHER,99.19,129.61,PERCENT OF TOTAL BILLED CHARGES
OBS BLADDER IRRIGATION,51700,CPT,450,RC,,INPATIENT,,,621.5,248.6,UC HEALTH,UC HEALTH COMMERCIAL,540.705,87,,,OTHER,466.13,609.07,PERCENT OF TOTAL BILLED CHARGES
OBS CHEST TUBE INSERT,32551,CPT,450,RC,,INPATIENT,,,1144.5,457.8,UC HEALTH,UC HEALTH COMMERCIAL,995.715,87,,,OTHER,858.38,1121.61,PERCENT OF TOTAL BILLED CHARGES
NG-OG TUBE,43753,CPT,450,RC,,INPATIENT,,,527.09,210.836,UC HEALTH,UC HEALTH COMMERCIAL,458.5683,87,,,OTHER,203.44,265.83,PERCENT OF TOTAL BILLED CHARGES
BIOPSY DEEP TISSUE OF BACK CT,21925,CPT,361,RC,,OUTPATIENT,,,2552.25,1020.9,UC HEALTH,UC HEALTH COMMERCIAL,2220.4575,87,,,OTHER,1914.19,2501.21,PERCENT OF TOTAL BILLED CHARGES
BIOPSY OF LIVER  NEEDLE,47000,CPT,402,RC,,OUTPATIENT,,,1526.75,610.7,UC HEALTH,UC HEALTH COMMERCIAL,1328.2725,87,,,OTHER,1145.06,1496.22,PERCENT OF TOTAL BILLED CHARGES
NEEDLE BIOPSY ABDOMINAL MASS,49180,CPT,361,RC,,OUTPATIENT,,,1513,605.2,UC HEALTH,UC HEALTH COMMERCIAL,1316.31,87,,,OTHER,1134.75,1482.74,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION INITIAL RAD,99152,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
ABSCESS DRAINAGE,49419,CPT,320,RC,,OUTPATIENT,,,3599.5,1439.8,UC HEALTH,UC HEALTH COMMERCIAL,3131.565,87,,,OTHER,2699.63,3527.51,PERCENT OF TOTAL BILLED CHARGES
MODERATE SEDATION (RAD),99153,CPT,761,RC,,OUTPATIENT,,,218.75,87.5,UC HEALTH,UC HEALTH COMMERCIAL,190.3125,87,,,OTHER,164.06,214.38,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM RADIOLOGY,7614946,CDM,,,,INPATIENT,,,638.5,255.4,UC HEALTH,UC HEALTH COMMERCIAL,555.495,87,,,OTHER,478.88,625.73,PERCENT OF TOTAL BILLED CHARGES
RECOVERY ROOM RADIOLOGY ADD'L,7614948,CDM,710,RC,,INPATIENT,,,128.25,51.3,UC HEALTH,UC HEALTH COMMERCIAL,111.5775,87,,,OTHER,96.19,125.69,PERCENT OF TOTAL BILLED CHARGES
NEBULIZER TREATMENT,94640,CPT,410,RC,,OUTPATIENT,,,374.47,149.788,UC HEALTH,UC HEALTH COMMERCIAL,325.7889,87,,,OTHER,98.81,129.12,PERCENT OF TOTAL BILLED CHARGES
BLOOD DRAW OFF VENOUS DEVICE,36591,CPT,260,RC,,OUTPATIENT,,,223.14,89.256,UC HEALTH,UC HEALTH COMMERCIAL,194.1318,87,,,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,OUTPATIENT,,,223.14,89.256,UC HEALTH,UC HEALTH COMMERCIAL,194.1318,87,,,OTHER,167.4,218.7,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE SIMPLE,51705,CPT,450,RC,,OUTPATIENT,,,530.46,212.184,UC HEALTH,UC HEALTH COMMERCIAL,461.5002,87,,,OTHER,397.8,519.9,PERCENT OF TOTAL BILLED CHARGES
CHANGE OF BLADDER TUBE COMPLEX,51710,CPT,320,RC,,OUTPATIENT,,,572.8,229.12,UC HEALTH,UC HEALTH COMMERCIAL,498.336,87,,,OTHER,429.6,561.3,PERCENT OF TOTAL BILLED CHARGES
US LIMITED NONVAS EXTR BILAT,7688250,CPT,450,RC,50,OUTPATIENT,,,554.5,221.8,UC HEALTH,UC HEALTH COMMERCIAL,482.415,87,,,OTHER,415.88,543.41,PERCENT OF TOTAL BILLED CHARGES
MDCR SCREENING EKG,G0404,HCPCS,770,RC,,INPATIENT,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PNEUMOCOCCOL VACCINE,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF HEPATITIS B VACC,G0010,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PNEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF INFLUENZA VIRUS VACC,G0008,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
ADMIN OF PHEUMOCOCCOL VACC,G0009,HCPCS,771,RC,,INPATIENT,,,57.75,23.1,UC HEALTH,UC HEALTH COMMERCIAL,50.2425,87,,,OTHER,43.31,56.6,PERCENT OF TOTAL BILLED CHARGES
LIVING WITH PAIN (GROUP CLASS),9150000,CDM,,,,OUTPATIENT,,,120,48,UC HEALTH,UC HEALTH COMMERCIAL,104.4,87,,,OTHER,90,117.6,PERCENT OF TOTAL BILLED CHARGES
US CAROTID DUPLEX,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,UC HEALTH,UC HEALTH COMMERCIAL,1174.2825,87,,,OTHER,1012.31,1322.76,PERCENT OF TOTAL BILLED CHARGES
VESSEL MAPPING HEMO ACCESS,G0365,HCPCS,402,RC,,INPATIENT,,,717.5,287,UC HEALTH,UC HEALTH COMMERCIAL,624.225,87,,,OTHER,538.13,703.15,PERCENT OF TOTAL BILLED CHARGES
US DUPLEX V/A FLOW BIL,93925,CPT,402,RC,,OUTPATIENT,,,959.25,383.7,UC HEALTH,UC HEALTH COMMERCIAL,834.5475,87,,,OTHER,719.44,940.07,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER BILATERAL,93970,CPT,921,RC,,OUTPATIENT,,,1293.25,517.3,UC HEALTH,UC HEALTH COMMERCIAL,1125.1275,87,,,OTHER,969.94,1267.39,PERCENT OF TOTAL BILLED CHARGES
US VEN DOPPLER UNILATERAL,93971,CPT,402,RC,,OUTPATIENT,,,928.5,371.4,UC HEALTH,UC HEALTH COMMERCIAL,807.795,87,,,OTHER,696.38,909.93,PERCENT OF TOTAL BILLED CHARGES
DUPLEX V/A FLOW UNILATERAL,93926,CPT,402,RC,,OUTPATIENT,,,536.5,214.6,UC HEALTH,UC HEALTH COMMERCIAL,466.755,87,,,OTHER,402.38,525.77,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER LIMITED,93976,CPT,402,RC,,OUTPATIENT,,,584,233.6,UC HEALTH,UC HEALTH COMMERCIAL,508.08,87,,,OTHER,438,572.32,PERCENT OF TOTAL BILLED CHARGES
LIVER DOPPLER ONLY,93975,CPT,402,RC,,OUTPATIENT,,,458.68,183.472,UC HEALTH,UC HEALTH COMMERCIAL,399.0516,87,,,OTHER,344,449.5,PERCENT OF TOTAL BILLED CHARGES
US HEAD DUP EXTRACRANIAL ARTER,93880,CPT,402,RC,,OUTPATIENT,,,1349.75,539.9,UC HEALTH,UC HEALTH COMMERCIAL,1174.2825,87,,,OTHER,1012.31,1322.76,PERCENT OF TOTAL BILLED CHARGES
LIVER ONLY,76705,CPT,402,RC,,OUTPATIENT,,,620.9,248.36,UC HEALTH,UC HEALTH COMMERCIAL,540.183,87,,,OTHER,465.7,608.5,PERCENT OF TOTAL BILLED CHARGES
AMB BP MONITOR RECORDING,93786,CPT,920,RC,,OUTPATIENT,,,224.25,89.7,UC HEALTH,UC HEALTH COMMERCIAL,195.0975,87,,,OTHER,168.19,219.77,PERCENT OF TOTAL BILLED CHARGES
AMB BP 24 HRS SCAN ANALYSIS,93788,CPT,480,RC,,OUTPATIENT,,,475.5,190.2,UC HEALTH,UC HEALTH COMMERCIAL,413.685,87,,,OTHER,356.63,465.99,PERCENT OF TOTAL BILLED CHARGES
THERAPEUTIC PHLEBOTOMY,99195,CPT,940,RC,,OUTPATIENT,,,266,106.4,UC HEALTH,UC HEALTH COMMERCIAL,231.42,87,,,OTHER,199.5,260.68,PERCENT OF TOTAL BILLED CHARGES
PICC LINE PLACEMENT,36569,CPT,361,RC,,INPATIENT,,,1516.25,606.5,UC HEALTH,UC HEALTH COMMERCIAL,1319.1375,87,,,OTHER,1137.19,1485.93,PERCENT OF TOTAL BILLED CHARGES
MEDTRONIC MINIMED INSULIN PUMP,9420009,CDM,,,,INPATIENT,,,300,120,UC HEALTH,UC HEALTH COMMERCIAL,261,87,,,OTHER,225,294,PERCENT OF TOTAL BILLED CHARGES
CARDIAC REHAB W/MONITOR,93798,CPT,948,RC,,OUTPATIENT,,,231.33,92.532,UC HEALTH,UC HEALTH COMMERCIAL,201.2571,87,,,OTHER,131.63,171.99,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB WITH EXERCISE,G0424,HCPCS,948,RC,,INPATIENT,,,192,76.8,UC HEALTH,UC HEALTH COMMERCIAL,167.04,87,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
SUPERVISED EXERCISE THERAPY,93668,CPT,943,RC,,OUTPATIENT,,,192,76.8,UC HEALTH,UC HEALTH COMMERCIAL,167.04,87,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
WALK TEST W/O2 SATS 6 MINS,94618,CPT,943,RC,,OUTPATIENT,,,223.13,89.252,UC HEALTH,UC HEALTH COMMERCIAL,194.1231,87,,,OTHER,84.56,110.5,PERCENT OF TOTAL BILLED CHARGES
PULMONARY REHAB MGMT CLASS (1),G0239,HCPCS,410,RC,,INPATIENT,,,192,76.8,UC HEALTH,UC HEALTH COMMERCIAL,167.04,87,,,OTHER,144,188.16,PERCENT OF TOTAL BILLED CHARGES
LR 1000 ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,90.88,36.35,AETNA,AETNA COMMERCIAL,89.07,98,,,OTHER,68.16,89.07,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,AETNA,AETNA COMMERCIAL,85.93,98,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,AETNA,AETNA COMMERCIAL,85.93,98,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,AETNA,AETNA COMMERCIAL,117738.08,98,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,AETNA,AETNA COMMERCIAL,117738.08,98,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,2516780,CDM,636,RC,,BOTH,,,120140.9,48056.36,AETNA,AETNA COMMERCIAL,117738.08,98,,,OTHER,90105.68,117738.08,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,AETNA,AETNA COMMERCIAL,72.52,98,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,AETNA,AETNA COMMERCIAL,69.5,98,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,AETNA,AETNA COMMERCIAL,69.5,98,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,AETNA,AETNA COMMERCIAL,76.54,98,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,AETNA,AETNA COMMERCIAL,76.54,98,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS KCL 20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,98.13,39.25,AETNA,AETNA COMMERCIAL,96.17,98,,,OTHER,73.6,96.17,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,AETNA,AETNA COMMERCIAL,80.06,98,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,AETNA,AETNA COMMERCIAL,80.06,98,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,AETNA,AETNA COMMERCIAL,2.72,98,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,AETNA,AETNA COMMERCIAL,2.72,98,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,AETNA,AETNA COMMERCIAL,2.92,98,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,AETNA,AETNA COMMERCIAL,2.92,98,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,2510250,CDM,636,RC,,BOTH,1,ML,2.98,1.19,AETNA,AETNA COMMERCIAL,2.92,98,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,AETNA,AETNA COMMERCIAL,63.75,98,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,AETNA,AETNA COMMERCIAL,63.75,98,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,AETNA,AETNA COMMERCIAL,20.84,98,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,AETNA,AETNA COMMERCIAL,20.84,98,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,AETNA,AETNA COMMERCIAL,65.22,98,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,AETNA,AETNA COMMERCIAL,65.22,98,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,AETNA,AETNA COMMERCIAL,51.99,98,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,AETNA,AETNA COMMERCIAL,51.99,98,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,AETNA,AETNA COMMERCIAL,8.17,98,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,AETNA,AETNA COMMERCIAL,8.17,98,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMULIN R) 3 ML VIAL,J1815,HCPCS,636,RC,,BOTH,3,ML,10.78,4.31,AETNA,AETNA COMMERCIAL,10.57,98,,,OTHER,8.09,10.57,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,66.25,26.5,AETNA,AETNA COMMERCIAL,64.93,98,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 1MG INJ,J1170,HCPCS,636,RC,,BOTH,1,ME,53.73,21.49,AETNA,AETNA COMMERCIAL,52.66,98,,,OTHER,40.3,52.66,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.4 MG/ML,J2310,HCPCS,636,RC,,BOTH,0.4,ML,72.54,29.02,AETNA,AETNA COMMERCIAL,71.09,98,,,OTHER,54.4,71.09,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,AETNA,AETNA COMMERCIAL,97.49,98,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,AETNA,AETNA COMMERCIAL,97.49,98,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
NS  100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,63.3,25.32,AETNA,AETNA COMMERCIAL,62.04,98,,,OTHER,47.48,62.04,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 0.5% 50ML VIAL   MD,J2001,HCPCS,636,RC,,BOTH,50,ML,53.6,21.44,AETNA,AETNA COMMERCIAL,52.53,98,,,OTHER,40.2,52.53,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,61.36,24.54,AETNA,AETNA COMMERCIAL,60.13,98,,,OTHER,46.02,60.13,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J7507,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,AETNA,AETNA COMMERCIAL,3.77,98,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J3490,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,AETNA,AETNA COMMERCIAL,3.77,98,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,AETNA,AETNA COMMERCIAL,87.78,98,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,AETNA,AETNA COMMERCIAL,87.78,98,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7070,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,AETNA,AETNA COMMERCIAL,87.78,98,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITAL 130MG/ML VIAL,J2560,HCPCS,636,RC,,BOTH,130,ME,190.89,76.36,AETNA,AETNA COMMERCIAL,187.07,98,,,OTHER,143.17,187.07,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 2 MG SYRINGE,J1170,HCPCS,636,RC,,BOTH,2,ME,57.58,23.03,AETNA,AETNA COMMERCIAL,56.43,98,,,OTHER,43.19,56.43,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,AETNA,AETNA COMMERCIAL,92.48,98,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,AETNA,AETNA COMMERCIAL,92.48,98,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE 25 MG AMP,J2550,HCPCS,636,RC,,BOTH,25,ME,48.33,19.33,AETNA,AETNA COMMERCIAL,47.36,98,,,OTHER,36.25,47.36,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,AETNA,AETNA COMMERCIAL,64.15,98,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,AETNA,AETNA COMMERCIAL,64.15,98,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,2515450,CDM,636,RC,,BOTH,2,GR,115.87,46.35,AETNA,AETNA COMMERCIAL,113.55,98,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,AETNA,AETNA COMMERCIAL,974.24,98,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,AETNA,AETNA COMMERCIAL,974.24,98,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 2.5MG,J8610,HCPCS,636,RC,,BOTH,2.5,ME,25.39,10.16,AETNA,AETNA COMMERCIAL,24.88,98,,,OTHER,19.04,24.88,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,AETNA,AETNA COMMERCIAL,974.24,98,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,AETNA,AETNA COMMERCIAL,22.12,98,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,AETNA,AETNA COMMERCIAL,22.12,98,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,J3490,HCPCS,636,RC,,BOTH,2,GR,115.87,46.35,AETNA,AETNA COMMERCIAL,113.55,98,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 1G VIAL,J3490,HCPCS,250,RC,,BOTH,1,GR,131.96,52.78,AETNA,AETNA COMMERCIAL,129.32,98,,,OTHER,98.97,129.32,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,AETNA,AETNA COMMERCIAL,64.15,98,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,AETNA,AETNA COMMERCIAL,64.15,98,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,2508230,CDM,250,RC,,BOTH,1.25,ME,22.57,9.03,AETNA,AETNA COMMERCIAL,22.12,98,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,AETNA,AETNA COMMERCIAL,974.24,98,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J1162,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,AETNA,AETNA COMMERCIAL,8994.52,98,,,OTHER,5016.31,8994.52,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,AETNA,AETNA COMMERCIAL,43.48,98,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,AETNA,AETNA COMMERCIAL,43.48,98,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J2150,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,AETNA,AETNA COMMERCIAL,178.9,98,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,AETNA,AETNA COMMERCIAL,111.81,98,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,AETNA,AETNA COMMERCIAL,111.81,98,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J7799,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,AETNA,AETNA COMMERCIAL,178.9,98,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J3490,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,AETNA,AETNA COMMERCIAL,8994.52,98,,,OTHER,6883.56,8994.52,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B IMM. GLOBULIN 5 ML,2510180,CDM,636,RC,,BOTH,5,ML,333.07,133.23,AETNA,AETNA COMMERCIAL,326.41,98,,,OTHER,148.18,326.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,AETNA,AETNA COMMERCIAL,68.41,98,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,AETNA,AETNA COMMERCIAL,68.41,98,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,AETNA,AETNA COMMERCIAL,4619.25,98,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,AETNA,AETNA COMMERCIAL,4619.25,98,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,AETNA,AETNA COMMERCIAL,75.6,98,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,AETNA,AETNA COMMERCIAL,75.6,98,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
ARIPIPRAZOLE 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,67.81,27.12,AETNA,AETNA COMMERCIAL,66.45,98,,,OTHER,50.86,66.45,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,AETNA,AETNA COMMERCIAL,65.97,98,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,AETNA,AETNA COMMERCIAL,65.97,98,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2274,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,AETNA,AETNA COMMERCIAL,132.28,98,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2270,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,AETNA,AETNA COMMERCIAL,132.28,98,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
NALBUPHINE 10MG/ML AMP,J2300,HCPCS,636,RC,,BOTH,10,ME,51.33,20.53,AETNA,AETNA COMMERCIAL,50.3,98,,,OTHER,38.5,50.3,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 2.5MG TAB,2515000,CDM,636,RC,,BOTH,2.5,ME,15.69,6.28,AETNA,AETNA COMMERCIAL,15.37,98,,,OTHER,11.77,15.37,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 250MG/50ML,J1956,HCPCS,636,RC,,BOTH,50,ML,81.19,32.48,AETNA,AETNA COMMERCIAL,79.57,98,,,OTHER,60.89,79.57,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,AETNA,AETNA COMMERCIAL,84.75,98,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,AETNA,AETNA COMMERCIAL,84.75,98,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,AETNA,AETNA COMMERCIAL,67.63,98,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,AETNA,AETNA COMMERCIAL,67.63,98,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,AETNA,AETNA COMMERCIAL,85.39,98,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,AETNA,AETNA COMMERCIAL,85.39,98,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE,J3490,HCPCS,250,RC,,BOTH,,,37.19,14.87,AETNA,AETNA COMMERCIAL,36.44,98,,,OTHER,27.89,36.44,PERCENT OF TOTAL BILLED CHARGES
PROPRANOLOL 1MG AMP,J1800,HCPCS,636,RC,,BOTH,1,ME,82.46,32.98,AETNA,AETNA COMMERCIAL,80.81,98,,,OTHER,61.85,80.81,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,AETNA,AETNA COMMERCIAL,40.28,98,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,AETNA,AETNA COMMERCIAL,40.28,98,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,AETNA,AETNA COMMERCIAL,67.86,98,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,AETNA,AETNA COMMERCIAL,67.86,98,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,2504940,CDM,250,RC,,BOTH,50,ME,41.1,16.44,AETNA,AETNA COMMERCIAL,40.28,98,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,AETNA,AETNA COMMERCIAL,12.19,98,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,AETNA,AETNA COMMERCIAL,12.19,98,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,2506040,CDM,250,RC,,BOTH,,,12.43,4.97,AETNA,AETNA COMMERCIAL,12.19,98,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J0280,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,AETNA,AETNA COMMERCIAL,22.26,98,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J0694,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,AETNA,AETNA COMMERCIAL,104.61,98,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,AETNA,AETNA COMMERCIAL,204.98,98,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,AETNA,AETNA COMMERCIAL,204.98,98,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,AETNA,AETNA COMMERCIAL,1714.14,98,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,AETNA,AETNA COMMERCIAL,1714.14,98,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,AETNA,AETNA COMMERCIAL,20.51,98,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,AETNA,AETNA COMMERCIAL,20.51,98,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,AETNA,AETNA COMMERCIAL,104.61,98,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J3490,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,AETNA,AETNA COMMERCIAL,22.26,98,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 2G VIAL,J3490,HCPCS,250,RC,,BOTH,2,GR,107.37,42.95,AETNA,AETNA COMMERCIAL,105.22,98,,,OTHER,80.53,105.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,2504480,CDM,636,RC,,BOTH,7.5,ME,1749.12,699.65,AETNA,AETNA COMMERCIAL,1714.14,98,,,OTHER,1311.84,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,2508220,CDM,250,RC,,BOTH,0.3,ME,20.93,8.37,AETNA,AETNA COMMERCIAL,20.51,98,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J7626,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,AETNA,AETNA COMMERCIAL,38.61,98,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J7674,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,AETNA,AETNA COMMERCIAL,44.98,98,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J3490,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,AETNA,AETNA COMMERCIAL,44.98,98,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,AETNA,AETNA COMMERCIAL,38.61,98,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,AETNA,AETNA COMMERCIAL,23.8,98,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,AETNA,AETNA COMMERCIAL,23.8,98,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,2504400,CDM,250,RC,,BOTH,4,GR,24.29,9.72,AETNA,AETNA COMMERCIAL,23.8,98,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,AETNA,AETNA COMMERCIAL,22.04,98,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,AETNA,AETNA COMMERCIAL,22.04,98,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,2502460,CDM,250,RC,,BOTH,,,22.49,9,AETNA,AETNA COMMERCIAL,22.04,98,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,AETNA,AETNA COMMERCIAL,81.68,98,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,AETNA,AETNA COMMERCIAL,81.68,98,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,AETNA,AETNA COMMERCIAL,123.91,98,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,AETNA,AETNA COMMERCIAL,123.91,98,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,AETNA,AETNA COMMERCIAL,123.91,98,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,AETNA,AETNA COMMERCIAL,123.91,98,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 5MG TAB,2519250,CDM,636,RC,,BOTH,5,ME,14.15,5.66,AETNA,AETNA COMMERCIAL,13.86,98,,,OTHER,10.61,13.86,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,AETNA,AETNA COMMERCIAL,173.27,98,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,AETNA,AETNA COMMERCIAL,173.27,98,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,2505390,CDM,636,RC,,BOTH,0.25,ME,176.81,70.72,AETNA,AETNA COMMERCIAL,173.27,98,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,AETNA,AETNA COMMERCIAL,22.84,98,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,AETNA,AETNA COMMERCIAL,22.84,98,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,AETNA,AETNA COMMERCIAL,15.66,98,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,AETNA,AETNA COMMERCIAL,15.66,98,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,2504300,CDM,250,RC,,BOTH,,,23.31,9.32,AETNA,AETNA COMMERCIAL,22.84,98,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,2504920,CDM,250,RC,,BOTH,,,15.98,6.39,AETNA,AETNA COMMERCIAL,15.66,98,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,AETNA,AETNA COMMERCIAL,55.55,98,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,AETNA,AETNA COMMERCIAL,55.55,98,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,J3490,HCPCS,250,RC,,BOTH,,,126.41,50.56,AETNA,AETNA COMMERCIAL,123.88,98,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,2515370,CDM,250,RC,,BOTH,,,126.41,50.56,AETNA,AETNA COMMERCIAL,123.88,98,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 20ML,J2001,HCPCS,636,RC,,BOTH,20,ML,62.37,24.95,AETNA,AETNA COMMERCIAL,61.12,98,,,OTHER,46.78,61.12,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,AETNA,AETNA COMMERCIAL,188.78,98,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,AETNA,AETNA COMMERCIAL,188.78,98,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
METHOCARBAMOL 100MG VIAL,J2800,HCPCS,636,RC,,BOTH,100,ME,204.62,81.85,AETNA,AETNA COMMERCIAL,200.53,98,,,OTHER,153.47,200.53,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 10 U/ML INJ,J2590,HCPCS,636,RC,,BOTH,10,UN,50.06,20.02,AETNA,AETNA COMMERCIAL,49.06,98,,,OTHER,37.55,49.06,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,AETNA,AETNA COMMERCIAL,58.05,98,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,AETNA,AETNA COMMERCIAL,58.05,98,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,2501130,CDM,636,RC,,BOTH,1.5,GR,59.23,23.69,AETNA,AETNA COMMERCIAL,58.05,98,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,J3490,HCPCS,250,RC,,BOTH,1000,ME,16.62,6.65,AETNA,AETNA COMMERCIAL,16.29,98,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,2516900,CDM,250,RC,,BOTH,1000,ME,16.62,6.65,AETNA,AETNA COMMERCIAL,16.29,98,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,AETNA,AETNA COMMERCIAL,60.61,98,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,AETNA,AETNA COMMERCIAL,60.61,98,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,AETNA,AETNA COMMERCIAL,86.97,98,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,AETNA,AETNA COMMERCIAL,86.97,98,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2274,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,AETNA,AETNA COMMERCIAL,51.86,98,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2270,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,AETNA,AETNA COMMERCIAL,51.86,98,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,AETNA,AETNA COMMERCIAL,82.24,98,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,AETNA,AETNA COMMERCIAL,82.24,98,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,J3490,HCPCS,250,RC,,BOTH,50,ME,17.65,7.06,AETNA,AETNA COMMERCIAL,17.3,98,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,2510700,CDM,250,RC,,BOTH,50,ME,17.65,7.06,AETNA,AETNA COMMERCIAL,17.3,98,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
NS 500ML,J7030,HCPCS,636,RC,,BOTH,500,ML,81.62,32.65,AETNA,AETNA COMMERCIAL,79.99,98,,,OTHER,61.22,79.99,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,AETNA,AETNA COMMERCIAL,5034.82,98,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,AETNA,AETNA COMMERCIAL,5034.82,98,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,2509490,CDM,636,RC,,BOTH,1,ME,472.36,188.94,AETNA,AETNA COMMERCIAL,462.91,98,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,AETNA,AETNA COMMERCIAL,462.91,98,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,AETNA,AETNA COMMERCIAL,462.91,98,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,J3490,HCPCS,250,RC,,BOTH,0.125,ME,48.04,19.22,AETNA,AETNA COMMERCIAL,47.08,98,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,AETNA,AETNA COMMERCIAL,5034.82,98,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,AETNA,AETNA COMMERCIAL,5034.82,98,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,2506740,CDM,250,RC,,BOTH,0.125,ME,48.04,19.22,AETNA,AETNA COMMERCIAL,47.08,98,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,AETNA,AETNA COMMERCIAL,491.57,98,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,AETNA,AETNA COMMERCIAL,491.57,98,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,2508270,CDM,250,RC,,BOTH,,,501.6,200.64,AETNA,AETNA COMMERCIAL,491.57,98,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,AETNA,AETNA COMMERCIAL,39.86,98,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,AETNA,AETNA COMMERCIAL,39.86,98,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,AETNA,AETNA COMMERCIAL,72.62,98,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,AETNA,AETNA COMMERCIAL,72.62,98,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,AETNA,AETNA COMMERCIAL,72.62,98,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,AETNA,AETNA COMMERCIAL,72.62,98,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,AETNA,AETNA COMMERCIAL,19.38,98,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,AETNA,AETNA COMMERCIAL,19.38,98,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,2505500,CDM,250,RC,,BOTH,5,ME,19.78,7.91,AETNA,AETNA COMMERCIAL,19.38,98,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,AETNA,AETNA COMMERCIAL,265.26,98,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,AETNA,AETNA COMMERCIAL,265.26,98,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,2509880,CDM,250,RC,,BOTH,,,270.68,108.27,AETNA,AETNA COMMERCIAL,265.26,98,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,AETNA,AETNA COMMERCIAL,66.43,98,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,AETNA,AETNA COMMERCIAL,66.43,98,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,2505960,CDM,636,RC,,BOTH,500,ME,67.78,27.11,AETNA,AETNA COMMERCIAL,66.43,98,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% 50ML MDV,J0665,HCPCS,636,RC,,BOTH,50,ML,42.7,17.08,AETNA,AETNA COMMERCIAL,41.84,98,,,OTHER,0.02,41.84,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 1MG AMP,J3430,HCPCS,636,RC,,BOTH,1,ME,96.12,38.45,AETNA,AETNA COMMERCIAL,94.2,98,,,OTHER,72.09,94.2,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,AETNA,AETNA COMMERCIAL,61.97,98,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,AETNA,AETNA COMMERCIAL,61.97,98,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,AETNA,AETNA COMMERCIAL,23.55,98,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,AETNA,AETNA COMMERCIAL,23.55,98,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,2507500,CDM,250,RC,,BOTH,50,ME,24.03,9.61,AETNA,AETNA COMMERCIAL,23.55,98,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,AETNA,AETNA COMMERCIAL,48.33,98,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,AETNA,AETNA COMMERCIAL,48.33,98,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3370,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,AETNA,AETNA COMMERCIAL,48.33,98,,,OTHER,36.99,48.33,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,AETNA,AETNA COMMERCIAL,49.42,98,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
METOCLOPRAMIDE 5MG/ML VIAL,J2765,HCPCS,636,RC,,BOTH,5,ME,45.92,18.37,AETNA,AETNA COMMERCIAL,45.01,98,,,OTHER,34.44,45.01,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,AETNA,AETNA COMMERCIAL,21.91,98,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,AETNA,AETNA COMMERCIAL,21.91,98,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,2507510,CDM,250,RC,,BOTH,12.5,ME,22.35,8.94,AETNA,AETNA COMMERCIAL,21.91,98,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,J3490,HCPCS,255,RC,,BOTH,30,ML,110.55,44.22,AETNA,AETNA COMMERCIAL,108.33,98,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,2508130,CDM,255,RC,,BOTH,30,ML,110.55,44.22,AETNA,AETNA COMMERCIAL,108.33,98,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 0.9% NACL,J1580,HCPCS,636,RC,,BOTH,80,ME,68.12,27.25,AETNA,AETNA COMMERCIAL,66.75,98,,,OTHER,51.09,66.75,PERCENT OF TOTAL BILLED CHARGES
SPIRONOLACTONE 25 MG TAB,J3490,HCPCS,250,RC,,BOTH,25,ME,17.63,7.05,AETNA,AETNA COMMERCIAL,17.27,98,,,OTHER,13.22,17.27,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,AETNA,AETNA COMMERCIAL,32.92,98,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,AETNA,AETNA COMMERCIAL,32.92,98,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,J3490,HCPCS,250,RC,,BOTH,180,ME,59.19,23.67,AETNA,AETNA COMMERCIAL,58,98,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,2506840,CDM,250,RC,,BOTH,180,ME,59.19,23.67,AETNA,AETNA COMMERCIAL,58,98,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,AETNA,AETNA COMMERCIAL,142.05,98,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,AETNA,AETNA COMMERCIAL,142.05,98,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
MENTHOL ZINCOX,J3490,HCPCS,250,RC,,BOTH,,,26.42,10.57,AETNA,AETNA COMMERCIAL,25.89,98,,,OTHER,19.82,25.89,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,AETNA,AETNA COMMERCIAL,308.8,98,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,AETNA,AETNA COMMERCIAL,308.8,98,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,2508790,CDM,636,RC,,BOTH,50,ME,125,50,AETNA,AETNA COMMERCIAL,122.5,98,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,AETNA,AETNA COMMERCIAL,118.08,98,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,AETNA,AETNA COMMERCIAL,118.08,98,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,AETNA,AETNA COMMERCIAL,118.08,98,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,AETNA,AETNA COMMERCIAL,118.08,98,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
GLYCOPYRROLATE 0.2 MG/ML,J3490,HCPCS,250,RC,,BOTH,0.2,ML,74.12,29.65,AETNA,AETNA COMMERCIAL,72.64,98,,,OTHER,55.59,72.64,PERCENT OF TOTAL BILLED CHARGES
HYDROCORT SOD.SUCC. 100MG VIAL,J1720,HCPCS,636,RC,,BOTH,100,ME,71.91,28.76,AETNA,AETNA COMMERCIAL,70.47,98,,,OTHER,53.93,70.47,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 40MG VIAL,J2920,HCPCS,636,RC,,BOTH,40,ME,58,23.2,AETNA,AETNA COMMERCIAL,56.84,98,,,OTHER,43.5,56.84,PERCENT OF TOTAL BILLED CHARGES
NS 250ML GLASS BOTTLE,J7030,HCPCS,636,RC,,BOTH,250,ML,79.33,31.73,AETNA,AETNA COMMERCIAL,77.75,98,,,OTHER,59.5,77.75,PERCENT OF TOTAL BILLED CHARGES
PROCHLORPERAZINE 10 MG VIAL,J0780,HCPCS,636,RC,,BOTH,10,ME,74.3,29.72,AETNA,AETNA COMMERCIAL,72.81,98,,,OTHER,55.73,72.81,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,AETNA,AETNA COMMERCIAL,16.26,98,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,AETNA,AETNA COMMERCIAL,16.26,98,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,2522260,CDM,250,RC,,BOTH,100,ME,16.59,6.64,AETNA,AETNA COMMERCIAL,16.26,98,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2371,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,AETNA,AETNA COMMERCIAL,56.03,98,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2370,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,AETNA,AETNA COMMERCIAL,56.03,98,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,AETNA,AETNA COMMERCIAL,99.27,98,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,AETNA,AETNA COMMERCIAL,99.27,98,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
FOLIC ACID 1 MG TAB,J3490,HCPCS,250,RC,,BOTH,1,ME,17.34,6.94,AETNA,AETNA COMMERCIAL,17,98,,,OTHER,13.01,17,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,AETNA,AETNA COMMERCIAL,82.43,98,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,AETNA,AETNA COMMERCIAL,82.43,98,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
HYDRALAZINE 20 MG/ML VIAL,J0360,HCPCS,636,RC,,BOTH,20,ME,142.58,57.03,AETNA,AETNA COMMERCIAL,139.73,98,,,OTHER,106.94,139.73,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,AETNA,AETNA COMMERCIAL,45.19,98,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,AETNA,AETNA COMMERCIAL,45.19,98,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
PATIENTS OWN MED,J3490,HCPCS,636,RC,,BOTH,,,0.52,0.21,AETNA,AETNA COMMERCIAL,0.51,98,,,OTHER,0.39,0.51,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,AETNA,AETNA COMMERCIAL,19.22,98,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,AETNA,AETNA COMMERCIAL,19.22,98,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,2504830,CDM,250,RC,,BOTH,10,ME,19.61,7.84,AETNA,AETNA COMMERCIAL,19.22,98,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,AETNA,AETNA COMMERCIAL,58.1,98,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,AETNA,AETNA COMMERCIAL,58.1,98,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,AETNA,AETNA COMMERCIAL,136.38,98,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,AETNA,AETNA COMMERCIAL,136.38,98,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,AETNA,AETNA COMMERCIAL,16.96,98,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,AETNA,AETNA COMMERCIAL,16.96,98,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,2509260,CDM,250,RC,,BOTH,40,ME,17.31,6.92,AETNA,AETNA COMMERCIAL,16.96,98,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,AETNA,AETNA COMMERCIAL,53.6,98,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,AETNA,AETNA COMMERCIAL,53.6,98,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,AETNA,AETNA COMMERCIAL,45.57,98,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 60MG/0.9% NS 50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,64.59,25.84,AETNA,AETNA COMMERCIAL,63.3,98,,,OTHER,48.44,63.3,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,AETNA,AETNA COMMERCIAL,65.97,98,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,AETNA,AETNA COMMERCIAL,65.97,98,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,2511540,CDM,636,RC,,BOTH,,,146.98,58.79,AETNA,AETNA COMMERCIAL,144.04,98,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,90715,HCPCS,636,RC,,BOTH,,,146.98,58.79,AETNA,AETNA COMMERCIAL,144.04,98,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 80MG VIAL,J1580,HCPCS,636,RC,,BOTH,80,ME,47.86,19.14,AETNA,AETNA COMMERCIAL,46.9,98,,,OTHER,35.89,46.9,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 4MEQ/ML 2ML VIAL,J3475,HCPCS,636,RC,,BOTH,2,ML,34.27,13.71,AETNA,AETNA COMMERCIAL,33.58,98,,,OTHER,25.7,33.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,AETNA,AETNA COMMERCIAL,54.79,98,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,AETNA,AETNA COMMERCIAL,54.79,98,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,AETNA,AETNA COMMERCIAL,54.79,98,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,AETNA,AETNA COMMERCIAL,54.79,98,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,AETNA,AETNA COMMERCIAL,63.38,98,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,AETNA,AETNA COMMERCIAL,63.38,98,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,2513040,CDM,636,RC,,BOTH,20,ME,44.88,17.95,AETNA,AETNA COMMERCIAL,43.98,98,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,AETNA,AETNA COMMERCIAL,43.98,98,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,AETNA,AETNA COMMERCIAL,43.98,98,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT 4MG,J3490,HCPCS,636,RC,,BOTH,4,ME,23.2,9.28,AETNA,AETNA COMMERCIAL,22.74,98,,,OTHER,17.4,22.74,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J0665,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,AETNA,AETNA COMMERCIAL,51.08,98,,,OTHER,0.02,51.08,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,AETNA,AETNA COMMERCIAL,51.08,98,,,OTHER,39.09,51.08,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,AETNA,AETNA COMMERCIAL,44.21,98,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,AETNA,AETNA COMMERCIAL,44.21,98,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,2506990,CDM,636,RC,,BOTH,50,ME,45.11,18.05,AETNA,AETNA COMMERCIAL,44.21,98,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
METHLYPREDNISOLONE 125MG VIAL,J2930,HCPCS,636,RC,,BOTH,125,ME,66.23,26.49,AETNA,AETNA COMMERCIAL,64.91,98,,,OTHER,49.67,64.91,PERCENT OF TOTAL BILLED CHARGES
LORAZEPAM 2 MG/ML VIAL,J2060,HCPCS,636,RC,,BOTH,2,ME,55.93,22.37,AETNA,AETNA COMMERCIAL,54.81,98,,,OTHER,41.94,54.81,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,S0164,HCPCS,636,RC,,BOTH,40,ME,74.08,29.63,AETNA,AETNA COMMERCIAL,72.6,98,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,2507670,CDM,636,RC,,BOTH,40,ME,74.08,29.63,AETNA,AETNA COMMERCIAL,72.6,98,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
NS  500ML,J7040,HCPCS,636,RC,,BOTH,500,ML,175.19,70.08,AETNA,AETNA COMMERCIAL,171.69,98,,,OTHER,131.39,171.69,PERCENT OF TOTAL BILLED CHARGES
NON FORMULARY MED REC,2504941,CDM,636,RC,,BOTH,,,0.05,0.02,AETNA,AETNA COMMERCIAL,0.05,98,,,OTHER,0.03,0.05,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 15MG VIAL,J1885,HCPCS,636,RC,,BOTH,15,ME,49.58,19.83,AETNA,AETNA COMMERCIAL,48.58,98,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
DUONEB 0.5MG/3.ML,J7620,HCPCS,636,RC,,BOTH,3,ML,2.22,0.89,AETNA,AETNA COMMERCIAL,2.17,98,,,OTHER,1.66,2.17,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,AETNA,AETNA COMMERCIAL,51.35,98,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,AETNA,AETNA COMMERCIAL,51.35,98,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
NS  250ML,J7050,HCPCS,636,RC,,BOTH,250,ML,83.9,33.56,AETNA,AETNA COMMERCIAL,82.22,98,,,OTHER,62.93,82.22,PERCENT OF TOTAL BILLED CHARGES
NS  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,122.12,48.85,AETNA,AETNA COMMERCIAL,119.67,98,,,OTHER,91.59,119.67,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,AETNA,AETNA COMMERCIAL,779.69,98,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,AETNA,AETNA COMMERCIAL,779.69,98,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,AETNA,AETNA COMMERCIAL,49.77,98,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,AETNA,AETNA COMMERCIAL,49.77,98,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,AETNA,AETNA COMMERCIAL,71.62,98,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,AETNA,AETNA COMMERCIAL,71.62,98,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,AETNA,AETNA COMMERCIAL,75.76,98,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,AETNA,AETNA COMMERCIAL,75.76,98,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
NEOSTIGMINE 1MG/ML INJ,J2710,HCPCS,636,RC,,BOTH,1,ME,81.21,32.48,AETNA,AETNA COMMERCIAL,79.59,98,,,OTHER,60.91,79.59,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 100 MG/2 ML VIAL,J1165,HCPCS,636,RC,,BOTH,100,ME,31.36,12.54,AETNA,AETNA COMMERCIAL,30.73,98,,,OTHER,23.52,30.73,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,AETNA,AETNA COMMERCIAL,90.28,98,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,AETNA,AETNA COMMERCIAL,90.28,98,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,AETNA,AETNA COMMERCIAL,255.14,98,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,AETNA,AETNA COMMERCIAL,255.14,98,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,AETNA,AETNA COMMERCIAL,461.19,98,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,AETNA,AETNA COMMERCIAL,461.19,98,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,2509110,CDM,636,RC,,BOTH,30,UN,470.6,188.24,AETNA,AETNA COMMERCIAL,461.19,98,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,AETNA,AETNA COMMERCIAL,81.5,98,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,AETNA,AETNA COMMERCIAL,81.5,98,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.2MG AMP,J2310,HCPCS,636,RC,,BOTH,0.2,ME,117.05,46.82,AETNA,AETNA COMMERCIAL,114.71,98,,,OTHER,87.79,114.71,PERCENT OF TOTAL BILLED CHARGES
HYDROXYZINE HCL 50 MG/ML VIAL ,J3410,HCPCS,636,RC,,BOTH,50,ME,101.36,40.54,AETNA,AETNA COMMERCIAL,99.33,98,,,OTHER,76.02,99.33,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,AETNA,AETNA COMMERCIAL,65.35,98,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,AETNA,AETNA COMMERCIAL,65.35,98,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,AETNA,AETNA COMMERCIAL,120.55,98,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,AETNA,AETNA COMMERCIAL,120.55,98,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,AETNA,AETNA COMMERCIAL,134.33,98,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,AETNA,AETNA COMMERCIAL,134.33,98,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 500MG INJ,J1956,HCPCS,636,RC,,BOTH,500,ME,67.61,27.04,AETNA,AETNA COMMERCIAL,66.26,98,,,OTHER,50.71,66.26,PERCENT OF TOTAL BILLED CHARGES
PERFLUTREN  SDV,Q9957,HCPCS,636,RC,,BOTH,,,813.57,325.43,AETNA,AETNA COMMERCIAL,797.3,98,,,OTHER,610.18,797.3,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,AETNA,AETNA COMMERCIAL,61.25,98,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,AETNA,AETNA COMMERCIAL,61.25,98,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,2513380,CDM,636,RC,,BOTH,100,ME,62.5,25,AETNA,AETNA COMMERCIAL,61.25,98,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,AETNA,AETNA COMMERCIAL,44.18,98,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,AETNA,AETNA COMMERCIAL,44.18,98,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,AETNA,AETNA COMMERCIAL,127.38,98,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,AETNA,AETNA COMMERCIAL,127.38,98,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,AETNA,AETNA COMMERCIAL,127.38,98,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,AETNA,AETNA COMMERCIAL,127.38,98,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7060,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,AETNA,AETNA COMMERCIAL,82.35,98,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,AETNA,AETNA COMMERCIAL,82.35,98,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,AETNA,AETNA COMMERCIAL,82.35,98,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,AETNA,AETNA COMMERCIAL,407.14,98,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,AETNA,AETNA COMMERCIAL,407.14,98,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,AETNA,AETNA COMMERCIAL,454.19,98,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,AETNA,AETNA COMMERCIAL,454.19,98,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,AETNA,AETNA COMMERCIAL,2.16,98,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,AETNA,AETNA COMMERCIAL,2.16,98,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,2512600,CDM,636,RC,,BOTH,100,ME,2.21,0.88,AETNA,AETNA COMMERCIAL,2.16,98,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 1000U/ML 2ML VIAL,J1644,HCPCS,636,RC,,BOTH,2,ML,78.89,31.56,AETNA,AETNA COMMERCIAL,77.31,98,,,OTHER,59.17,77.31,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 20U/LR 1000 ML,J2590,HCPCS,636,RC,,BOTH,1000,ML,276.21,110.48,AETNA,AETNA COMMERCIAL,270.68,98,,,OTHER,207.15,270.68,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,AETNA,AETNA COMMERCIAL,74.83,98,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,AETNA,AETNA COMMERCIAL,74.83,98,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,AETNA,AETNA COMMERCIAL,83.48,98,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,AETNA,AETNA COMMERCIAL,83.48,98,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,AETNA,AETNA COMMERCIAL,83.48,98,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,AETNA,AETNA COMMERCIAL,301.56,98,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,AETNA,AETNA COMMERCIAL,301.56,98,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,AETNA,AETNA COMMERCIAL,116.61,98,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,AETNA,AETNA COMMERCIAL,116.61,98,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 2.25G VIAL,J2543,HCPCS,636,RC,,BOTH,2.25,GR,72.92,29.17,AETNA,AETNA COMMERCIAL,71.46,98,,,OTHER,54.69,71.46,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,AETNA,AETNA COMMERCIAL,105.42,98,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,AETNA,AETNA COMMERCIAL,105.42,98,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,AETNA,AETNA COMMERCIAL,105.42,98,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,AETNA,AETNA COMMERCIAL,105.42,98,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,AETNA,AETNA COMMERCIAL,32.81,98,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,AETNA,AETNA COMMERCIAL,32.81,98,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,2507710,CDM,636,RC,,BOTH,20,ML,33.48,13.39,AETNA,AETNA COMMERCIAL,32.81,98,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% SDV 2ML,J2001,HCPCS,636,RC,,BOTH,2,ML,48.52,19.41,AETNA,AETNA COMMERCIAL,47.55,98,,,OTHER,36.39,47.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,AETNA,AETNA COMMERCIAL,91.36,98,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,AETNA,AETNA COMMERCIAL,91.36,98,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,2501270,CDM,636,RC,,BOTH,3,GR,93.22,37.29,AETNA,AETNA COMMERCIAL,91.36,98,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,AETNA,AETNA COMMERCIAL,91.36,98,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 30MG VIAL,J1885,HCPCS,636,RC,,BOTH,30,ME,57.77,23.11,AETNA,AETNA COMMERCIAL,56.62,98,,,OTHER,43.33,56.62,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40MG VIAL,J1940,HCPCS,636,RC,,BOTH,40,ME,45.24,18.09,AETNA,AETNA COMMERCIAL,44.33,98,,,OTHER,33.93,44.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,AETNA,AETNA COMMERCIAL,75.94,98,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,AETNA,AETNA COMMERCIAL,75.94,98,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3370,HCPCS,636,RC,,BOTH,1,GR,77.49,31,AETNA,AETNA COMMERCIAL,75.94,98,,,OTHER,58.12,75.94,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM,J2250,HCPCS,636,RC,,BOTH,1,ME,50.03,20.01,AETNA,AETNA COMMERCIAL,49.03,98,,,OTHER,37.52,49.03,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,AETNA,AETNA COMMERCIAL,58.1,98,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,AETNA,AETNA COMMERCIAL,58.1,98,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,AETNA,AETNA COMMERCIAL,360.16,98,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,AETNA,AETNA COMMERCIAL,360.16,98,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,AETNA,AETNA COMMERCIAL,360.16,98,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,AETNA,AETNA COMMERCIAL,360.16,98,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,AETNA,AETNA COMMERCIAL,182.39,98,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,AETNA,AETNA COMMERCIAL,182.39,98,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3372,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,AETNA,AETNA COMMERCIAL,111.99,98,,,OTHER,6.72,111.99,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3490,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,AETNA,AETNA COMMERCIAL,111.99,98,,,OTHER,85.7,111.99,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J7517,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,AETNA,AETNA COMMERCIAL,5.09,98,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J3490,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,AETNA,AETNA COMMERCIAL,5.09,98,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,AETNA,AETNA COMMERCIAL,48.11,98,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,AETNA,AETNA COMMERCIAL,48.11,98,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J7613,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,AETNA,AETNA COMMERCIAL,0.79,98,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J3490,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,AETNA,AETNA COMMERCIAL,0.79,98,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,AETNA,AETNA COMMERCIAL,892.46,98,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,AETNA,AETNA COMMERCIAL,892.46,98,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,2511380,CDM,636,RC,,BOTH,1,ME,910.67,364.27,AETNA,AETNA COMMERCIAL,892.46,98,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,AETNA,AETNA COMMERCIAL,4280.57,98,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,AETNA,AETNA COMMERCIAL,4280.57,98,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,AETNA,AETNA COMMERCIAL,1735.5,98,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,AETNA,AETNA COMMERCIAL,1735.5,98,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,2505151,CDM,636,RC,,BOTH,0.5,ME,1770.92,708.37,AETNA,AETNA COMMERCIAL,1735.5,98,,,OTHER,1328.19,1735.5,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,AETNA,AETNA COMMERCIAL,773.23,98,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,AETNA,AETNA COMMERCIAL,773.23,98,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3372,HCPCS,636,RC,,BOTH,300,ML,129.54,51.82,AETNA,AETNA COMMERCIAL,126.95,98,,,OTHER,6.72,126.95,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3490,HCPCS,636,RC,,BOTH,200,ML,129.54,51.82,AETNA,AETNA COMMERCIAL,126.95,98,,,OTHER,97.15,126.95,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 750MG/150ML PB,J1956,HCPCS,636,RC,,BOTH,750,ME,108,43.2,AETNA,AETNA COMMERCIAL,105.84,98,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,AETNA,AETNA COMMERCIAL,4242.08,98,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,AETNA,AETNA COMMERCIAL,4242.08,98,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,2504470,CDM,636,RC,,BOTH,22.5,ME,4328.65,1731.46,AETNA,AETNA COMMERCIAL,4242.08,98,,,OTHER,3246.49,4242.08,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG/300ML IV,J2020,HCPCS,636,RC,,BOTH,600,ME,207.7,83.08,AETNA,AETNA COMMERCIAL,203.55,98,,,OTHER,155.78,203.55,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,AETNA,AETNA COMMERCIAL,99.94,98,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,AETNA,AETNA COMMERCIAL,99.94,98,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 3.375G VIAL,J2543,HCPCS,636,RC,,BOTH,3.375,GR,166.16,66.46,AETNA,AETNA COMMERCIAL,162.83,98,,,OTHER,124.62,162.83,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3372,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,AETNA,AETNA COMMERCIAL,137.54,98,,,OTHER,6.72,137.54,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3490,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,AETNA,AETNA COMMERCIAL,137.54,98,,,OTHER,105.26,137.54,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,AETNA,AETNA COMMERCIAL,81.38,98,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,AETNA,AETNA COMMERCIAL,81.38,98,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,AETNA,AETNA COMMERCIAL,86.11,98,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,AETNA,AETNA COMMERCIAL,86.11,98,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,AETNA,AETNA COMMERCIAL,16.07,98,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,AETNA,AETNA COMMERCIAL,16.07,98,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,AETNA,AETNA COMMERCIAL,1583.65,98,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,AETNA,AETNA COMMERCIAL,1583.65,98,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 500MG VIAL,J2930,HCPCS,636,RC,,BOTH,500,ME,103.65,41.46,AETNA,AETNA COMMERCIAL,101.58,98,,,OTHER,77.74,101.58,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J2597,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,AETNA,AETNA COMMERCIAL,154.06,98,,,OTHER,6.58,154.06,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J3490,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,AETNA,AETNA COMMERCIAL,154.06,98,,,OTHER,117.9,154.06,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,AETNA,AETNA COMMERCIAL,4.08,98,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,AETNA,AETNA COMMERCIAL,4.08,98,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,AETNA,AETNA COMMERCIAL,74.6,98,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,AETNA,AETNA COMMERCIAL,74.6,98,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 60MG INJ,J1885,HCPCS,636,RC,,BOTH,60,ME,46.32,18.53,AETNA,AETNA COMMERCIAL,45.39,98,,,OTHER,34.74,45.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3372,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,AETNA,AETNA COMMERCIAL,140.91,98,,,OTHER,6.72,140.91,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3490,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,AETNA,AETNA COMMERCIAL,140.91,98,,,OTHER,107.84,140.91,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,AETNA,AETNA COMMERCIAL,263.17,98,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,AETNA,AETNA COMMERCIAL,263.17,98,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,2508360,CDM,636,RC,,BOTH,4,ME,268.54,107.42,AETNA,AETNA COMMERCIAL,263.17,98,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
KENALOG-40 INJ,J3301,HCPCS,636,RC,,BOTH,10,ME,65.27,26.11,AETNA,AETNA COMMERCIAL,63.97,98,,,OTHER,48.96,63.97,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 2GM PREMIX BAG,J3475,HCPCS,636,RC,,BOTH,2,GR,101.76,40.71,AETNA,AETNA COMMERCIAL,99.73,98,,,OTHER,76.32,99.73,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,AETNA,AETNA COMMERCIAL,627.93,98,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,AETNA,AETNA COMMERCIAL,627.93,98,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,2516870,CDM,636,RC,,BOTH,5,ML,640.74,256.3,AETNA,AETNA COMMERCIAL,627.93,98,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,AETNA,AETNA COMMERCIAL,48.58,98,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,AETNA,AETNA COMMERCIAL,48.58,98,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,AETNA,AETNA COMMERCIAL,126.87,98,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,AETNA,AETNA COMMERCIAL,126.87,98,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
PIPERACILLIN/TAZOBAC 4G/0.5 IV,J2543,HCPCS,636,RC,,BOTH,4,GR,166.16,66.47,AETNA,AETNA COMMERCIAL,162.84,98,,,OTHER,124.62,162.84,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,AETNA,AETNA COMMERCIAL,55.22,98,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,AETNA,AETNA COMMERCIAL,55.22,98,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,AETNA,AETNA COMMERCIAL,120.78,98,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,AETNA,AETNA COMMERCIAL,120.78,98,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,AETNA,AETNA COMMERCIAL,229.76,98,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,AETNA,AETNA COMMERCIAL,229.76,98,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,AETNA,AETNA COMMERCIAL,47.87,98,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,AETNA,AETNA COMMERCIAL,47.87,98,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,AETNA,AETNA COMMERCIAL,45.45,98,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,AETNA,AETNA COMMERCIAL,45.45,98,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,2502720,CDM,636,RC,,BOTH,4,ME,46.38,18.55,AETNA,AETNA COMMERCIAL,45.45,98,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,AETNA,AETNA COMMERCIAL,114.23,98,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,AETNA,AETNA COMMERCIAL,114.23,98,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J2760,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,AETNA,AETNA COMMERCIAL,783.31,98,,,OTHER,466.54,783.31,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J3490,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,AETNA,AETNA COMMERCIAL,783.31,98,,,OTHER,599.48,783.31,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,AETNA,AETNA COMMERCIAL,88.43,98,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,AETNA,AETNA COMMERCIAL,88.43,98,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,2500750,CDM,636,RC,,BOTH,2.5,ME,90.23,36.09,AETNA,AETNA COMMERCIAL,88.43,98,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 500MG INJ,J2185,HCPCS,636,RC,,BOTH,500,ME,64.96,25.98,AETNA,AETNA COMMERCIAL,63.66,98,,,OTHER,48.72,63.66,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML,J2250,HCPCS,636,RC,,BOTH,5,ML,50.52,20.21,AETNA,AETNA COMMERCIAL,49.51,98,,,OTHER,37.89,49.51,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML VIAL,J2250,HCPCS,636,RC,,BOTH,5,ME,58.31,23.32,AETNA,AETNA COMMERCIAL,57.14,98,,,OTHER,43.73,57.14,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,2505240,CDM,636,RC,,BOTH,1,GR,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 250 MG/5 ML VIAL,J1165,HCPCS,636,RC,,BOTH,250,ME,22.1,8.84,AETNA,AETNA COMMERCIAL,21.66,98,,,OTHER,16.57,21.66,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,AETNA,AETNA COMMERCIAL,6198.59,98,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,AETNA,AETNA COMMERCIAL,6198.59,98,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,AETNA,AETNA COMMERCIAL,183.1,98,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,AETNA,AETNA COMMERCIAL,183.1,98,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,2504590,CDM,636,RC,,BOTH,10,ME,186.84,74.74,AETNA,AETNA COMMERCIAL,183.1,98,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,AETNA,AETNA COMMERCIAL,640.24,98,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,AETNA,AETNA COMMERCIAL,640.24,98,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,2513160,CDM,636,RC,,BOTH,1,ME,653.31,261.32,AETNA,AETNA COMMERCIAL,640.24,98,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% VIAL   SD,J2001,HCPCS,636,RC,,BOTH,10,ME,47.14,18.86,AETNA,AETNA COMMERCIAL,46.2,98,,,OTHER,35.35,46.2,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,AETNA,AETNA COMMERCIAL,55.41,98,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,AETNA,AETNA COMMERCIAL,55.41,98,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,AETNA,AETNA COMMERCIAL,63.98,98,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,AETNA,AETNA COMMERCIAL,63.98,98,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,2505170,CDM,636,RC,,BOTH,20,ME,65.29,26.11,AETNA,AETNA COMMERCIAL,63.98,98,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,AETNA,AETNA COMMERCIAL,127.58,98,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,AETNA,AETNA COMMERCIAL,127.58,98,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,BOTH,,,51.37,20.55,AETNA,AETNA COMMERCIAL,50.34,98,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3490,HCPCS,636,RC,,BOTH,,,51.37,20.55,AETNA,AETNA COMMERCIAL,50.34,98,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,AETNA,AETNA COMMERCIAL,132.32,98,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,AETNA,AETNA COMMERCIAL,132.32,98,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 5OOOU/ML INJ,J1644,HCPCS,636,RC,,BOTH,5000,UN,53.84,21.54,AETNA,AETNA COMMERCIAL,52.77,98,,,OTHER,40.38,52.77,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,AETNA,AETNA COMMERCIAL,4631.22,98,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,AETNA,AETNA COMMERCIAL,4631.22,98,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,AETNA,AETNA COMMERCIAL,48.97,98,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,AETNA,AETNA COMMERCIAL,48.97,98,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0150,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,AETNA,AETNA COMMERCIAL,48.97,98,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,AETNA,AETNA COMMERCIAL,150.69,98,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,AETNA,AETNA COMMERCIAL,150.69,98,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT HOME PACK,Q0162,HCPCS,636,RC,,BOTH,,,23.75,9.5,AETNA,AETNA COMMERCIAL,23.28,98,,,OTHER,17.81,23.28,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,AETNA,AETNA COMMERCIAL,11,98,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,AETNA,AETNA COMMERCIAL,11,98,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,AETNA,AETNA COMMERCIAL,83.55,98,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,AETNA,AETNA COMMERCIAL,83.55,98,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,2512620,CDM,636,RC,,BOTH,350,ME,85.26,34.1,AETNA,AETNA COMMERCIAL,83.55,98,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,AETNA,AETNA COMMERCIAL,71.68,98,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,AETNA,AETNA COMMERCIAL,71.68,98,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
METHYLPRED 1G VIAL,J2930,HCPCS,636,RC,,BOTH,1,GR,172.48,68.99,AETNA,AETNA COMMERCIAL,169.03,98,,,OTHER,129.36,169.03,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE,J3475,HCPCS,636,RC,,BOTH,500,ME,77.51,31,AETNA,AETNA COMMERCIAL,75.96,98,,,OTHER,58.13,75.96,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,AETNA,AETNA COMMERCIAL,197.9,98,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,AETNA,AETNA COMMERCIAL,197.9,98,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,2505150,CDM,636,RC,,BOTH,80,ME,201.94,80.78,AETNA,AETNA COMMERCIAL,197.9,98,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,AETNA,AETNA COMMERCIAL,76.85,98,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,AETNA,AETNA COMMERCIAL,76.85,98,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G POTASS 5MMU VIAL,J2540,HCPCS,636,RC,,BOTH,,,76.53,30.61,AETNA,AETNA COMMERCIAL,75,98,,,OTHER,57.4,75,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE 5GM/10ML,J3475,HCPCS,636,RC,,BOTH,10,ML,88.79,35.52,AETNA,AETNA COMMERCIAL,87.02,98,,,OTHER,66.6,87.02,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,AETNA,AETNA COMMERCIAL,55.71,98,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,AETNA,AETNA COMMERCIAL,55.71,98,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,AETNA,AETNA COMMERCIAL,4303.72,98,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,AETNA,AETNA COMMERCIAL,4303.72,98,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,2514280,CDM,636,RC,,BOTH,100,ME,4391.55,1756.62,AETNA,AETNA COMMERCIAL,4303.72,98,,,OTHER,3293.66,4303.72,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,AETNA,AETNA COMMERCIAL,104.85,98,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,AETNA,AETNA COMMERCIAL,104.85,98,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,AETNA,AETNA COMMERCIAL,2057.76,98,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,AETNA,AETNA COMMERCIAL,2057.76,98,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 10 MG AMP,J3430,HCPCS,636,RC,,BOTH,10,ME,147.4,58.96,AETNA,AETNA COMMERCIAL,144.45,98,,,OTHER,110.55,144.45,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,AETNA,AETNA COMMERCIAL,4232.05,98,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,AETNA,AETNA COMMERCIAL,4232.05,98,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,AETNA,AETNA COMMERCIAL,334.5,98,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,AETNA,AETNA COMMERCIAL,334.5,98,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514820,CDM,636,RC,,BOTH,10,ME,341.32,136.53,AETNA,AETNA COMMERCIAL,334.5,98,,,OTHER,255.99,334.5,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,AETNA,AETNA COMMERCIAL,93.11,98,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,AETNA,AETNA COMMERCIAL,93.11,98,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,AETNA,AETNA COMMERCIAL,249.95,98,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,AETNA,AETNA COMMERCIAL,249.95,98,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,AETNA,AETNA COMMERCIAL,249.95,98,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,AETNA,AETNA COMMERCIAL,249.95,98,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J1805,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,AETNA,AETNA COMMERCIAL,84.55,98,,,OTHER,0.23,84.55,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J3490,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,AETNA,AETNA COMMERCIAL,84.55,98,,,OTHER,64.71,84.55,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,AETNA,AETNA COMMERCIAL,3730.78,98,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,AETNA,AETNA COMMERCIAL,3730.78,98,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,2514950,CDM,636,RC,,BOTH,1,ME,3806.92,1522.77,AETNA,AETNA COMMERCIAL,3730.78,98,,,OTHER,2855.19,3730.78,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G VIAL,J2185,HCPCS,636,RC,,BOTH,1,GR,135.9,54.36,AETNA,AETNA COMMERCIAL,133.18,98,,,OTHER,101.93,133.18,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,AETNA,AETNA COMMERCIAL,1370.35,98,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,AETNA,AETNA COMMERCIAL,1370.35,98,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
NITROGLYCERIN 50 MG/D5W100,J2305,HCPCS,636,RC,,BOTH,50,ME,126.32,50.53,AETNA,AETNA COMMERCIAL,123.8,98,,,OTHER,1.51,123.8,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,AETNA,AETNA COMMERCIAL,239.11,98,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,AETNA,AETNA COMMERCIAL,239.11,98,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,2504240,CDM,636,RC,,BOTH,100,ME,243.99,97.59,AETNA,AETNA COMMERCIAL,239.11,98,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1642,HCPCS,636,RC,,BOTH,10,UN,51.53,20.61,AETNA,AETNA COMMERCIAL,50.5,98,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1644,HCPCS,636,RC,,BOTH,1000,UN,51.53,20.61,AETNA,AETNA COMMERCIAL,50.5,98,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,AETNA,AETNA COMMERCIAL,1110.35,98,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,AETNA,AETNA COMMERCIAL,1110.35,98,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,AETNA,AETNA COMMERCIAL,42.84,98,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,AETNA,AETNA COMMERCIAL,42.84,98,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,AETNA,AETNA COMMERCIAL,1282.19,98,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,AETNA,AETNA COMMERCIAL,1282.19,98,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,2503770,CDM,636,RC,,BOTH,2,ML,1308.36,523.34,AETNA,AETNA COMMERCIAL,1282.19,98,,,OTHER,981.27,1282.19,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,AETNA,AETNA COMMERCIAL,1955.15,98,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,AETNA,AETNA COMMERCIAL,1955.15,98,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,AETNA,AETNA COMMERCIAL,1757.62,98,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,AETNA,AETNA COMMERCIAL,1757.62,98,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,AETNA,AETNA COMMERCIAL,179.18,98,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,AETNA,AETNA COMMERCIAL,179.18,98,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,2507600,CDM,636,RC,,BOTH,500,ME,182.84,73.13,AETNA,AETNA COMMERCIAL,179.18,98,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,AETNA,AETNA COMMERCIAL,84.87,98,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,AETNA,AETNA COMMERCIAL,84.87,98,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,AETNA,AETNA COMMERCIAL,266.3,98,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,AETNA,AETNA COMMERCIAL,266.3,98,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,2514600,CDM,636,RC,,BOTH,2,GR,271.74,108.69,AETNA,AETNA COMMERCIAL,266.3,98,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,AETNA,AETNA COMMERCIAL,46.03,98,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,AETNA,AETNA COMMERCIAL,46.03,98,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,AETNA,AETNA COMMERCIAL,1417.22,98,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,AETNA,AETNA COMMERCIAL,1417.22,98,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,AETNA,AETNA COMMERCIAL,86.1,98,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,AETNA,AETNA COMMERCIAL,86.1,98,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,AETNA,AETNA COMMERCIAL,1452.18,98,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,AETNA,AETNA COMMERCIAL,1452.18,98,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,AETNA,AETNA COMMERCIAL,22.27,98,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,AETNA,AETNA COMMERCIAL,22.27,98,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,2505100,CDM,636,RC,,BOTH,10,ME,22.73,9.09,AETNA,AETNA COMMERCIAL,22.27,98,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,AETNA,AETNA COMMERCIAL,124.31,98,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,AETNA,AETNA COMMERCIAL,124.31,98,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,AETNA,AETNA COMMERCIAL,1130.86,98,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,AETNA,AETNA COMMERCIAL,1130.86,98,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,AETNA,AETNA COMMERCIAL,636.81,98,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,AETNA,AETNA COMMERCIAL,636.81,98,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,2500420,CDM,636,RC,,BOTH,0.05,ML,649.81,259.92,AETNA,AETNA COMMERCIAL,636.81,98,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J1836,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,AETNA,AETNA COMMERCIAL,67.51,98,,,OTHER,0.03,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,AETNA,AETNA COMMERCIAL,10.29,98,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,AETNA,AETNA COMMERCIAL,10.29,98,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J3490,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,AETNA,AETNA COMMERCIAL,67.51,98,,,OTHER,51.66,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,AETNA,AETNA COMMERCIAL,10.29,98,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,AETNA,AETNA COMMERCIAL,43.55,98,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,AETNA,AETNA COMMERCIAL,43.55,98,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,2506180,CDM,636,RC,,BOTH,10,ME,44.44,17.78,AETNA,AETNA COMMERCIAL,43.55,98,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 100 MG SYRINGE,J2001,HCPCS,636,RC,,BOTH,100,ME,56.99,22.8,AETNA,AETNA COMMERCIAL,55.85,98,,,OTHER,42.74,55.85,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0136,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,AETNA,AETNA COMMERCIAL,192.36,98,,,OTHER,0.05,192.36,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0131,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,AETNA,AETNA COMMERCIAL,192.36,98,,,OTHER,147.21,192.36,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,AETNA,AETNA COMMERCIAL,6652.34,98,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,AETNA,AETNA COMMERCIAL,6652.34,98,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PENICILL G BENZ 1.2MMU SYR,J0561,HCPCS,636,RC,,BOTH,,,527.8,211.12,AETNA,AETNA COMMERCIAL,517.24,98,,,OTHER,23.1,517.24,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,AETNA,AETNA COMMERCIAL,4664.86,98,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,AETNA,AETNA COMMERCIAL,4664.86,98,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,AETNA,AETNA COMMERCIAL,1972.01,98,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,AETNA,AETNA COMMERCIAL,1972.01,98,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,AETNA,AETNA COMMERCIAL,1326.04,98,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,AETNA,AETNA COMMERCIAL,1326.04,98,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,AETNA,AETNA COMMERCIAL,499.7,98,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,AETNA,AETNA COMMERCIAL,499.7,98,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,AETNA,AETNA COMMERCIAL,3474.44,98,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,AETNA,AETNA COMMERCIAL,3474.44,98,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 4%PF,J2001,HCPCS,636,RC,,BOTH,10,ME,49.11,19.64,AETNA,AETNA COMMERCIAL,48.12,98,,,OTHER,36.83,48.12,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 2% 10ML AMP,J2001,HCPCS,636,RC,,BOTH,10,ME,50.69,20.28,AETNA,AETNA COMMERCIAL,49.68,98,,,OTHER,38.02,49.68,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,AETNA,AETNA COMMERCIAL,1555.4,98,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,AETNA,AETNA COMMERCIAL,1555.4,98,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J2598,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,AETNA,AETNA COMMERCIAL,537.4,98,,,OTHER,1.97,537.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J3490,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,AETNA,AETNA COMMERCIAL,537.4,98,,,OTHER,411.27,537.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,AETNA,AETNA COMMERCIAL,3123.8,98,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,AETNA,AETNA COMMERCIAL,3123.8,98,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J2704,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,AETNA,AETNA COMMERCIAL,57.84,98,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,AETNA,AETNA COMMERCIAL,57.84,98,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE O.5% 30ML SD,J2001,HCPCS,636,RC,,BOTH,30,ML,70.78,28.31,AETNA,AETNA COMMERCIAL,69.36,98,,,OTHER,53.09,69.36,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,AETNA,AETNA COMMERCIAL,2546.75,98,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,AETNA,AETNA COMMERCIAL,2546.75,98,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 25000U BAG,J1644,HCPCS,636,RC,,BOTH,25000,UN,106.82,42.73,AETNA,AETNA COMMERCIAL,104.68,98,,,OTHER,80.11,104.68,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,AETNA,AETNA COMMERCIAL,886.24,98,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,AETNA,AETNA COMMERCIAL,886.24,98,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,AETNA,AETNA COMMERCIAL,886.24,98,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,AETNA,AETNA COMMERCIAL,886.24,98,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,AETNA,AETNA COMMERCIAL,7388.77,98,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,AETNA,AETNA COMMERCIAL,7388.77,98,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,AETNA,AETNA COMMERCIAL,10207.44,98,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,AETNA,AETNA COMMERCIAL,10207.44,98,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 30ML VIAL  SD,J2001,HCPCS,636,RC,,BOTH,30,ML,50.36,20.14,AETNA,AETNA COMMERCIAL,49.35,98,,,OTHER,37.77,49.35,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,AETNA,AETNA COMMERCIAL,13582.73,98,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,AETNA,AETNA COMMERCIAL,13582.73,98,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,AETNA,AETNA COMMERCIAL,2356.35,98,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,AETNA,AETNA COMMERCIAL,2356.35,98,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,AETNA,AETNA COMMERCIAL,5280.02,98,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,AETNA,AETNA COMMERCIAL,5280.02,98,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,2511210,CDM,636,RC,,BOTH,3.5,ME,5387.78,2155.11,AETNA,AETNA COMMERCIAL,5280.02,98,,,OTHER,4040.84,5280.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,AETNA,AETNA COMMERCIAL,8571.64,98,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,AETNA,AETNA COMMERCIAL,8571.64,98,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,AETNA,AETNA COMMERCIAL,15988.32,98,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,AETNA,AETNA COMMERCIAL,15988.32,98,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,2514290,CDM,636,RC,,BOTH,400,ME,16314.61,6525.84,AETNA,AETNA COMMERCIAL,15988.32,98,,,OTHER,12235.96,15988.32,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,2509810,CDM,636,RC,,BOTH,4,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MAG SULF/WATER,J3475,HCPCS,636,RC,,BOTH,500,ME,473.17,189.27,AETNA,AETNA COMMERCIAL,463.7,98,,,OTHER,354.87,463.7,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,AETNA,AETNA COMMERCIAL,22945.32,98,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,AETNA,AETNA COMMERCIAL,22945.32,98,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,AETNA,AETNA COMMERCIAL,955.56,98,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,AETNA,AETNA COMMERCIAL,955.56,98,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,AETNA,AETNA COMMERCIAL,3323.23,98,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,C9476,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,AETNA,AETNA COMMERCIAL,4890.18,98,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,AETNA,AETNA COMMERCIAL,7872.02,98,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,AETNA,AETNA COMMERCIAL,7872.02,98,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,AETNA,AETNA COMMERCIAL,4647.92,98,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,AETNA,AETNA COMMERCIAL,4647.92,98,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,AETNA,AETNA COMMERCIAL,526.77,98,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,AETNA,AETNA COMMERCIAL,526.77,98,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,AETNA,AETNA COMMERCIAL,4617.24,98,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,AETNA,AETNA COMMERCIAL,4617.24,98,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,AETNA,AETNA COMMERCIAL,9968.49,98,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,AETNA,AETNA COMMERCIAL,9968.49,98,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,2506310,CDM,636,RC,,BOTH,50,ME,10171.93,4068.77,AETNA,AETNA COMMERCIAL,9968.49,98,,,OTHER,7628.95,9968.49,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,AETNA,AETNA COMMERCIAL,1697.96,98,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,AETNA,AETNA COMMERCIAL,1697.96,98,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514790,CDM,636,RC,,BOTH,10,ME,1732.61,693.04,AETNA,AETNA COMMERCIAL,1697.96,98,,,OTHER,1299.46,1697.96,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,AETNA,AETNA COMMERCIAL,8917.64,98,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,AETNA,AETNA COMMERCIAL,8917.64,98,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,2513220,CDM,636,RC,,BOTH,1,ME,250,100,AETNA,AETNA COMMERCIAL,245,98,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,AETNA,AETNA COMMERCIAL,7447.27,98,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,AETNA,AETNA COMMERCIAL,7447.27,98,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM 500MG/5ML VIAL,J1953,HCPCS,636,RC,,BOTH,500,ME,35.72,14.29,AETNA,AETNA COMMERCIAL,35.01,98,,,OTHER,26.79,35.01,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,AETNA,AETNA COMMERCIAL,49.25,98,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,AETNA,AETNA COMMERCIAL,49.25,98,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0690,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,AETNA,AETNA COMMERCIAL,49.25,98,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,AETNA,AETNA COMMERCIAL,49.25,98,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,AETNA,AETNA COMMERCIAL,82.19,98,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,AETNA,AETNA COMMERCIAL,82.19,98,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,AETNA,AETNA COMMERCIAL,82.19,98,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,AETNA,AETNA COMMERCIAL,82.19,98,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,2514960,CDM,636,RC,,BOTH,50,ML,83.87,33.55,AETNA,AETNA COMMERCIAL,82.19,98,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) 75/25 PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,87.37,34.95,AETNA,AETNA COMMERCIAL,85.62,98,,,OTHER,65.53,85.62,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALIN N) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,134.82,53.93,AETNA,AETNA COMMERCIAL,132.12,98,,,OTHER,101.12,132.12,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,AETNA,AETNA COMMERCIAL,19155.13,98,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,AETNA,AETNA COMMERCIAL,19155.13,98,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,AETNA,AETNA COMMERCIAL,19155.13,98,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,AETNA,AETNA COMMERCIAL,19155.13,98,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,AETNA,AETNA COMMERCIAL,7275.86,98,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,AETNA,AETNA COMMERCIAL,7275.86,98,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,2510900,CDM,636,RC,,BOTH,60,ME,7424.35,2969.74,AETNA,AETNA COMMERCIAL,7275.86,98,,,OTHER,5568.26,7275.86,PERCENT OF TOTAL BILLED CHARGES
INSULIN (LANTUS SOLOSTAR) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,240.94,96.38,AETNA,AETNA COMMERCIAL,236.12,98,,,OTHER,180.71,236.12,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,AETNA,AETNA COMMERCIAL,2656.29,98,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,AETNA,AETNA COMMERCIAL,2656.29,98,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,AETNA,AETNA COMMERCIAL,2656.29,98,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,AETNA,AETNA COMMERCIAL,2656.29,98,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,AETNA,AETNA COMMERCIAL,2656.29,98,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,303.8,121.52,AETNA,AETNA COMMERCIAL,297.72,98,,,OTHER,227.85,297.72,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,AETNA,AETNA COMMERCIAL,2079.8,98,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,AETNA,AETNA COMMERCIAL,2079.8,98,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,2514210,CDM,636,RC,,BOTH,15,ME,2122.24,848.9,AETNA,AETNA COMMERCIAL,2079.8,98,,,OTHER,1591.68,2079.8,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,AETNA,AETNA COMMERCIAL,6831.87,98,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,AETNA,AETNA COMMERCIAL,6831.87,98,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,AETNA,AETNA COMMERCIAL,864.68,98,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,AETNA,AETNA COMMERCIAL,864.68,98,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,AETNA,AETNA COMMERCIAL,133.64,98,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,AETNA,AETNA COMMERCIAL,133.64,98,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,AETNA,AETNA COMMERCIAL,133.64,98,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,AETNA,AETNA COMMERCIAL,133.64,98,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,2514590,CDM,636,RC,,BOTH,80,ME,136.36,54.55,AETNA,AETNA COMMERCIAL,133.64,98,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,AETNA,AETNA COMMERCIAL,1046.85,98,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,AETNA,AETNA COMMERCIAL,1046.85,98,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2511990,CDM,636,RC,,BOTH,1,ME,1068.21,427.28,AETNA,AETNA COMMERCIAL,1046.85,98,,,OTHER,801.16,1046.85,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,2501680,CDM,636,RC,,BOTH,1,ME,70.21,28.08,AETNA,AETNA COMMERCIAL,68.81,98,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,AETNA,AETNA COMMERCIAL,68.81,98,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,AETNA,AETNA COMMERCIAL,68.81,98,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,AETNA,AETNA COMMERCIAL,8084.33,98,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,AETNA,AETNA COMMERCIAL,8084.33,98,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,AETNA,AETNA COMMERCIAL,17976.74,98,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,AETNA,AETNA COMMERCIAL,17976.74,98,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,AETNA,AETNA COMMERCIAL,3523.93,98,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,AETNA,AETNA COMMERCIAL,3523.93,98,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,AETNA,AETNA COMMERCIAL,34258.59,98,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,AETNA,AETNA COMMERCIAL,34258.59,98,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,AETNA,AETNA COMMERCIAL,24630.35,98,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,AETNA,AETNA COMMERCIAL,24630.35,98,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,2500530,CDM,636,RC,,BOTH,100,ME,25133.01,10053.2,AETNA,AETNA COMMERCIAL,24630.35,98,,,OTHER,18849.76,24630.35,PERCENT OF TOTAL BILLED CHARGES
ONABOTULINUMTOXINA (BOTOX),J0585,HCPCS,636,RC,,BOTH,1,UN,1172.09,468.84,AETNA,AETNA COMMERCIAL,1148.65,98,,,OTHER,6.64,1148.65,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,AETNA,AETNA COMMERCIAL,1962.71,98,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,AETNA,AETNA COMMERCIAL,1962.71,98,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,2511840,CDM,636,RC,,BOTH,1,ME,2002.77,801.11,AETNA,AETNA COMMERCIAL,1962.71,98,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,AETNA,AETNA COMMERCIAL,14409.21,98,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,AETNA,AETNA COMMERCIAL,14409.21,98,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,AETNA,AETNA COMMERCIAL,5867.59,98,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,AETNA,AETNA COMMERCIAL,5867.59,98,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,AETNA,AETNA COMMERCIAL,5.7,98,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,AETNA,AETNA COMMERCIAL,5.7,98,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,2513120,CDM,636,RC,,BOTH,0.5,ME,5.81,2.33,AETNA,AETNA COMMERCIAL,5.7,98,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,AETNA,AETNA COMMERCIAL,68.54,98,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,AETNA,AETNA COMMERCIAL,68.54,98,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,2505020,CDM,636,RC,,BOTH,0.1,ME,69.94,27.98,AETNA,AETNA COMMERCIAL,68.54,98,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,AETNA,AETNA COMMERCIAL,8391.2,98,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,AETNA,AETNA COMMERCIAL,4460.15,98,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,AETNA,AETNA COMMERCIAL,4460.15,98,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,2512870,CDM,636,RC,,BOTH,1,ME,4551.17,1820.47,AETNA,AETNA COMMERCIAL,4460.15,98,,,OTHER,3413.38,4460.15,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,AETNA,AETNA COMMERCIAL,1118.31,98,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,AETNA,AETNA COMMERCIAL,1118.31,98,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,J2182,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,AETNA,AETNA COMMERCIAL,6152.2,98,,,OTHER,32,6152.2,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,C9473,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,AETNA,AETNA COMMERCIAL,6152.2,98,,,OTHER,4708.32,6152.2,PERCENT OF TOTAL BILLED CHARGES
PEMBROLIZUMAB 100MG/4ML,J9271,HCPCS,636,RC,,BOTH,4,ML,9937.15,3974.86,AETNA,AETNA COMMERCIAL,9738.4,98,,,OTHER,60.18,9738.4,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,AETNA,AETNA COMMERCIAL,93.87,98,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,AETNA,AETNA COMMERCIAL,93.87,98,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,2504150,CDM,636,RC,,BOTH,20,ML,95.78,38.31,AETNA,AETNA COMMERCIAL,93.87,98,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J2704,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,AETNA,AETNA COMMERCIAL,151.6,98,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J3490,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,AETNA,AETNA COMMERCIAL,151.6,98,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,AETNA,AETNA COMMERCIAL,3113.5,98,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,AETNA,AETNA COMMERCIAL,18624.32,98,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,AETNA,AETNA COMMERCIAL,14659.86,98,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,AETNA,AETNA COMMERCIAL,14659.86,98,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1930,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,AETNA,AETNA COMMERCIAL,14659.86,98,,,OTHER,50.4,14659.86,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,AETNA,AETNA COMMERCIAL,5210.31,98,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,AETNA,AETNA COMMERCIAL,5210.31,98,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,2514240,CDM,636,RC,,BOTH,120,ME,5316.64,2126.66,AETNA,AETNA COMMERCIAL,5210.31,98,,,OTHER,3987.48,5210.31,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,AETNA,AETNA COMMERCIAL,556.21,98,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,AETNA,AETNA COMMERCIAL,556.21,98,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,AETNA,AETNA COMMERCIAL,33552.58,98,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,AETNA,AETNA COMMERCIAL,33552.58,98,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,AETNA,AETNA COMMERCIAL,49.83,98,,,OTHER,0.02,49.83,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,AETNA,AETNA COMMERCIAL,49.83,98,,,OTHER,38.14,49.83,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,AETNA,AETNA COMMERCIAL,177.36,98,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,AETNA,AETNA COMMERCIAL,177.36,98,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,2515510,CDM,636,RC,,BOTH,1,ME,180.98,72.39,AETNA,AETNA COMMERCIAL,177.36,98,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,AETNA,AETNA COMMERCIAL,16668.02,98,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,AETNA,AETNA COMMERCIAL,16668.02,98,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1G BAG,J2001,HCPCS,636,RC,,BOTH,1,GR,104.73,41.89,AETNA,AETNA COMMERCIAL,102.64,98,,,OTHER,78.55,102.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,AETNA,AETNA COMMERCIAL,2490.13,98,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,AETNA,AETNA COMMERCIAL,2490.13,98,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,AETNA,AETNA COMMERCIAL,2405.18,98,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,AETNA,AETNA COMMERCIAL,2405.18,98,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512020,CDM,636,RC,,BOTH,1,ME,2454.27,981.71,AETNA,AETNA COMMERCIAL,2405.18,98,,,OTHER,1840.7,2405.18,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,AETNA,AETNA COMMERCIAL,2899.87,98,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,AETNA,AETNA COMMERCIAL,2899.87,98,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,2504290,CDM,636,RC,,BOTH,,,2959.05,1183.62,AETNA,AETNA COMMERCIAL,2899.87,98,,,OTHER,2219.29,2899.87,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,AETNA,AETNA COMMERCIAL,181.59,98,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,AETNA,AETNA COMMERCIAL,181.59,98,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,2501950,CDM,636,RC,,BOTH,100,ME,185.29,74.12,AETNA,AETNA COMMERCIAL,181.59,98,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,AETNA,AETNA COMMERCIAL,4460.17,98,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,AETNA,AETNA COMMERCIAL,4460.17,98,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,AETNA,AETNA COMMERCIAL,4460.17,98,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,AETNA,AETNA COMMERCIAL,4460.17,98,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,AETNA,AETNA COMMERCIAL,7737.87,98,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,AETNA,AETNA COMMERCIAL,7737.87,98,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,AETNA,AETNA COMMERCIAL,2029.97,98,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,AETNA,AETNA COMMERCIAL,2029.97,98,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,AETNA,AETNA COMMERCIAL,906.35,98,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,AETNA,AETNA COMMERCIAL,906.35,98,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,AETNA,AETNA COMMERCIAL,7027.61,98,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,AETNA,AETNA COMMERCIAL,7027.61,98,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,AETNA,AETNA COMMERCIAL,46.08,98,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,AETNA,AETNA COMMERCIAL,46.08,98,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,AETNA,AETNA COMMERCIAL,3973.94,98,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,AETNA,AETNA COMMERCIAL,3973.94,98,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,2510300,CDM,636,RC,,BOTH,,,4055.04,1622.02,AETNA,AETNA COMMERCIAL,3973.94,98,,,OTHER,3041.28,3973.94,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,AETNA,AETNA COMMERCIAL,17524.06,98,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,AETNA,AETNA COMMERCIAL,17524.06,98,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,AETNA,AETNA COMMERCIAL,17524.06,98,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,AETNA,AETNA COMMERCIAL,17524.06,98,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,J2350,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,AETNA,AETNA COMMERCIAL,33818.69,98,,,OTHER,61.7,33818.69,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,C9494,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,AETNA,AETNA COMMERCIAL,33818.69,98,,,OTHER,25881.65,33818.69,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,AETNA,AETNA COMMERCIAL,751.59,98,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,AETNA,AETNA COMMERCIAL,751.59,98,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,AETNA,AETNA COMMERCIAL,12850.82,98,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,AETNA,AETNA COMMERCIAL,12850.82,98,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,AETNA,AETNA COMMERCIAL,29034.24,98,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,AETNA,AETNA COMMERCIAL,29034.24,98,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,AETNA,AETNA COMMERCIAL,29034.24,98,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,AETNA,AETNA COMMERCIAL,29034.24,98,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,AETNA,AETNA COMMERCIAL,4762.61,98,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,AETNA,AETNA COMMERCIAL,4762.61,98,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512030,CDM,636,RC,,BOTH,1,ME,4859.8,1943.92,AETNA,AETNA COMMERCIAL,4762.61,98,,,OTHER,3644.85,4762.61,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,AETNA,AETNA COMMERCIAL,17474.46,98,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,AETNA,AETNA COMMERCIAL,17474.46,98,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,2504050,CDM,636,RC,,BOTH,30,ML,17831.08,7132.43,AETNA,AETNA COMMERCIAL,17474.46,98,,,OTHER,13373.31,17474.46,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,AETNA,AETNA COMMERCIAL,929.71,98,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,AETNA,AETNA COMMERCIAL,929.71,98,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J2724,HCPCS,636,RC,,BOTH,,,2217.07,886.83,AETNA,AETNA COMMERCIAL,2172.73,98,,,OTHER,15.78,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,AETNA,AETNA COMMERCIAL,2172.73,98,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,AETNA,AETNA COMMERCIAL,2172.73,98,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,C9132,HCPCS,636,RC,,BOTH,,,2217.07,886.83,AETNA,AETNA COMMERCIAL,2172.73,98,,,OTHER,1662.8,2172.73,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,AETNA,AETNA COMMERCIAL,6595.38,98,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,AETNA,AETNA COMMERCIAL,6595.38,98,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,2512120,CDM,636,RC,,BOTH,500,ML,6729.98,2691.99,AETNA,AETNA COMMERCIAL,6595.38,98,,,OTHER,5047.49,6595.38,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,AETNA,AETNA COMMERCIAL,728.91,98,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,AETNA,AETNA COMMERCIAL,728.91,98,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,2510490,CDM,636,RC,,BOTH,500,ME,743.79,297.51,AETNA,AETNA COMMERCIAL,728.91,98,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,AETNA,AETNA COMMERCIAL,1888.46,98,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,AETNA,AETNA COMMERCIAL,1888.46,98,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,AETNA,AETNA COMMERCIAL,1895.44,98,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,AETNA,AETNA COMMERCIAL,1895.44,98,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,2517300,CDM,636,RC,,BOTH,750,ME,1934.12,773.65,AETNA,AETNA COMMERCIAL,1895.44,98,,,OTHER,1450.59,1895.44,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,2519870,CDM,636,RC,,BOTH,,,10377.46,4150.98,AETNA,AETNA COMMERCIAL,10169.91,98,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,C9159,HCPCS,636,RC,,BOTH,,,10377.46,4150.98,AETNA,AETNA COMMERCIAL,10169.91,98,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J2724,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,AETNA,AETNA COMMERCIAL,7185.5,98,,,OTHER,15.78,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,AETNA,AETNA COMMERCIAL,7185.5,98,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,AETNA,AETNA COMMERCIAL,7185.5,98,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,C9132,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,AETNA,AETNA COMMERCIAL,7185.5,98,,,OTHER,5499.1,7185.5,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,AETNA,AETNA COMMERCIAL,144.04,98,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,AETNA,AETNA COMMERCIAL,144.04,98,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
PNEUMOCOCCAL VACCINE 0.5ML,2518440,CDM,636,RC,,BOTH,0.5,ML,295.08,118.03,AETNA,AETNA COMMERCIAL,289.18,98,,,OTHER,221.31,289.18,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,2511640,CDM,636,RC,,BOTH,,,146.98,58.79,AETNA,AETNA COMMERCIAL,144.04,98,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,AETNA,AETNA COMMERCIAL,1188.82,98,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,AETNA,AETNA COMMERCIAL,1188.82,98,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
FLU VACCINE HIGH DOSE,2514130,CDM,636,RC,,BOTH,,,179.64,71.86,AETNA,AETNA COMMERCIAL,176.05,98,,,OTHER,134.73,176.05,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,Q2036,HCPCS,636,RC,,BOTH,,,64.97,25.99,AETNA,AETNA COMMERCIAL,63.67,98,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,2511440,CDM,636,RC,,BOTH,,,64.97,25.99,AETNA,AETNA COMMERCIAL,63.67,98,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,AETNA,AETNA COMMERCIAL,38.48,98,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,AETNA,AETNA COMMERCIAL,38.48,98,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,2510770,CDM,250,RC,,BOTH,,,39.27,15.71,AETNA,AETNA COMMERCIAL,38.48,98,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
METHYLNALTREXONE BROMIDE,J2212,HCPCS,636,RC,,BOTH,0.1,ME,347.96,139.18,AETNA,AETNA COMMERCIAL,341,98,,,OTHER,1.21,341,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,AETNA,AETNA COMMERCIAL,64.75,98,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,AETNA,AETNA COMMERCIAL,64.75,98,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,AETNA,AETNA COMMERCIAL,66.81,98,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,AETNA,AETNA COMMERCIAL,66.81,98,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
RABIES IMM GLOB 1500U/ML 5ML,2515770,CDM,636,RC,,BOTH,5,ML,5629.18,2251.67,AETNA,AETNA COMMERCIAL,5516.59,98,,,OTHER,299.93,5516.59,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,AETNA,AETNA COMMERCIAL,15.23,98,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,AETNA,AETNA COMMERCIAL,15.23,98,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,2518680,CDM,636,RC,,BOTH,0.5,ML,110.93,44.37,AETNA,AETNA COMMERCIAL,108.71,98,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,AETNA,AETNA COMMERCIAL,108.71,98,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,AETNA,AETNA COMMERCIAL,108.71,98,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,AETNA,AETNA COMMERCIAL,21.5,98,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,AETNA,AETNA COMMERCIAL,21.5,98,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
RABIES VACCINE,2520290,CDM,636,RC,,BOTH,,,870.92,348.37,AETNA,AETNA COMMERCIAL,853.5,98,,,OTHER,338.91,853.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,AETNA,AETNA COMMERCIAL,21.14,98,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,AETNA,AETNA COMMERCIAL,21.14,98,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,AETNA,AETNA COMMERCIAL,73.5,98,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,AETNA,AETNA COMMERCIAL,29.89,98,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,AETNA,AETNA COMMERCIAL,55.12,98,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,AETNA,AETNA COMMERCIAL,55.12,98,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
HALOPERIDOL 5 MG/ML AMP,J1630,HCPCS,636,RC,,BOTH,5,ME,88.26,35.3,AETNA,AETNA COMMERCIAL,86.49,98,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,AETNA,AETNA COMMERCIAL,57.84,98,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,AETNA,AETNA COMMERCIAL,57.84,98,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,AETNA,AETNA COMMERCIAL,5.99,98,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,AETNA,AETNA COMMERCIAL,5.99,98,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,2519130,CDM,636,RC,,BOTH,3,ME,6.12,2.45,AETNA,AETNA COMMERCIAL,5.99,98,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,AETNA,AETNA COMMERCIAL,307.9,98,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,AETNA,AETNA COMMERCIAL,307.9,98,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,AETNA,AETNA COMMERCIAL,307.9,98,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,AETNA,AETNA COMMERCIAL,307.9,98,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
LR 1000 ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,90.88,36.35,BLUE CROSS ANTHEM,COMMERCIAL,72.71,80,,,OTHER,68.16,89.07,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,BLUE CROSS ANTHEM,COMMERCIAL,70.15,80,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,BLUE CROSS ANTHEM,COMMERCIAL,70.15,80,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,BLUE CROSS ANTHEM,COMMERCIAL,96112.72,80,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,BLUE CROSS ANTHEM,COMMERCIAL,96112.72,80,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,2516780,CDM,636,RC,,BOTH,,,120140.9,48056.36,BLUE CROSS ANTHEM,COMMERCIAL,96112.72,80,,,OTHER,90105.68,117738.08,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,59.2,80,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,BLUE CROSS ANTHEM,COMMERCIAL,59.2,80,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,BLUE CROSS ANTHEM,COMMERCIAL,56.73,80,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,BLUE CROSS ANTHEM,COMMERCIAL,56.73,80,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,BLUE CROSS ANTHEM,COMMERCIAL,62.48,80,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,BLUE CROSS ANTHEM,COMMERCIAL,62.48,80,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS KCL 20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,98.13,39.25,BLUE CROSS ANTHEM,COMMERCIAL,78.5,80,,,OTHER,73.6,96.17,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,BLUE CROSS ANTHEM,COMMERCIAL,65.35,80,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,BLUE CROSS ANTHEM,COMMERCIAL,65.35,80,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,BLUE CROSS ANTHEM,COMMERCIAL,2.22,80,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,BLUE CROSS ANTHEM,COMMERCIAL,2.22,80,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,BLUE CROSS ANTHEM,COMMERCIAL,2.39,80,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,BLUE CROSS ANTHEM,COMMERCIAL,2.39,80,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,2510250,CDM,636,RC,,BOTH,1,ML,2.98,1.19,BLUE CROSS ANTHEM,COMMERCIAL,2.39,80,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,BLUE CROSS ANTHEM,COMMERCIAL,52.04,80,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,BLUE CROSS ANTHEM,COMMERCIAL,52.04,80,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,BLUE CROSS ANTHEM,COMMERCIAL,17.02,80,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,BLUE CROSS ANTHEM,COMMERCIAL,17.02,80,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,BLUE CROSS ANTHEM,COMMERCIAL,53.24,80,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,BLUE CROSS ANTHEM,COMMERCIAL,53.24,80,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,BLUE CROSS ANTHEM,COMMERCIAL,42.44,80,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,BLUE CROSS ANTHEM,COMMERCIAL,42.44,80,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,BLUE CROSS ANTHEM,COMMERCIAL,6.67,80,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,BLUE CROSS ANTHEM,COMMERCIAL,6.67,80,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMULIN R) 3 ML VIAL,J1815,HCPCS,636,RC,,BOTH,3,ML,10.78,4.31,BLUE CROSS ANTHEM,COMMERCIAL,8.63,80,,,OTHER,8.09,10.57,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,66.25,26.5,BLUE CROSS ANTHEM,COMMERCIAL,53,80,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 1MG INJ,J1170,HCPCS,636,RC,,BOTH,1,ME,53.73,21.49,BLUE CROSS ANTHEM,COMMERCIAL,42.98,80,,,OTHER,40.3,52.66,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.4 MG/ML,J2310,HCPCS,636,RC,,BOTH,0.4,ML,72.54,29.02,BLUE CROSS ANTHEM,COMMERCIAL,58.03,80,,,OTHER,54.4,71.09,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,BLUE CROSS ANTHEM,COMMERCIAL,79.58,80,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,BLUE CROSS ANTHEM,COMMERCIAL,79.58,80,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
NS  100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,63.3,25.32,BLUE CROSS ANTHEM,COMMERCIAL,50.64,80,,,OTHER,47.48,62.04,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 0.5% 50ML VIAL   MD,J2001,HCPCS,636,RC,,BOTH,50,ML,53.6,21.44,BLUE CROSS ANTHEM,COMMERCIAL,42.88,80,,,OTHER,40.2,52.53,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,61.36,24.54,BLUE CROSS ANTHEM,COMMERCIAL,49.09,80,,,OTHER,46.02,60.13,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J7507,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,BLUE CROSS ANTHEM,COMMERCIAL,3.08,80,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J3490,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,BLUE CROSS ANTHEM,COMMERCIAL,3.08,80,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,BLUE CROSS ANTHEM,COMMERCIAL,71.66,80,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,BLUE CROSS ANTHEM,COMMERCIAL,71.66,80,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7070,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,BLUE CROSS ANTHEM,COMMERCIAL,71.66,80,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITAL 130MG/ML VIAL,J2560,HCPCS,636,RC,,BOTH,130,ME,190.89,76.36,BLUE CROSS ANTHEM,COMMERCIAL,152.71,80,,,OTHER,143.17,187.07,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 2 MG SYRINGE,J1170,HCPCS,636,RC,,BOTH,2,ME,57.58,23.03,BLUE CROSS ANTHEM,COMMERCIAL,46.06,80,,,OTHER,43.19,56.43,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,BLUE CROSS ANTHEM,COMMERCIAL,75.49,80,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,BLUE CROSS ANTHEM,COMMERCIAL,75.49,80,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE 25 MG AMP,J2550,HCPCS,636,RC,,BOTH,25,ME,48.33,19.33,BLUE CROSS ANTHEM,COMMERCIAL,38.66,80,,,OTHER,36.25,47.36,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,BLUE CROSS ANTHEM,COMMERCIAL,52.37,80,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,BLUE CROSS ANTHEM,COMMERCIAL,52.37,80,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,2515450,CDM,636,RC,,BOTH,2,GR,115.87,46.35,BLUE CROSS ANTHEM,COMMERCIAL,92.7,80,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,BLUE CROSS ANTHEM,COMMERCIAL,795.3,80,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,BLUE CROSS ANTHEM,COMMERCIAL,795.3,80,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 2.5MG,J8610,HCPCS,636,RC,,BOTH,2.5,ME,25.39,10.16,BLUE CROSS ANTHEM,COMMERCIAL,20.31,80,,,OTHER,19.04,24.88,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,BLUE CROSS ANTHEM,COMMERCIAL,795.3,80,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,BLUE CROSS ANTHEM,COMMERCIAL,18.06,80,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,BLUE CROSS ANTHEM,COMMERCIAL,18.06,80,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,J3490,HCPCS,636,RC,,BOTH,2,GR,115.87,46.35,BLUE CROSS ANTHEM,COMMERCIAL,92.7,80,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 1G VIAL,J3490,HCPCS,250,RC,,BOTH,1,GR,131.96,52.78,BLUE CROSS ANTHEM,COMMERCIAL,105.57,80,,,OTHER,98.97,129.32,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,BLUE CROSS ANTHEM,COMMERCIAL,52.37,80,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,BLUE CROSS ANTHEM,COMMERCIAL,52.37,80,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,2508230,CDM,250,RC,,BOTH,1.25,ME,22.57,9.03,BLUE CROSS ANTHEM,COMMERCIAL,18.06,80,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,BLUE CROSS ANTHEM,COMMERCIAL,795.3,80,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J1162,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,BLUE CROSS ANTHEM,COMMERCIAL,7342.46,80,,,OTHER,5016.31,8994.52,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,BLUE CROSS ANTHEM,COMMERCIAL,35.49,80,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,BLUE CROSS ANTHEM,COMMERCIAL,35.49,80,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J2150,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,BLUE CROSS ANTHEM,COMMERCIAL,146.04,80,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,BLUE CROSS ANTHEM,COMMERCIAL,91.27,80,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,BLUE CROSS ANTHEM,COMMERCIAL,91.27,80,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J7799,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,BLUE CROSS ANTHEM,COMMERCIAL,146.04,80,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J3490,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,BLUE CROSS ANTHEM,COMMERCIAL,7342.46,80,,,OTHER,6883.56,8994.52,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B IMM. GLOBULIN 5 ML,2510180,CDM,636,RC,,BOTH,5,ML,333.07,133.23,BLUE CROSS ANTHEM,COMMERCIAL,266.46,80,,,OTHER,148.18,326.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,BLUE CROSS ANTHEM,COMMERCIAL,55.84,80,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,BLUE CROSS ANTHEM,COMMERCIAL,55.84,80,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,BLUE CROSS ANTHEM,COMMERCIAL,3770.82,80,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,BLUE CROSS ANTHEM,COMMERCIAL,3770.82,80,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,BLUE CROSS ANTHEM,COMMERCIAL,61.71,80,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,BLUE CROSS ANTHEM,COMMERCIAL,61.71,80,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
ARIPIPRAZOLE 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,67.81,27.12,BLUE CROSS ANTHEM,COMMERCIAL,54.25,80,,,OTHER,50.86,66.45,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,BLUE CROSS ANTHEM,COMMERCIAL,53.86,80,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,BLUE CROSS ANTHEM,COMMERCIAL,53.86,80,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2274,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,BLUE CROSS ANTHEM,COMMERCIAL,107.98,80,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2270,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,BLUE CROSS ANTHEM,COMMERCIAL,107.98,80,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
NALBUPHINE 10MG/ML AMP,J2300,HCPCS,636,RC,,BOTH,10,ME,51.33,20.53,BLUE CROSS ANTHEM,COMMERCIAL,41.06,80,,,OTHER,38.5,50.3,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 2.5MG TAB,2515000,CDM,636,RC,,BOTH,2.5,ME,15.69,6.28,BLUE CROSS ANTHEM,COMMERCIAL,12.55,80,,,OTHER,11.77,15.37,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 250MG/50ML,J1956,HCPCS,636,RC,,BOTH,50,ML,81.19,32.48,BLUE CROSS ANTHEM,COMMERCIAL,64.95,80,,,OTHER,60.89,79.57,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,BLUE CROSS ANTHEM,COMMERCIAL,69.18,80,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,BLUE CROSS ANTHEM,COMMERCIAL,69.18,80,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,BLUE CROSS ANTHEM,COMMERCIAL,55.21,80,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,BLUE CROSS ANTHEM,COMMERCIAL,55.21,80,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,BLUE CROSS ANTHEM,COMMERCIAL,69.7,80,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,BLUE CROSS ANTHEM,COMMERCIAL,69.7,80,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE,J3490,HCPCS,250,RC,,BOTH,,,37.19,14.87,BLUE CROSS ANTHEM,COMMERCIAL,29.75,80,,,OTHER,27.89,36.44,PERCENT OF TOTAL BILLED CHARGES
PROPRANOLOL 1MG AMP,J1800,HCPCS,636,RC,,BOTH,1,ME,82.46,32.98,BLUE CROSS ANTHEM,COMMERCIAL,65.97,80,,,OTHER,61.85,80.81,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,BLUE CROSS ANTHEM,COMMERCIAL,32.88,80,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,BLUE CROSS ANTHEM,COMMERCIAL,32.88,80,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,BLUE CROSS ANTHEM,COMMERCIAL,55.39,80,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,BLUE CROSS ANTHEM,COMMERCIAL,55.39,80,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,2504940,CDM,250,RC,,BOTH,50,ME,41.1,16.44,BLUE CROSS ANTHEM,COMMERCIAL,32.88,80,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,BLUE CROSS ANTHEM,COMMERCIAL,9.95,80,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,BLUE CROSS ANTHEM,COMMERCIAL,9.95,80,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,2506040,CDM,250,RC,,BOTH,,,12.43,4.97,BLUE CROSS ANTHEM,COMMERCIAL,9.95,80,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J0280,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,BLUE CROSS ANTHEM,COMMERCIAL,18.17,80,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J0694,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,BLUE CROSS ANTHEM,COMMERCIAL,85.39,80,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,BLUE CROSS ANTHEM,COMMERCIAL,167.33,80,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,BLUE CROSS ANTHEM,COMMERCIAL,167.33,80,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,BLUE CROSS ANTHEM,COMMERCIAL,1399.3,80,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,BLUE CROSS ANTHEM,COMMERCIAL,1399.3,80,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,BLUE CROSS ANTHEM,COMMERCIAL,16.75,80,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,BLUE CROSS ANTHEM,COMMERCIAL,16.75,80,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,BLUE CROSS ANTHEM,COMMERCIAL,85.39,80,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J3490,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,BLUE CROSS ANTHEM,COMMERCIAL,18.17,80,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 2G VIAL,J3490,HCPCS,250,RC,,BOTH,2,GR,107.37,42.95,BLUE CROSS ANTHEM,COMMERCIAL,85.9,80,,,OTHER,80.53,105.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,2504480,CDM,636,RC,,BOTH,7.5,ME,1749.12,699.65,BLUE CROSS ANTHEM,COMMERCIAL,1399.3,80,,,OTHER,1311.84,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,2508220,CDM,250,RC,,BOTH,0.3,ME,20.93,8.37,BLUE CROSS ANTHEM,COMMERCIAL,16.75,80,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J7626,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,BLUE CROSS ANTHEM,COMMERCIAL,31.52,80,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J7674,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,BLUE CROSS ANTHEM,COMMERCIAL,36.72,80,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J3490,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,BLUE CROSS ANTHEM,COMMERCIAL,36.72,80,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,BLUE CROSS ANTHEM,COMMERCIAL,31.52,80,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,BLUE CROSS ANTHEM,COMMERCIAL,19.43,80,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,BLUE CROSS ANTHEM,COMMERCIAL,19.43,80,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,2504400,CDM,250,RC,,BOTH,4,GR,24.29,9.72,BLUE CROSS ANTHEM,COMMERCIAL,19.43,80,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,BLUE CROSS ANTHEM,COMMERCIAL,17.99,80,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,BLUE CROSS ANTHEM,COMMERCIAL,17.99,80,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,2502460,CDM,250,RC,,BOTH,,,22.49,9,BLUE CROSS ANTHEM,COMMERCIAL,17.99,80,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,BLUE CROSS ANTHEM,COMMERCIAL,66.68,80,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,BLUE CROSS ANTHEM,COMMERCIAL,66.68,80,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,BLUE CROSS ANTHEM,COMMERCIAL,101.15,80,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,BLUE CROSS ANTHEM,COMMERCIAL,101.15,80,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,BLUE CROSS ANTHEM,COMMERCIAL,101.15,80,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,BLUE CROSS ANTHEM,COMMERCIAL,101.15,80,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 5MG TAB,2519250,CDM,636,RC,,BOTH,5,ME,14.15,5.66,BLUE CROSS ANTHEM,COMMERCIAL,11.32,80,,,OTHER,10.61,13.86,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,BLUE CROSS ANTHEM,COMMERCIAL,141.44,80,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,BLUE CROSS ANTHEM,COMMERCIAL,141.44,80,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,2505390,CDM,636,RC,,BOTH,0.25,ME,176.81,70.72,BLUE CROSS ANTHEM,COMMERCIAL,141.44,80,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,BLUE CROSS ANTHEM,COMMERCIAL,18.65,80,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,BLUE CROSS ANTHEM,COMMERCIAL,18.65,80,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,BLUE CROSS ANTHEM,COMMERCIAL,12.79,80,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,BLUE CROSS ANTHEM,COMMERCIAL,12.79,80,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,2504300,CDM,250,RC,,BOTH,,,23.31,9.32,BLUE CROSS ANTHEM,COMMERCIAL,18.65,80,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,2504920,CDM,250,RC,,BOTH,,,15.98,6.39,BLUE CROSS ANTHEM,COMMERCIAL,12.79,80,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,BLUE CROSS ANTHEM,COMMERCIAL,45.34,80,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,BLUE CROSS ANTHEM,COMMERCIAL,45.34,80,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,J3490,HCPCS,250,RC,,BOTH,,,126.41,50.56,BLUE CROSS ANTHEM,COMMERCIAL,101.13,80,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,2515370,CDM,250,RC,,BOTH,,,126.41,50.56,BLUE CROSS ANTHEM,COMMERCIAL,101.13,80,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 20ML,J2001,HCPCS,636,RC,,BOTH,20,ML,62.37,24.95,BLUE CROSS ANTHEM,COMMERCIAL,49.89,80,,,OTHER,46.78,61.12,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,BLUE CROSS ANTHEM,COMMERCIAL,154.1,80,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,BLUE CROSS ANTHEM,COMMERCIAL,154.1,80,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
METHOCARBAMOL 100MG VIAL,J2800,HCPCS,636,RC,,BOTH,100,ME,204.62,81.85,BLUE CROSS ANTHEM,COMMERCIAL,163.7,80,,,OTHER,153.47,200.53,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 10 U/ML INJ,J2590,HCPCS,636,RC,,BOTH,10,UN,50.06,20.02,BLUE CROSS ANTHEM,COMMERCIAL,40.05,80,,,OTHER,37.55,49.06,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,BLUE CROSS ANTHEM,COMMERCIAL,47.38,80,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,BLUE CROSS ANTHEM,COMMERCIAL,47.38,80,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,2501130,CDM,636,RC,,BOTH,1.5,GR,59.23,23.69,BLUE CROSS ANTHEM,COMMERCIAL,47.38,80,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,J3490,HCPCS,250,RC,,BOTH,1000,ME,16.62,6.65,BLUE CROSS ANTHEM,COMMERCIAL,13.3,80,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,2516900,CDM,250,RC,,BOTH,1000,ME,16.62,6.65,BLUE CROSS ANTHEM,COMMERCIAL,13.3,80,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,BLUE CROSS ANTHEM,COMMERCIAL,49.48,80,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,BLUE CROSS ANTHEM,COMMERCIAL,49.48,80,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,BLUE CROSS ANTHEM,COMMERCIAL,70.99,80,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,BLUE CROSS ANTHEM,COMMERCIAL,70.99,80,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2274,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,BLUE CROSS ANTHEM,COMMERCIAL,42.34,80,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2270,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,BLUE CROSS ANTHEM,COMMERCIAL,42.34,80,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,BLUE CROSS ANTHEM,COMMERCIAL,67.14,80,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,BLUE CROSS ANTHEM,COMMERCIAL,67.14,80,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,J3490,HCPCS,250,RC,,BOTH,50,ME,17.65,7.06,BLUE CROSS ANTHEM,COMMERCIAL,14.12,80,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,2510700,CDM,250,RC,,BOTH,50,ME,17.65,7.06,BLUE CROSS ANTHEM,COMMERCIAL,14.12,80,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
NS 500ML,J7030,HCPCS,636,RC,,BOTH,500,ML,81.62,32.65,BLUE CROSS ANTHEM,COMMERCIAL,65.3,80,,,OTHER,61.22,79.99,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,BLUE CROSS ANTHEM,COMMERCIAL,4110.06,80,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,BLUE CROSS ANTHEM,COMMERCIAL,4110.06,80,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,2509490,CDM,636,RC,,BOTH,1,ME,472.36,188.94,BLUE CROSS ANTHEM,COMMERCIAL,377.89,80,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,BLUE CROSS ANTHEM,COMMERCIAL,377.89,80,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,BLUE CROSS ANTHEM,COMMERCIAL,377.89,80,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,J3490,HCPCS,250,RC,,BOTH,0.125,ME,48.04,19.22,BLUE CROSS ANTHEM,COMMERCIAL,38.43,80,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,BLUE CROSS ANTHEM,COMMERCIAL,4110.06,80,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,BLUE CROSS ANTHEM,COMMERCIAL,4110.06,80,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,2506740,CDM,250,RC,,BOTH,0.125,ME,48.04,19.22,BLUE CROSS ANTHEM,COMMERCIAL,38.43,80,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,BLUE CROSS ANTHEM,COMMERCIAL,401.28,80,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,BLUE CROSS ANTHEM,COMMERCIAL,401.28,80,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,2508270,CDM,250,RC,,BOTH,,,501.6,200.64,BLUE CROSS ANTHEM,COMMERCIAL,401.28,80,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,BLUE CROSS ANTHEM,COMMERCIAL,32.54,80,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,BLUE CROSS ANTHEM,COMMERCIAL,32.54,80,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,BLUE CROSS ANTHEM,COMMERCIAL,59.29,80,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,BLUE CROSS ANTHEM,COMMERCIAL,59.29,80,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,BLUE CROSS ANTHEM,COMMERCIAL,59.29,80,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,BLUE CROSS ANTHEM,COMMERCIAL,59.29,80,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,BLUE CROSS ANTHEM,COMMERCIAL,15.82,80,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,BLUE CROSS ANTHEM,COMMERCIAL,15.82,80,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,2505500,CDM,250,RC,,BOTH,5,ME,19.78,7.91,BLUE CROSS ANTHEM,COMMERCIAL,15.82,80,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,BLUE CROSS ANTHEM,COMMERCIAL,216.54,80,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,BLUE CROSS ANTHEM,COMMERCIAL,216.54,80,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,2509880,CDM,250,RC,,BOTH,,,270.68,108.27,BLUE CROSS ANTHEM,COMMERCIAL,216.54,80,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,BLUE CROSS ANTHEM,COMMERCIAL,54.23,80,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,BLUE CROSS ANTHEM,COMMERCIAL,54.23,80,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,2505960,CDM,636,RC,,BOTH,500,ME,67.78,27.11,BLUE CROSS ANTHEM,COMMERCIAL,54.23,80,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% 50ML MDV,J0665,HCPCS,636,RC,,BOTH,50,ML,42.7,17.08,BLUE CROSS ANTHEM,COMMERCIAL,34.16,80,,,OTHER,0.02,41.84,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 1MG AMP,J3430,HCPCS,636,RC,,BOTH,1,ME,96.12,38.45,BLUE CROSS ANTHEM,COMMERCIAL,76.9,80,,,OTHER,72.09,94.2,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,BLUE CROSS ANTHEM,COMMERCIAL,50.59,80,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,BLUE CROSS ANTHEM,COMMERCIAL,50.59,80,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,BLUE CROSS ANTHEM,COMMERCIAL,19.23,80,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,BLUE CROSS ANTHEM,COMMERCIAL,19.23,80,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,2507500,CDM,250,RC,,BOTH,50,ME,24.03,9.61,BLUE CROSS ANTHEM,COMMERCIAL,19.23,80,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,BLUE CROSS ANTHEM,COMMERCIAL,39.45,80,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,BLUE CROSS ANTHEM,COMMERCIAL,39.45,80,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3370,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,BLUE CROSS ANTHEM,COMMERCIAL,39.45,80,,,OTHER,36.99,48.33,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,BLUE CROSS ANTHEM,COMMERCIAL,40.34,80,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
METOCLOPRAMIDE 5MG/ML VIAL,J2765,HCPCS,636,RC,,BOTH,5,ME,45.92,18.37,BLUE CROSS ANTHEM,COMMERCIAL,36.74,80,,,OTHER,34.44,45.01,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,BLUE CROSS ANTHEM,COMMERCIAL,17.88,80,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,BLUE CROSS ANTHEM,COMMERCIAL,17.88,80,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,2507510,CDM,250,RC,,BOTH,12.5,ME,22.35,8.94,BLUE CROSS ANTHEM,COMMERCIAL,17.88,80,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,J3490,HCPCS,255,RC,,BOTH,30,ML,110.55,44.22,BLUE CROSS ANTHEM,COMMERCIAL,88.44,80,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,2508130,CDM,255,RC,,BOTH,30,ML,110.55,44.22,BLUE CROSS ANTHEM,COMMERCIAL,88.44,80,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 0.9% NACL,J1580,HCPCS,636,RC,,BOTH,80,ME,68.12,27.25,BLUE CROSS ANTHEM,COMMERCIAL,54.49,80,,,OTHER,51.09,66.75,PERCENT OF TOTAL BILLED CHARGES
SPIRONOLACTONE 25 MG TAB,J3490,HCPCS,250,RC,,BOTH,25,ME,17.63,7.05,BLUE CROSS ANTHEM,COMMERCIAL,14.1,80,,,OTHER,13.22,17.27,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,BLUE CROSS ANTHEM,COMMERCIAL,26.87,80,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,BLUE CROSS ANTHEM,COMMERCIAL,26.87,80,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,J3490,HCPCS,250,RC,,BOTH,180,ME,59.19,23.67,BLUE CROSS ANTHEM,COMMERCIAL,47.35,80,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,2506840,CDM,250,RC,,BOTH,180,ME,59.19,23.67,BLUE CROSS ANTHEM,COMMERCIAL,47.35,80,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,BLUE CROSS ANTHEM,COMMERCIAL,115.96,80,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,BLUE CROSS ANTHEM,COMMERCIAL,115.96,80,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
MENTHOL ZINCOX,J3490,HCPCS,250,RC,,BOTH,,,26.42,10.57,BLUE CROSS ANTHEM,COMMERCIAL,21.14,80,,,OTHER,19.82,25.89,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,BLUE CROSS ANTHEM,COMMERCIAL,252.08,80,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,BLUE CROSS ANTHEM,COMMERCIAL,252.08,80,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,2508790,CDM,636,RC,,BOTH,50,ME,125,50,BLUE CROSS ANTHEM,COMMERCIAL,100,80,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,BLUE CROSS ANTHEM,COMMERCIAL,96.39,80,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,BLUE CROSS ANTHEM,COMMERCIAL,96.39,80,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,BLUE CROSS ANTHEM,COMMERCIAL,96.39,80,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,BLUE CROSS ANTHEM,COMMERCIAL,96.39,80,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
GLYCOPYRROLATE 0.2 MG/ML,2509510,CDM,250,RC,,BOTH,0.2,ML,74.12,29.65,BLUE CROSS ANTHEM,COMMERCIAL,59.3,80,,,OTHER,55.59,72.64,PERCENT OF TOTAL BILLED CHARGES
HYDROCORT SOD.SUCC. 100MG VIAL,J1720,HCPCS,636,RC,,BOTH,100,ME,71.91,28.76,BLUE CROSS ANTHEM,COMMERCIAL,57.53,80,,,OTHER,53.93,70.47,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 40MG VIAL,J2920,HCPCS,636,RC,,BOTH,40,ME,58,23.2,BLUE CROSS ANTHEM,COMMERCIAL,46.4,80,,,OTHER,43.5,56.84,PERCENT OF TOTAL BILLED CHARGES
NS 250ML GLASS BOTTLE,J7030,HCPCS,636,RC,,BOTH,250,ML,79.33,31.73,BLUE CROSS ANTHEM,COMMERCIAL,63.47,80,,,OTHER,59.5,77.75,PERCENT OF TOTAL BILLED CHARGES
PROCHLORPERAZINE 10 MG VIAL,J0780,HCPCS,636,RC,,BOTH,10,ME,74.3,29.72,BLUE CROSS ANTHEM,COMMERCIAL,59.44,80,,,OTHER,55.73,72.81,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,BLUE CROSS ANTHEM,COMMERCIAL,13.27,80,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,BLUE CROSS ANTHEM,COMMERCIAL,13.27,80,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,2522260,CDM,250,RC,,BOTH,100,ME,16.59,6.64,BLUE CROSS ANTHEM,COMMERCIAL,13.27,80,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2371,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,BLUE CROSS ANTHEM,COMMERCIAL,45.74,80,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2370,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,BLUE CROSS ANTHEM,COMMERCIAL,45.74,80,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,BLUE CROSS ANTHEM,COMMERCIAL,81.03,80,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,BLUE CROSS ANTHEM,COMMERCIAL,81.03,80,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
FOLIC ACID 1 MG TAB,J3490,HCPCS,250,RC,,BOTH,1,ME,17.34,6.94,BLUE CROSS ANTHEM,COMMERCIAL,13.87,80,,,OTHER,13.01,17,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,BLUE CROSS ANTHEM,COMMERCIAL,67.29,80,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,BLUE CROSS ANTHEM,COMMERCIAL,67.29,80,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
HYDRALAZINE 20 MG/ML VIAL,J0360,HCPCS,636,RC,,BOTH,20,ME,142.58,57.03,BLUE CROSS ANTHEM,COMMERCIAL,114.06,80,,,OTHER,106.94,139.73,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,BLUE CROSS ANTHEM,COMMERCIAL,36.89,80,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,BLUE CROSS ANTHEM,COMMERCIAL,36.89,80,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
PATIENTS OWN MED,J3490,HCPCS,636,RC,,BOTH,,,0.52,0.21,BLUE CROSS ANTHEM,COMMERCIAL,0.42,80,,,OTHER,0.39,0.51,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,BLUE CROSS ANTHEM,COMMERCIAL,15.69,80,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,BLUE CROSS ANTHEM,COMMERCIAL,15.69,80,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,2504830,CDM,250,RC,,BOTH,10,ME,19.61,7.84,BLUE CROSS ANTHEM,COMMERCIAL,15.69,80,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,BLUE CROSS ANTHEM,COMMERCIAL,47.43,80,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,BLUE CROSS ANTHEM,COMMERCIAL,47.43,80,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,BLUE CROSS ANTHEM,COMMERCIAL,111.33,80,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,BLUE CROSS ANTHEM,COMMERCIAL,111.33,80,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,BLUE CROSS ANTHEM,COMMERCIAL,13.85,80,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,BLUE CROSS ANTHEM,COMMERCIAL,13.85,80,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,2509260,CDM,250,RC,,BOTH,40,ME,17.31,6.92,BLUE CROSS ANTHEM,COMMERCIAL,13.85,80,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,BLUE CROSS ANTHEM,COMMERCIAL,43.75,80,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,BLUE CROSS ANTHEM,COMMERCIAL,43.75,80,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,37.2,80,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,BLUE CROSS ANTHEM,COMMERCIAL,37.2,80,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 60MG/0.9% NS 50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,64.59,25.84,BLUE CROSS ANTHEM,COMMERCIAL,51.67,80,,,OTHER,48.44,63.3,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,BLUE CROSS ANTHEM,COMMERCIAL,53.85,80,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,BLUE CROSS ANTHEM,COMMERCIAL,53.85,80,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,2511540,CDM,636,RC,,BOTH,,,146.98,58.79,BLUE CROSS ANTHEM,COMMERCIAL,117.58,80,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,90715,HCPCS,636,RC,,BOTH,,,146.98,58.79,BLUE CROSS ANTHEM,COMMERCIAL,117.58,80,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 80MG VIAL,J1580,HCPCS,636,RC,,BOTH,80,ME,47.86,19.14,BLUE CROSS ANTHEM,COMMERCIAL,38.29,80,,,OTHER,35.89,46.9,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 4MEQ/ML 2ML VIAL,J3475,HCPCS,636,RC,,BOTH,2,ML,34.27,13.71,BLUE CROSS ANTHEM,COMMERCIAL,27.41,80,,,OTHER,25.7,33.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,BLUE CROSS ANTHEM,COMMERCIAL,44.73,80,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,BLUE CROSS ANTHEM,COMMERCIAL,44.73,80,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,BLUE CROSS ANTHEM,COMMERCIAL,44.73,80,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,BLUE CROSS ANTHEM,COMMERCIAL,44.73,80,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,BLUE CROSS ANTHEM,COMMERCIAL,51.74,80,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,BLUE CROSS ANTHEM,COMMERCIAL,51.74,80,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,2513040,CDM,636,RC,,BOTH,20,ME,44.88,17.95,BLUE CROSS ANTHEM,COMMERCIAL,35.91,80,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,BLUE CROSS ANTHEM,COMMERCIAL,35.91,80,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,BLUE CROSS ANTHEM,COMMERCIAL,35.91,80,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT 4MG,J3490,HCPCS,636,RC,,BOTH,4,ME,23.2,9.28,BLUE CROSS ANTHEM,COMMERCIAL,18.56,80,,,OTHER,17.4,22.74,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J0665,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,BLUE CROSS ANTHEM,COMMERCIAL,41.7,80,,,OTHER,0.02,51.08,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,BLUE CROSS ANTHEM,COMMERCIAL,41.7,80,,,OTHER,39.09,51.08,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,BLUE CROSS ANTHEM,COMMERCIAL,36.09,80,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,BLUE CROSS ANTHEM,COMMERCIAL,36.09,80,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,2506990,CDM,636,RC,,BOTH,50,ME,45.11,18.05,BLUE CROSS ANTHEM,COMMERCIAL,36.09,80,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
METHLYPREDNISOLONE 125MG VIAL,J2930,HCPCS,636,RC,,BOTH,125,ME,66.23,26.49,BLUE CROSS ANTHEM,COMMERCIAL,52.99,80,,,OTHER,49.67,64.91,PERCENT OF TOTAL BILLED CHARGES
LORAZEPAM 2 MG/ML VIAL,J2060,HCPCS,636,RC,,BOTH,2,ME,55.93,22.37,BLUE CROSS ANTHEM,COMMERCIAL,44.74,80,,,OTHER,41.94,54.81,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,S0164,HCPCS,636,RC,,BOTH,40,ME,74.08,29.63,BLUE CROSS ANTHEM,COMMERCIAL,59.27,80,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,2507670,CDM,636,RC,,BOTH,40,ME,74.08,29.63,BLUE CROSS ANTHEM,COMMERCIAL,59.27,80,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
NS  500ML,J7040,HCPCS,636,RC,,BOTH,500,ML,175.19,70.08,BLUE CROSS ANTHEM,COMMERCIAL,140.15,80,,,OTHER,131.39,171.69,PERCENT OF TOTAL BILLED CHARGES
NON FORMULARY MED REC,2504941,CDM,636,RC,,BOTH,,,0.05,0.02,BLUE CROSS ANTHEM,COMMERCIAL,0.04,80,,,OTHER,0.03,0.05,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 15MG VIAL,J1885,HCPCS,636,RC,,BOTH,15,ME,49.58,19.83,BLUE CROSS ANTHEM,COMMERCIAL,39.66,80,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
DUONEB 0.5MG/3.ML,J7620,HCPCS,636,RC,,BOTH,3,ML,2.22,0.89,BLUE CROSS ANTHEM,COMMERCIAL,1.77,80,,,OTHER,1.66,2.17,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,BLUE CROSS ANTHEM,COMMERCIAL,41.92,80,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,BLUE CROSS ANTHEM,COMMERCIAL,41.92,80,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
NS  250ML,J7050,HCPCS,636,RC,,BOTH,250,ML,83.9,33.56,BLUE CROSS ANTHEM,COMMERCIAL,67.12,80,,,OTHER,62.93,82.22,PERCENT OF TOTAL BILLED CHARGES
NS  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,122.12,48.85,BLUE CROSS ANTHEM,COMMERCIAL,97.69,80,,,OTHER,91.59,119.67,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,BLUE CROSS ANTHEM,COMMERCIAL,636.48,80,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,BLUE CROSS ANTHEM,COMMERCIAL,636.48,80,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,BLUE CROSS ANTHEM,COMMERCIAL,40.63,80,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,BLUE CROSS ANTHEM,COMMERCIAL,40.63,80,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,BLUE CROSS ANTHEM,COMMERCIAL,58.46,80,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,BLUE CROSS ANTHEM,COMMERCIAL,58.46,80,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,BLUE CROSS ANTHEM,COMMERCIAL,61.85,80,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,BLUE CROSS ANTHEM,COMMERCIAL,61.85,80,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
NEOSTIGMINE 1MG/ML INJ,J2710,HCPCS,636,RC,,BOTH,1,ME,81.21,32.48,BLUE CROSS ANTHEM,COMMERCIAL,64.97,80,,,OTHER,60.91,79.59,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 100 MG/2 ML VIAL,J1165,HCPCS,636,RC,,BOTH,100,ME,31.36,12.54,BLUE CROSS ANTHEM,COMMERCIAL,25.08,80,,,OTHER,23.52,30.73,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,BLUE CROSS ANTHEM,COMMERCIAL,73.7,80,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,BLUE CROSS ANTHEM,COMMERCIAL,73.7,80,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,BLUE CROSS ANTHEM,COMMERCIAL,208.28,80,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,BLUE CROSS ANTHEM,COMMERCIAL,208.28,80,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,BLUE CROSS ANTHEM,COMMERCIAL,376.48,80,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,BLUE CROSS ANTHEM,COMMERCIAL,376.48,80,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,2509110,CDM,636,RC,,BOTH,30,UN,470.6,188.24,BLUE CROSS ANTHEM,COMMERCIAL,376.48,80,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,BLUE CROSS ANTHEM,COMMERCIAL,66.53,80,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,BLUE CROSS ANTHEM,COMMERCIAL,66.53,80,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.2MG AMP,J2310,HCPCS,636,RC,,BOTH,0.2,ME,117.05,46.82,BLUE CROSS ANTHEM,COMMERCIAL,93.64,80,,,OTHER,87.79,114.71,PERCENT OF TOTAL BILLED CHARGES
HYDROXYZINE HCL 50 MG/ML VIAL ,J3410,HCPCS,636,RC,,BOTH,50,ME,101.36,40.54,BLUE CROSS ANTHEM,COMMERCIAL,81.09,80,,,OTHER,76.02,99.33,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,BLUE CROSS ANTHEM,COMMERCIAL,53.34,80,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,BLUE CROSS ANTHEM,COMMERCIAL,53.34,80,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,BLUE CROSS ANTHEM,COMMERCIAL,98.4,80,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,BLUE CROSS ANTHEM,COMMERCIAL,98.4,80,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,BLUE CROSS ANTHEM,COMMERCIAL,109.66,80,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,BLUE CROSS ANTHEM,COMMERCIAL,109.66,80,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 500MG INJ,J1956,HCPCS,636,RC,,BOTH,500,ME,67.61,27.04,BLUE CROSS ANTHEM,COMMERCIAL,54.09,80,,,OTHER,50.71,66.26,PERCENT OF TOTAL BILLED CHARGES
PERFLUTREN  SDV,Q9957,HCPCS,636,RC,,BOTH,,,813.57,325.43,BLUE CROSS ANTHEM,COMMERCIAL,650.86,80,,,OTHER,610.18,797.3,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,BLUE CROSS ANTHEM,COMMERCIAL,50,80,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,BLUE CROSS ANTHEM,COMMERCIAL,50,80,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,2513380,CDM,636,RC,,BOTH,100,ME,62.5,25,BLUE CROSS ANTHEM,COMMERCIAL,50,80,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,BLUE CROSS ANTHEM,COMMERCIAL,36.06,80,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,BLUE CROSS ANTHEM,COMMERCIAL,36.06,80,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,BLUE CROSS ANTHEM,COMMERCIAL,103.98,80,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,BLUE CROSS ANTHEM,COMMERCIAL,103.98,80,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,BLUE CROSS ANTHEM,COMMERCIAL,103.98,80,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,BLUE CROSS ANTHEM,COMMERCIAL,103.98,80,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7060,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,BLUE CROSS ANTHEM,COMMERCIAL,67.22,80,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,BLUE CROSS ANTHEM,COMMERCIAL,67.22,80,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,BLUE CROSS ANTHEM,COMMERCIAL,67.22,80,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,BLUE CROSS ANTHEM,COMMERCIAL,332.36,80,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,BLUE CROSS ANTHEM,COMMERCIAL,332.36,80,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,BLUE CROSS ANTHEM,COMMERCIAL,370.77,80,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,BLUE CROSS ANTHEM,COMMERCIAL,370.77,80,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,BLUE CROSS ANTHEM,COMMERCIAL,1.76,80,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,BLUE CROSS ANTHEM,COMMERCIAL,1.76,80,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,2512600,CDM,636,RC,,BOTH,100,ME,2.21,0.88,BLUE CROSS ANTHEM,COMMERCIAL,1.76,80,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 1000U/ML 2ML VIAL,J1644,HCPCS,636,RC,,BOTH,2,ML,78.89,31.56,BLUE CROSS ANTHEM,COMMERCIAL,63.11,80,,,OTHER,59.17,77.31,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 20U/LR 1000 ML,J2590,HCPCS,636,RC,,BOTH,1000,ML,276.21,110.48,BLUE CROSS ANTHEM,COMMERCIAL,220.96,80,,,OTHER,207.15,270.68,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,BLUE CROSS ANTHEM,COMMERCIAL,61.09,80,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,BLUE CROSS ANTHEM,COMMERCIAL,61.09,80,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,BLUE CROSS ANTHEM,COMMERCIAL,68.14,80,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,BLUE CROSS ANTHEM,COMMERCIAL,68.14,80,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,BLUE CROSS ANTHEM,COMMERCIAL,68.14,80,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,BLUE CROSS ANTHEM,COMMERCIAL,246.17,80,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,BLUE CROSS ANTHEM,COMMERCIAL,246.17,80,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,BLUE CROSS ANTHEM,COMMERCIAL,95.19,80,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,BLUE CROSS ANTHEM,COMMERCIAL,95.19,80,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 2.25G VIAL,J2543,HCPCS,636,RC,,BOTH,2.25,GR,72.92,29.17,BLUE CROSS ANTHEM,COMMERCIAL,58.33,80,,,OTHER,54.69,71.46,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,BLUE CROSS ANTHEM,COMMERCIAL,86.06,80,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,BLUE CROSS ANTHEM,COMMERCIAL,86.06,80,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,BLUE CROSS ANTHEM,COMMERCIAL,86.06,80,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,BLUE CROSS ANTHEM,COMMERCIAL,86.06,80,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,BLUE CROSS ANTHEM,COMMERCIAL,26.79,80,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,BLUE CROSS ANTHEM,COMMERCIAL,26.79,80,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,2507710,CDM,636,RC,,BOTH,20,ML,33.48,13.39,BLUE CROSS ANTHEM,COMMERCIAL,26.79,80,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% SDV 2ML,J2001,HCPCS,636,RC,,BOTH,2,ML,48.52,19.41,BLUE CROSS ANTHEM,COMMERCIAL,38.82,80,,,OTHER,36.39,47.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,BLUE CROSS ANTHEM,COMMERCIAL,74.58,80,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,BLUE CROSS ANTHEM,COMMERCIAL,74.58,80,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,2501270,CDM,636,RC,,BOTH,3,GR,93.22,37.29,BLUE CROSS ANTHEM,COMMERCIAL,74.58,80,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,BLUE CROSS ANTHEM,COMMERCIAL,74.58,80,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 30MG VIAL,J1885,HCPCS,636,RC,,BOTH,30,ME,57.77,23.11,BLUE CROSS ANTHEM,COMMERCIAL,46.22,80,,,OTHER,43.33,56.62,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40MG VIAL,J1940,HCPCS,636,RC,,BOTH,40,ME,45.24,18.09,BLUE CROSS ANTHEM,COMMERCIAL,36.19,80,,,OTHER,33.93,44.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,BLUE CROSS ANTHEM,COMMERCIAL,61.99,80,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,BLUE CROSS ANTHEM,COMMERCIAL,61.99,80,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3370,HCPCS,636,RC,,BOTH,1,GR,77.49,31,BLUE CROSS ANTHEM,COMMERCIAL,61.99,80,,,OTHER,58.12,75.94,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM,J2250,HCPCS,636,RC,,BOTH,1,ME,50.03,20.01,BLUE CROSS ANTHEM,COMMERCIAL,40.02,80,,,OTHER,37.52,49.03,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,BLUE CROSS ANTHEM,COMMERCIAL,47.43,80,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,BLUE CROSS ANTHEM,COMMERCIAL,47.43,80,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,BLUE CROSS ANTHEM,COMMERCIAL,294.01,80,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,BLUE CROSS ANTHEM,COMMERCIAL,294.01,80,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,BLUE CROSS ANTHEM,COMMERCIAL,294.01,80,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,BLUE CROSS ANTHEM,COMMERCIAL,294.01,80,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,BLUE CROSS ANTHEM,COMMERCIAL,148.89,80,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,BLUE CROSS ANTHEM,COMMERCIAL,148.89,80,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3372,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,BLUE CROSS ANTHEM,COMMERCIAL,91.42,80,,,OTHER,6.72,111.99,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3490,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,BLUE CROSS ANTHEM,COMMERCIAL,91.42,80,,,OTHER,85.7,111.99,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J7517,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,BLUE CROSS ANTHEM,COMMERCIAL,4.16,80,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J3490,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,BLUE CROSS ANTHEM,COMMERCIAL,4.16,80,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,BLUE CROSS ANTHEM,COMMERCIAL,39.28,80,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,BLUE CROSS ANTHEM,COMMERCIAL,39.28,80,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J7613,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,BLUE CROSS ANTHEM,COMMERCIAL,0.64,80,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J3490,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,BLUE CROSS ANTHEM,COMMERCIAL,0.64,80,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,BLUE CROSS ANTHEM,COMMERCIAL,728.54,80,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,BLUE CROSS ANTHEM,COMMERCIAL,728.54,80,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,2511380,CDM,636,RC,,BOTH,1,ME,910.67,364.27,BLUE CROSS ANTHEM,COMMERCIAL,728.54,80,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,BLUE CROSS ANTHEM,COMMERCIAL,3494.34,80,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,BLUE CROSS ANTHEM,COMMERCIAL,3494.34,80,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,BLUE CROSS ANTHEM,COMMERCIAL,1416.74,80,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,BLUE CROSS ANTHEM,COMMERCIAL,1416.74,80,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,2505151,CDM,636,RC,,BOTH,0.5,ME,1770.92,708.37,BLUE CROSS ANTHEM,COMMERCIAL,1416.74,80,,,OTHER,1328.19,1735.5,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,BLUE CROSS ANTHEM,COMMERCIAL,631.21,80,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,BLUE CROSS ANTHEM,COMMERCIAL,631.21,80,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3372,HCPCS,636,RC,,BOTH,300,ML,129.54,51.82,BLUE CROSS ANTHEM,COMMERCIAL,103.63,80,,,OTHER,6.72,126.95,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3490,HCPCS,636,RC,,BOTH,200,ML,129.54,51.82,BLUE CROSS ANTHEM,COMMERCIAL,103.63,80,,,OTHER,97.15,126.95,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 750MG/150ML PB,J1956,HCPCS,636,RC,,BOTH,750,ME,108,43.2,BLUE CROSS ANTHEM,COMMERCIAL,86.4,80,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,BLUE CROSS ANTHEM,COMMERCIAL,3462.92,80,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,BLUE CROSS ANTHEM,COMMERCIAL,3462.92,80,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,2504470,CDM,636,RC,,BOTH,22.5,ME,4328.65,1731.46,BLUE CROSS ANTHEM,COMMERCIAL,3462.92,80,,,OTHER,3246.49,4242.08,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG/300ML IV,J2020,HCPCS,636,RC,,BOTH,600,ME,207.7,83.08,BLUE CROSS ANTHEM,COMMERCIAL,166.16,80,,,OTHER,155.78,203.55,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,BLUE CROSS ANTHEM,COMMERCIAL,81.58,80,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,BLUE CROSS ANTHEM,COMMERCIAL,81.58,80,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 3.375G VIAL,J2543,HCPCS,636,RC,,BOTH,3.375,GR,166.16,66.46,BLUE CROSS ANTHEM,COMMERCIAL,132.93,80,,,OTHER,124.62,162.83,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3372,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,BLUE CROSS ANTHEM,COMMERCIAL,112.28,80,,,OTHER,6.72,137.54,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3490,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,BLUE CROSS ANTHEM,COMMERCIAL,112.28,80,,,OTHER,105.26,137.54,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,BLUE CROSS ANTHEM,COMMERCIAL,66.43,80,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,BLUE CROSS ANTHEM,COMMERCIAL,66.43,80,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,BLUE CROSS ANTHEM,COMMERCIAL,70.3,80,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,BLUE CROSS ANTHEM,COMMERCIAL,70.3,80,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,BLUE CROSS ANTHEM,COMMERCIAL,13.12,80,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,BLUE CROSS ANTHEM,COMMERCIAL,13.12,80,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,BLUE CROSS ANTHEM,COMMERCIAL,1292.78,80,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,BLUE CROSS ANTHEM,COMMERCIAL,1292.78,80,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 500MG VIAL,J2930,HCPCS,636,RC,,BOTH,500,ME,103.65,41.46,BLUE CROSS ANTHEM,COMMERCIAL,82.92,80,,,OTHER,77.74,101.58,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J2597,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,BLUE CROSS ANTHEM,COMMERCIAL,125.76,80,,,OTHER,6.58,154.06,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J3490,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,BLUE CROSS ANTHEM,COMMERCIAL,125.76,80,,,OTHER,117.9,154.06,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,BLUE CROSS ANTHEM,COMMERCIAL,3.33,80,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,BLUE CROSS ANTHEM,COMMERCIAL,3.33,80,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,BLUE CROSS ANTHEM,COMMERCIAL,60.9,80,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,BLUE CROSS ANTHEM,COMMERCIAL,60.9,80,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 60MG INJ,J1885,HCPCS,636,RC,,BOTH,60,ME,46.32,18.53,BLUE CROSS ANTHEM,COMMERCIAL,37.06,80,,,OTHER,34.74,45.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3372,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,BLUE CROSS ANTHEM,COMMERCIAL,115.03,80,,,OTHER,6.72,140.91,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3490,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,BLUE CROSS ANTHEM,COMMERCIAL,115.03,80,,,OTHER,107.84,140.91,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,BLUE CROSS ANTHEM,COMMERCIAL,214.83,80,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,BLUE CROSS ANTHEM,COMMERCIAL,214.83,80,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,2508360,CDM,636,RC,,BOTH,4,ME,268.54,107.42,BLUE CROSS ANTHEM,COMMERCIAL,214.83,80,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
KENALOG-40 INJ,J3301,HCPCS,636,RC,,BOTH,10,ME,65.27,26.11,BLUE CROSS ANTHEM,COMMERCIAL,52.22,80,,,OTHER,48.96,63.97,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 2GM PREMIX BAG,J3475,HCPCS,636,RC,,BOTH,2,GR,101.76,40.71,BLUE CROSS ANTHEM,COMMERCIAL,81.41,80,,,OTHER,76.32,99.73,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,BLUE CROSS ANTHEM,COMMERCIAL,512.59,80,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,BLUE CROSS ANTHEM,COMMERCIAL,512.59,80,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,2516870,CDM,636,RC,,BOTH,5,ML,640.74,256.3,BLUE CROSS ANTHEM,COMMERCIAL,512.59,80,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,BLUE CROSS ANTHEM,COMMERCIAL,39.66,80,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,BLUE CROSS ANTHEM,COMMERCIAL,39.66,80,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,BLUE CROSS ANTHEM,COMMERCIAL,103.57,80,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,BLUE CROSS ANTHEM,COMMERCIAL,103.57,80,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
PIPERACILLIN/TAZOBAC 4G/0.5 IV,J2543,HCPCS,636,RC,,BOTH,4,GR,166.16,66.47,BLUE CROSS ANTHEM,COMMERCIAL,132.93,80,,,OTHER,124.62,162.84,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,BLUE CROSS ANTHEM,COMMERCIAL,45.07,80,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,BLUE CROSS ANTHEM,COMMERCIAL,45.07,80,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,BLUE CROSS ANTHEM,COMMERCIAL,98.6,80,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,BLUE CROSS ANTHEM,COMMERCIAL,98.6,80,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,BLUE CROSS ANTHEM,COMMERCIAL,187.56,80,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,BLUE CROSS ANTHEM,COMMERCIAL,187.56,80,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,BLUE CROSS ANTHEM,COMMERCIAL,39.07,80,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,BLUE CROSS ANTHEM,COMMERCIAL,39.07,80,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,BLUE CROSS ANTHEM,COMMERCIAL,37.11,80,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,BLUE CROSS ANTHEM,COMMERCIAL,37.11,80,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,2502720,CDM,636,RC,,BOTH,4,ME,46.38,18.55,BLUE CROSS ANTHEM,COMMERCIAL,37.11,80,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,BLUE CROSS ANTHEM,COMMERCIAL,93.25,80,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,BLUE CROSS ANTHEM,COMMERCIAL,93.25,80,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J2760,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,BLUE CROSS ANTHEM,COMMERCIAL,639.44,80,,,OTHER,466.54,783.31,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J3490,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,BLUE CROSS ANTHEM,COMMERCIAL,639.44,80,,,OTHER,599.48,783.31,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,BLUE CROSS ANTHEM,COMMERCIAL,72.18,80,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,BLUE CROSS ANTHEM,COMMERCIAL,72.18,80,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,2500750,CDM,636,RC,,BOTH,2.5,ME,90.23,36.09,BLUE CROSS ANTHEM,COMMERCIAL,72.18,80,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 500MG INJ,J2185,HCPCS,636,RC,,BOTH,500,ME,64.96,25.98,BLUE CROSS ANTHEM,COMMERCIAL,51.97,80,,,OTHER,48.72,63.66,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML,J2250,HCPCS,636,RC,,BOTH,5,ML,50.52,20.21,BLUE CROSS ANTHEM,COMMERCIAL,40.42,80,,,OTHER,37.89,49.51,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML VIAL,J2250,HCPCS,636,RC,,BOTH,5,ME,58.31,23.32,BLUE CROSS ANTHEM,COMMERCIAL,46.65,80,,,OTHER,43.73,57.14,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,2505240,CDM,636,RC,,BOTH,1,GR,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 250 MG/5 ML VIAL,J1165,HCPCS,636,RC,,BOTH,250,ME,22.1,8.84,BLUE CROSS ANTHEM,COMMERCIAL,17.68,80,,,OTHER,16.57,21.66,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,BLUE CROSS ANTHEM,COMMERCIAL,5060.07,80,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,BLUE CROSS ANTHEM,COMMERCIAL,5060.07,80,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,BLUE CROSS ANTHEM,COMMERCIAL,149.47,80,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,BLUE CROSS ANTHEM,COMMERCIAL,149.47,80,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,2504590,CDM,636,RC,,BOTH,10,ME,186.84,74.74,BLUE CROSS ANTHEM,COMMERCIAL,149.47,80,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,BLUE CROSS ANTHEM,COMMERCIAL,522.65,80,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,BLUE CROSS ANTHEM,COMMERCIAL,522.65,80,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,2513160,CDM,636,RC,,BOTH,1,ME,653.31,261.32,BLUE CROSS ANTHEM,COMMERCIAL,522.65,80,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% VIAL   SD,J2001,HCPCS,636,RC,,BOTH,10,ME,47.14,18.86,BLUE CROSS ANTHEM,COMMERCIAL,37.71,80,,,OTHER,35.35,46.2,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,BLUE CROSS ANTHEM,COMMERCIAL,45.24,80,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,BLUE CROSS ANTHEM,COMMERCIAL,45.24,80,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,BLUE CROSS ANTHEM,COMMERCIAL,52.23,80,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,BLUE CROSS ANTHEM,COMMERCIAL,52.23,80,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,2505170,CDM,636,RC,,BOTH,20,ME,65.29,26.11,BLUE CROSS ANTHEM,COMMERCIAL,52.23,80,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,BLUE CROSS ANTHEM,COMMERCIAL,104.15,80,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,BLUE CROSS ANTHEM,COMMERCIAL,104.15,80,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,BOTH,,,51.37,20.55,BLUE CROSS ANTHEM,COMMERCIAL,41.1,80,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3490,HCPCS,636,RC,,BOTH,,,51.37,20.55,BLUE CROSS ANTHEM,COMMERCIAL,41.1,80,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,BLUE CROSS ANTHEM,COMMERCIAL,108.02,80,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,BLUE CROSS ANTHEM,COMMERCIAL,108.02,80,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 5OOOU/ML INJ,J1644,HCPCS,636,RC,,BOTH,5000,UN,53.84,21.54,BLUE CROSS ANTHEM,COMMERCIAL,43.07,80,,,OTHER,40.38,52.77,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,BLUE CROSS ANTHEM,COMMERCIAL,3780.58,80,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,BLUE CROSS ANTHEM,COMMERCIAL,3780.58,80,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,BLUE CROSS ANTHEM,COMMERCIAL,39.97,80,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,BLUE CROSS ANTHEM,COMMERCIAL,39.97,80,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0150,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,BLUE CROSS ANTHEM,COMMERCIAL,39.97,80,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,BLUE CROSS ANTHEM,COMMERCIAL,123.01,80,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,BLUE CROSS ANTHEM,COMMERCIAL,123.01,80,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT HOME PACK,Q0162,HCPCS,636,RC,,BOTH,,,23.75,9.5,BLUE CROSS ANTHEM,COMMERCIAL,19,80,,,OTHER,17.81,23.28,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,BLUE CROSS ANTHEM,COMMERCIAL,8.98,80,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,BLUE CROSS ANTHEM,COMMERCIAL,8.98,80,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,BLUE CROSS ANTHEM,COMMERCIAL,68.21,80,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,BLUE CROSS ANTHEM,COMMERCIAL,68.21,80,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,2512620,CDM,636,RC,,BOTH,350,ME,85.26,34.1,BLUE CROSS ANTHEM,COMMERCIAL,68.21,80,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,BLUE CROSS ANTHEM,COMMERCIAL,58.51,80,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,BLUE CROSS ANTHEM,COMMERCIAL,58.51,80,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
METHYLPRED 1G VIAL,J2930,HCPCS,636,RC,,BOTH,1,GR,172.48,68.99,BLUE CROSS ANTHEM,COMMERCIAL,137.98,80,,,OTHER,129.36,169.03,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE,J3475,HCPCS,636,RC,,BOTH,500,ME,77.51,31,BLUE CROSS ANTHEM,COMMERCIAL,62.01,80,,,OTHER,58.13,75.96,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,BLUE CROSS ANTHEM,COMMERCIAL,161.55,80,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,BLUE CROSS ANTHEM,COMMERCIAL,161.55,80,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,2505150,CDM,636,RC,,BOTH,80,ME,201.94,80.78,BLUE CROSS ANTHEM,COMMERCIAL,161.55,80,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,BLUE CROSS ANTHEM,COMMERCIAL,62.74,80,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,BLUE CROSS ANTHEM,COMMERCIAL,62.74,80,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G POTASS 5MMU VIAL,J2540,HCPCS,636,RC,,BOTH,,,76.53,30.61,BLUE CROSS ANTHEM,COMMERCIAL,61.23,80,,,OTHER,57.4,75,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE 5GM/10ML,J3475,HCPCS,636,RC,,BOTH,10,ML,88.79,35.52,BLUE CROSS ANTHEM,COMMERCIAL,71.03,80,,,OTHER,66.6,87.02,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,BLUE CROSS ANTHEM,COMMERCIAL,45.48,80,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,BLUE CROSS ANTHEM,COMMERCIAL,45.48,80,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,BLUE CROSS ANTHEM,COMMERCIAL,3513.24,80,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,BLUE CROSS ANTHEM,COMMERCIAL,3513.24,80,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,2514280,CDM,636,RC,,BOTH,100,ME,4391.55,1756.62,BLUE CROSS ANTHEM,COMMERCIAL,3513.24,80,,,OTHER,3293.66,4303.72,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,BLUE CROSS ANTHEM,COMMERCIAL,85.6,80,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,BLUE CROSS ANTHEM,COMMERCIAL,85.6,80,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,BLUE CROSS ANTHEM,COMMERCIAL,1679.81,80,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,BLUE CROSS ANTHEM,COMMERCIAL,1679.81,80,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 10 MG AMP,J3430,HCPCS,636,RC,,BOTH,10,ME,147.4,58.96,BLUE CROSS ANTHEM,COMMERCIAL,117.92,80,,,OTHER,110.55,144.45,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,BLUE CROSS ANTHEM,COMMERCIAL,3454.73,80,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,BLUE CROSS ANTHEM,COMMERCIAL,3454.73,80,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,BLUE CROSS ANTHEM,COMMERCIAL,273.06,80,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,BLUE CROSS ANTHEM,COMMERCIAL,273.06,80,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514820,CDM,636,RC,,BOTH,10,ME,341.32,136.53,BLUE CROSS ANTHEM,COMMERCIAL,273.06,80,,,OTHER,255.99,334.5,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,BLUE CROSS ANTHEM,COMMERCIAL,76.01,80,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,BLUE CROSS ANTHEM,COMMERCIAL,76.01,80,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,BLUE CROSS ANTHEM,COMMERCIAL,204.04,80,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,BLUE CROSS ANTHEM,COMMERCIAL,204.04,80,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,BLUE CROSS ANTHEM,COMMERCIAL,204.04,80,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,BLUE CROSS ANTHEM,COMMERCIAL,204.04,80,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J1805,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,BLUE CROSS ANTHEM,COMMERCIAL,69.02,80,,,OTHER,0.23,84.55,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J3490,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,BLUE CROSS ANTHEM,COMMERCIAL,69.02,80,,,OTHER,64.71,84.55,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,BLUE CROSS ANTHEM,COMMERCIAL,3045.54,80,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,BLUE CROSS ANTHEM,COMMERCIAL,3045.54,80,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,2514950,CDM,636,RC,,BOTH,1,ME,3806.92,1522.77,BLUE CROSS ANTHEM,COMMERCIAL,3045.54,80,,,OTHER,2855.19,3730.78,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G VIAL,J2185,HCPCS,636,RC,,BOTH,1,GR,135.9,54.36,BLUE CROSS ANTHEM,COMMERCIAL,108.72,80,,,OTHER,101.93,133.18,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,BLUE CROSS ANTHEM,COMMERCIAL,1118.65,80,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,BLUE CROSS ANTHEM,COMMERCIAL,1118.65,80,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
NITROGLYCERIN 50 MG/D5W100,J2305,HCPCS,636,RC,,BOTH,50,ME,126.32,50.53,BLUE CROSS ANTHEM,COMMERCIAL,101.06,80,,,OTHER,1.51,123.8,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,BLUE CROSS ANTHEM,COMMERCIAL,195.19,80,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,BLUE CROSS ANTHEM,COMMERCIAL,195.19,80,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,2504240,CDM,636,RC,,BOTH,100,ME,243.99,97.59,BLUE CROSS ANTHEM,COMMERCIAL,195.19,80,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1642,HCPCS,636,RC,,BOTH,10,UN,51.53,20.61,BLUE CROSS ANTHEM,COMMERCIAL,41.22,80,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1644,HCPCS,636,RC,,BOTH,1000,UN,51.53,20.61,BLUE CROSS ANTHEM,COMMERCIAL,41.22,80,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,BLUE CROSS ANTHEM,COMMERCIAL,906.41,80,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,BLUE CROSS ANTHEM,COMMERCIAL,906.41,80,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,BLUE CROSS ANTHEM,COMMERCIAL,34.97,80,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,BLUE CROSS ANTHEM,COMMERCIAL,34.97,80,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,BLUE CROSS ANTHEM,COMMERCIAL,1046.69,80,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,BLUE CROSS ANTHEM,COMMERCIAL,1046.69,80,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,2503770,CDM,636,RC,,BOTH,2,ML,1308.36,523.34,BLUE CROSS ANTHEM,COMMERCIAL,1046.69,80,,,OTHER,981.27,1282.19,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,BLUE CROSS ANTHEM,COMMERCIAL,1596.04,80,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,BLUE CROSS ANTHEM,COMMERCIAL,1596.04,80,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,BLUE CROSS ANTHEM,COMMERCIAL,1434.8,80,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,BLUE CROSS ANTHEM,COMMERCIAL,1434.8,80,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,BLUE CROSS ANTHEM,COMMERCIAL,146.27,80,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,BLUE CROSS ANTHEM,COMMERCIAL,146.27,80,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,2507600,CDM,636,RC,,BOTH,500,ME,182.84,73.13,BLUE CROSS ANTHEM,COMMERCIAL,146.27,80,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,BLUE CROSS ANTHEM,COMMERCIAL,69.28,80,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,BLUE CROSS ANTHEM,COMMERCIAL,69.28,80,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,BLUE CROSS ANTHEM,COMMERCIAL,217.39,80,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,BLUE CROSS ANTHEM,COMMERCIAL,217.39,80,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,2514600,CDM,636,RC,,BOTH,2,GR,271.74,108.69,BLUE CROSS ANTHEM,COMMERCIAL,217.39,80,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,BLUE CROSS ANTHEM,COMMERCIAL,37.58,80,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,BLUE CROSS ANTHEM,COMMERCIAL,37.58,80,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,BLUE CROSS ANTHEM,COMMERCIAL,1156.91,80,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,BLUE CROSS ANTHEM,COMMERCIAL,1156.91,80,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,BLUE CROSS ANTHEM,COMMERCIAL,70.29,80,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,BLUE CROSS ANTHEM,COMMERCIAL,70.29,80,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,BLUE CROSS ANTHEM,COMMERCIAL,1185.45,80,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,BLUE CROSS ANTHEM,COMMERCIAL,1185.45,80,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,BLUE CROSS ANTHEM,COMMERCIAL,18.18,80,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,BLUE CROSS ANTHEM,COMMERCIAL,18.18,80,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,2505100,CDM,636,RC,,BOTH,10,ME,22.73,9.09,BLUE CROSS ANTHEM,COMMERCIAL,18.18,80,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,BLUE CROSS ANTHEM,COMMERCIAL,101.48,80,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,BLUE CROSS ANTHEM,COMMERCIAL,101.48,80,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,BLUE CROSS ANTHEM,COMMERCIAL,923.15,80,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,BLUE CROSS ANTHEM,COMMERCIAL,923.15,80,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,BLUE CROSS ANTHEM,COMMERCIAL,519.85,80,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,BLUE CROSS ANTHEM,COMMERCIAL,519.85,80,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,2500420,CDM,636,RC,,BOTH,0.05,ML,649.81,259.92,BLUE CROSS ANTHEM,COMMERCIAL,519.85,80,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J1836,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,BLUE CROSS ANTHEM,COMMERCIAL,55.11,80,,,OTHER,0.03,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,BLUE CROSS ANTHEM,COMMERCIAL,8.4,80,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,BLUE CROSS ANTHEM,COMMERCIAL,8.4,80,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J3490,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,BLUE CROSS ANTHEM,COMMERCIAL,55.11,80,,,OTHER,51.66,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,BLUE CROSS ANTHEM,COMMERCIAL,8.4,80,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,BLUE CROSS ANTHEM,COMMERCIAL,35.55,80,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,BLUE CROSS ANTHEM,COMMERCIAL,35.55,80,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,2506180,CDM,636,RC,,BOTH,10,ME,44.44,17.78,BLUE CROSS ANTHEM,COMMERCIAL,35.55,80,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 100 MG SYRINGE,J2001,HCPCS,636,RC,,BOTH,100,ME,56.99,22.8,BLUE CROSS ANTHEM,COMMERCIAL,45.59,80,,,OTHER,42.74,55.85,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0136,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,BLUE CROSS ANTHEM,COMMERCIAL,157.03,80,,,OTHER,0.05,192.36,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0131,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,BLUE CROSS ANTHEM,COMMERCIAL,157.03,80,,,OTHER,147.21,192.36,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,BLUE CROSS ANTHEM,COMMERCIAL,5430.48,80,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,BLUE CROSS ANTHEM,COMMERCIAL,5430.48,80,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PENICILL G BENZ 1.2MMU SYR,J0561,HCPCS,636,RC,,BOTH,,,527.8,211.12,BLUE CROSS ANTHEM,COMMERCIAL,422.24,80,,,OTHER,23.1,517.24,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,BLUE CROSS ANTHEM,COMMERCIAL,3808.05,80,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,BLUE CROSS ANTHEM,COMMERCIAL,3808.05,80,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,BLUE CROSS ANTHEM,COMMERCIAL,1609.8,80,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,BLUE CROSS ANTHEM,COMMERCIAL,1609.8,80,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,BLUE CROSS ANTHEM,COMMERCIAL,1082.48,80,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,BLUE CROSS ANTHEM,COMMERCIAL,1082.48,80,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,BLUE CROSS ANTHEM,COMMERCIAL,407.92,80,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,BLUE CROSS ANTHEM,COMMERCIAL,407.92,80,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,BLUE CROSS ANTHEM,COMMERCIAL,2836.28,80,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,BLUE CROSS ANTHEM,COMMERCIAL,2836.28,80,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 4%PF,J2001,HCPCS,636,RC,,BOTH,10,ME,49.11,19.64,BLUE CROSS ANTHEM,COMMERCIAL,39.28,80,,,OTHER,36.83,48.12,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 2% 10ML AMP,J2001,HCPCS,636,RC,,BOTH,10,ME,50.69,20.28,BLUE CROSS ANTHEM,COMMERCIAL,40.55,80,,,OTHER,38.02,49.68,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,BLUE CROSS ANTHEM,COMMERCIAL,1269.71,80,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,BLUE CROSS ANTHEM,COMMERCIAL,1269.71,80,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J2598,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,BLUE CROSS ANTHEM,COMMERCIAL,438.69,80,,,OTHER,1.97,537.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J3490,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,BLUE CROSS ANTHEM,COMMERCIAL,438.69,80,,,OTHER,411.27,537.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,BLUE CROSS ANTHEM,COMMERCIAL,2550.04,80,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,BLUE CROSS ANTHEM,COMMERCIAL,2550.04,80,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J2704,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,BLUE CROSS ANTHEM,COMMERCIAL,47.22,80,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,BLUE CROSS ANTHEM,COMMERCIAL,47.22,80,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE O.5% 30ML SD,J2001,HCPCS,636,RC,,BOTH,30,ML,70.78,28.31,BLUE CROSS ANTHEM,COMMERCIAL,56.62,80,,,OTHER,53.09,69.36,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,BLUE CROSS ANTHEM,COMMERCIAL,2078.98,80,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,BLUE CROSS ANTHEM,COMMERCIAL,2078.98,80,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 25000U BAG,J1644,HCPCS,636,RC,,BOTH,25000,UN,106.82,42.73,BLUE CROSS ANTHEM,COMMERCIAL,85.45,80,,,OTHER,80.11,104.68,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,BLUE CROSS ANTHEM,COMMERCIAL,723.46,80,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,BLUE CROSS ANTHEM,COMMERCIAL,723.46,80,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,BLUE CROSS ANTHEM,COMMERCIAL,723.46,80,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,BLUE CROSS ANTHEM,COMMERCIAL,723.46,80,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,BLUE CROSS ANTHEM,COMMERCIAL,6031.65,80,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,BLUE CROSS ANTHEM,COMMERCIAL,6031.65,80,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,BLUE CROSS ANTHEM,COMMERCIAL,8332.6,80,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,BLUE CROSS ANTHEM,COMMERCIAL,8332.6,80,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 30ML VIAL  SD,J2001,HCPCS,636,RC,,BOTH,30,ML,50.36,20.14,BLUE CROSS ANTHEM,COMMERCIAL,40.29,80,,,OTHER,37.77,49.35,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,BLUE CROSS ANTHEM,COMMERCIAL,11087.94,80,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,BLUE CROSS ANTHEM,COMMERCIAL,11087.94,80,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,BLUE CROSS ANTHEM,COMMERCIAL,1923.55,80,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,BLUE CROSS ANTHEM,COMMERCIAL,1923.55,80,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,BLUE CROSS ANTHEM,COMMERCIAL,4310.22,80,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,BLUE CROSS ANTHEM,COMMERCIAL,4310.22,80,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,2511210,CDM,636,RC,,BOTH,3.5,ME,5387.78,2155.11,BLUE CROSS ANTHEM,COMMERCIAL,4310.22,80,,,OTHER,4040.84,5280.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,BLUE CROSS ANTHEM,COMMERCIAL,6997.26,80,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,BLUE CROSS ANTHEM,COMMERCIAL,6997.26,80,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,BLUE CROSS ANTHEM,COMMERCIAL,13051.69,80,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,BLUE CROSS ANTHEM,COMMERCIAL,13051.69,80,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,2514290,CDM,636,RC,,BOTH,400,ME,16314.61,6525.84,BLUE CROSS ANTHEM,COMMERCIAL,13051.69,80,,,OTHER,12235.96,15988.32,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,2509810,CDM,636,RC,,BOTH,4,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MAG SULF/WATER,J3475,HCPCS,636,RC,,BOTH,500,ME,473.17,189.27,BLUE CROSS ANTHEM,COMMERCIAL,378.53,80,,,OTHER,354.87,463.7,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,BLUE CROSS ANTHEM,COMMERCIAL,18730.87,80,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,BLUE CROSS ANTHEM,COMMERCIAL,18730.87,80,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,BLUE CROSS ANTHEM,COMMERCIAL,780.05,80,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,BLUE CROSS ANTHEM,COMMERCIAL,780.05,80,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,BLUE CROSS ANTHEM,COMMERCIAL,2712.84,80,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,C9476,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,BLUE CROSS ANTHEM,COMMERCIAL,3991.98,80,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,BLUE CROSS ANTHEM,COMMERCIAL,6426.13,80,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,BLUE CROSS ANTHEM,COMMERCIAL,6426.13,80,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,BLUE CROSS ANTHEM,COMMERCIAL,3794.22,80,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,BLUE CROSS ANTHEM,COMMERCIAL,3794.22,80,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,BLUE CROSS ANTHEM,COMMERCIAL,430.02,80,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,BLUE CROSS ANTHEM,COMMERCIAL,430.02,80,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,BLUE CROSS ANTHEM,COMMERCIAL,3769.18,80,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,BLUE CROSS ANTHEM,COMMERCIAL,3769.18,80,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,BLUE CROSS ANTHEM,COMMERCIAL,8137.54,80,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,BLUE CROSS ANTHEM,COMMERCIAL,8137.54,80,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,2506310,CDM,636,RC,,BOTH,50,ME,10171.93,4068.77,BLUE CROSS ANTHEM,COMMERCIAL,8137.54,80,,,OTHER,7628.95,9968.49,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,BLUE CROSS ANTHEM,COMMERCIAL,1386.09,80,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,BLUE CROSS ANTHEM,COMMERCIAL,1386.09,80,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514790,CDM,636,RC,,BOTH,10,ME,1732.61,693.04,BLUE CROSS ANTHEM,COMMERCIAL,1386.09,80,,,OTHER,1299.46,1697.96,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,BLUE CROSS ANTHEM,COMMERCIAL,7279.71,80,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,BLUE CROSS ANTHEM,COMMERCIAL,7279.71,80,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,2513220,CDM,636,RC,,BOTH,1,ME,250,100,BLUE CROSS ANTHEM,COMMERCIAL,200,80,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,BLUE CROSS ANTHEM,COMMERCIAL,6079.4,80,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,BLUE CROSS ANTHEM,COMMERCIAL,6079.4,80,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM 500MG/5ML VIAL,J1953,HCPCS,636,RC,,BOTH,500,ME,35.72,14.29,BLUE CROSS ANTHEM,COMMERCIAL,28.58,80,,,OTHER,26.79,35.01,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,BLUE CROSS ANTHEM,COMMERCIAL,40.2,80,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,BLUE CROSS ANTHEM,COMMERCIAL,40.2,80,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0690,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,BLUE CROSS ANTHEM,COMMERCIAL,40.2,80,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,BLUE CROSS ANTHEM,COMMERCIAL,40.2,80,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,BLUE CROSS ANTHEM,COMMERCIAL,67.1,80,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,BLUE CROSS ANTHEM,COMMERCIAL,67.1,80,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,BLUE CROSS ANTHEM,COMMERCIAL,67.1,80,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,BLUE CROSS ANTHEM,COMMERCIAL,67.1,80,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,2514960,CDM,636,RC,,BOTH,50,ML,83.87,33.55,BLUE CROSS ANTHEM,COMMERCIAL,67.1,80,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) 75/25 PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,87.37,34.95,BLUE CROSS ANTHEM,COMMERCIAL,69.9,80,,,OTHER,65.53,85.62,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALIN N) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,134.82,53.93,BLUE CROSS ANTHEM,COMMERCIAL,107.86,80,,,OTHER,101.12,132.12,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,BLUE CROSS ANTHEM,COMMERCIAL,15636.84,80,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,BLUE CROSS ANTHEM,COMMERCIAL,15636.84,80,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,BLUE CROSS ANTHEM,COMMERCIAL,15636.84,80,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,BLUE CROSS ANTHEM,COMMERCIAL,15636.84,80,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,BLUE CROSS ANTHEM,COMMERCIAL,5939.48,80,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,BLUE CROSS ANTHEM,COMMERCIAL,5939.48,80,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,2510900,CDM,636,RC,,BOTH,60,ME,7424.35,2969.74,BLUE CROSS ANTHEM,COMMERCIAL,5939.48,80,,,OTHER,5568.26,7275.86,PERCENT OF TOTAL BILLED CHARGES
INSULIN (LANTUS SOLOSTAR) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,240.94,96.38,BLUE CROSS ANTHEM,COMMERCIAL,192.75,80,,,OTHER,180.71,236.12,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,BLUE CROSS ANTHEM,COMMERCIAL,2168.4,80,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,BLUE CROSS ANTHEM,COMMERCIAL,2168.4,80,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,BLUE CROSS ANTHEM,COMMERCIAL,2168.4,80,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,BLUE CROSS ANTHEM,COMMERCIAL,2168.4,80,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,BLUE CROSS ANTHEM,COMMERCIAL,2168.4,80,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,303.8,121.52,BLUE CROSS ANTHEM,COMMERCIAL,243.04,80,,,OTHER,227.85,297.72,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,BLUE CROSS ANTHEM,COMMERCIAL,1697.79,80,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,BLUE CROSS ANTHEM,COMMERCIAL,1697.79,80,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,2514210,CDM,636,RC,,BOTH,15,ME,2122.24,848.9,BLUE CROSS ANTHEM,COMMERCIAL,1697.79,80,,,OTHER,1591.68,2079.8,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,BLUE CROSS ANTHEM,COMMERCIAL,5577.04,80,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,BLUE CROSS ANTHEM,COMMERCIAL,5577.04,80,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,BLUE CROSS ANTHEM,COMMERCIAL,705.86,80,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,BLUE CROSS ANTHEM,COMMERCIAL,705.86,80,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,BLUE CROSS ANTHEM,COMMERCIAL,109.09,80,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,BLUE CROSS ANTHEM,COMMERCIAL,109.09,80,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,BLUE CROSS ANTHEM,COMMERCIAL,109.09,80,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,BLUE CROSS ANTHEM,COMMERCIAL,109.09,80,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,2514590,CDM,636,RC,,BOTH,80,ME,136.36,54.55,BLUE CROSS ANTHEM,COMMERCIAL,109.09,80,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,BLUE CROSS ANTHEM,COMMERCIAL,854.57,80,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,BLUE CROSS ANTHEM,COMMERCIAL,854.57,80,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2511990,CDM,636,RC,,BOTH,1,ME,1068.21,427.28,BLUE CROSS ANTHEM,COMMERCIAL,854.57,80,,,OTHER,801.16,1046.85,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,2501680,CDM,636,RC,,BOTH,1,ME,70.21,28.08,BLUE CROSS ANTHEM,COMMERCIAL,56.17,80,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,BLUE CROSS ANTHEM,COMMERCIAL,56.17,80,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,BLUE CROSS ANTHEM,COMMERCIAL,56.17,80,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,BLUE CROSS ANTHEM,COMMERCIAL,6599.46,80,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,BLUE CROSS ANTHEM,COMMERCIAL,6599.46,80,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,BLUE CROSS ANTHEM,COMMERCIAL,14674.89,80,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,BLUE CROSS ANTHEM,COMMERCIAL,14674.89,80,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,BLUE CROSS ANTHEM,COMMERCIAL,2876.68,80,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,BLUE CROSS ANTHEM,COMMERCIAL,2876.68,80,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,BLUE CROSS ANTHEM,COMMERCIAL,27966.19,80,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,BLUE CROSS ANTHEM,COMMERCIAL,27966.19,80,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,BLUE CROSS ANTHEM,COMMERCIAL,20106.41,80,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,BLUE CROSS ANTHEM,COMMERCIAL,20106.41,80,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,2500530,CDM,636,RC,,BOTH,100,ME,25133.01,10053.2,BLUE CROSS ANTHEM,COMMERCIAL,20106.41,80,,,OTHER,18849.76,24630.35,PERCENT OF TOTAL BILLED CHARGES
ONABOTULINUMTOXINA (BOTOX),J0585,HCPCS,636,RC,,BOTH,1,UN,1172.09,468.84,BLUE CROSS ANTHEM,COMMERCIAL,937.67,80,,,OTHER,6.64,1148.65,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,BLUE CROSS ANTHEM,COMMERCIAL,1602.22,80,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,BLUE CROSS ANTHEM,COMMERCIAL,1602.22,80,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,2511840,CDM,636,RC,,BOTH,1,ME,2002.77,801.11,BLUE CROSS ANTHEM,COMMERCIAL,1602.22,80,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,BLUE CROSS ANTHEM,COMMERCIAL,11762.62,80,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,BLUE CROSS ANTHEM,COMMERCIAL,11762.62,80,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,BLUE CROSS ANTHEM,COMMERCIAL,4789.87,80,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,BLUE CROSS ANTHEM,COMMERCIAL,4789.87,80,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,BLUE CROSS ANTHEM,COMMERCIAL,4.65,80,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,BLUE CROSS ANTHEM,COMMERCIAL,4.65,80,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,2513120,CDM,636,RC,,BOTH,0.5,ME,5.81,2.33,BLUE CROSS ANTHEM,COMMERCIAL,4.65,80,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,BLUE CROSS ANTHEM,COMMERCIAL,55.95,80,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,BLUE CROSS ANTHEM,COMMERCIAL,55.95,80,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,2505020,CDM,636,RC,,BOTH,0.1,ME,69.94,27.98,BLUE CROSS ANTHEM,COMMERCIAL,55.95,80,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,BLUE CROSS ANTHEM,COMMERCIAL,6849.96,80,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,BLUE CROSS ANTHEM,COMMERCIAL,3640.94,80,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,BLUE CROSS ANTHEM,COMMERCIAL,3640.94,80,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,2512870,CDM,636,RC,,BOTH,1,ME,4551.17,1820.47,BLUE CROSS ANTHEM,COMMERCIAL,3640.94,80,,,OTHER,3413.38,4460.15,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,BLUE CROSS ANTHEM,COMMERCIAL,912.9,80,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,BLUE CROSS ANTHEM,COMMERCIAL,912.9,80,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,J2182,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,BLUE CROSS ANTHEM,COMMERCIAL,5022.21,80,,,OTHER,32,6152.2,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,C9473,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,BLUE CROSS ANTHEM,COMMERCIAL,5022.21,80,,,OTHER,4708.32,6152.2,PERCENT OF TOTAL BILLED CHARGES
PEMBROLIZUMAB 100MG/4ML,J9271,HCPCS,636,RC,,BOTH,4,ML,9937.15,3974.86,BLUE CROSS ANTHEM,COMMERCIAL,7949.72,80,,,OTHER,60.18,9738.4,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,BLUE CROSS ANTHEM,COMMERCIAL,76.63,80,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,BLUE CROSS ANTHEM,COMMERCIAL,76.63,80,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,2504150,CDM,636,RC,,BOTH,20,ML,95.78,38.31,BLUE CROSS ANTHEM,COMMERCIAL,76.63,80,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J2704,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,BLUE CROSS ANTHEM,COMMERCIAL,123.76,80,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J3490,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,BLUE CROSS ANTHEM,COMMERCIAL,123.76,80,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,BLUE CROSS ANTHEM,COMMERCIAL,2541.63,80,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,BLUE CROSS ANTHEM,COMMERCIAL,15203.53,80,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,BLUE CROSS ANTHEM,COMMERCIAL,11967.23,80,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,BLUE CROSS ANTHEM,COMMERCIAL,11967.23,80,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1930,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,BLUE CROSS ANTHEM,COMMERCIAL,11967.23,80,,,OTHER,50.4,14659.86,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,BLUE CROSS ANTHEM,COMMERCIAL,4253.31,80,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,BLUE CROSS ANTHEM,COMMERCIAL,4253.31,80,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,2514240,CDM,636,RC,,BOTH,120,ME,5316.64,2126.66,BLUE CROSS ANTHEM,COMMERCIAL,4253.31,80,,,OTHER,3987.48,5210.31,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,BLUE CROSS ANTHEM,COMMERCIAL,454.05,80,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,BLUE CROSS ANTHEM,COMMERCIAL,454.05,80,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,BLUE CROSS ANTHEM,COMMERCIAL,27389.86,80,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,BLUE CROSS ANTHEM,COMMERCIAL,27389.86,80,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,BLUE CROSS ANTHEM,COMMERCIAL,40.68,80,,,OTHER,0.02,49.83,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,BLUE CROSS ANTHEM,COMMERCIAL,40.68,80,,,OTHER,38.14,49.83,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,BLUE CROSS ANTHEM,COMMERCIAL,144.78,80,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,BLUE CROSS ANTHEM,COMMERCIAL,144.78,80,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,2515510,CDM,636,RC,,BOTH,1,ME,180.98,72.39,BLUE CROSS ANTHEM,COMMERCIAL,144.78,80,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,BLUE CROSS ANTHEM,COMMERCIAL,13606.54,80,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,BLUE CROSS ANTHEM,COMMERCIAL,13606.54,80,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1G BAG,J2001,HCPCS,636,RC,,BOTH,1,GR,104.73,41.89,BLUE CROSS ANTHEM,COMMERCIAL,83.78,80,,,OTHER,78.55,102.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,BLUE CROSS ANTHEM,COMMERCIAL,2032.76,80,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,BLUE CROSS ANTHEM,COMMERCIAL,2032.76,80,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,BLUE CROSS ANTHEM,COMMERCIAL,1963.42,80,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,BLUE CROSS ANTHEM,COMMERCIAL,1963.42,80,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512020,CDM,636,RC,,BOTH,1,ME,2454.27,981.71,BLUE CROSS ANTHEM,COMMERCIAL,1963.42,80,,,OTHER,1840.7,2405.18,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,BLUE CROSS ANTHEM,COMMERCIAL,2367.24,80,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,BLUE CROSS ANTHEM,COMMERCIAL,2367.24,80,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,2504290,CDM,636,RC,,BOTH,,,2959.05,1183.62,BLUE CROSS ANTHEM,COMMERCIAL,2367.24,80,,,OTHER,2219.29,2899.87,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,BLUE CROSS ANTHEM,COMMERCIAL,148.24,80,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,BLUE CROSS ANTHEM,COMMERCIAL,148.24,80,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,2501950,CDM,636,RC,,BOTH,100,ME,185.29,74.12,BLUE CROSS ANTHEM,COMMERCIAL,148.24,80,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,BLUE CROSS ANTHEM,COMMERCIAL,3640.96,80,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,BLUE CROSS ANTHEM,COMMERCIAL,3640.96,80,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,BLUE CROSS ANTHEM,COMMERCIAL,3640.96,80,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,BLUE CROSS ANTHEM,COMMERCIAL,3640.96,80,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,BLUE CROSS ANTHEM,COMMERCIAL,6316.63,80,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,BLUE CROSS ANTHEM,COMMERCIAL,6316.63,80,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,BLUE CROSS ANTHEM,COMMERCIAL,1657.12,80,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,BLUE CROSS ANTHEM,COMMERCIAL,1657.12,80,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,BLUE CROSS ANTHEM,COMMERCIAL,739.88,80,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,BLUE CROSS ANTHEM,COMMERCIAL,739.88,80,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,BLUE CROSS ANTHEM,COMMERCIAL,5736.82,80,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,BLUE CROSS ANTHEM,COMMERCIAL,5736.82,80,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,BLUE CROSS ANTHEM,COMMERCIAL,37.62,80,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,BLUE CROSS ANTHEM,COMMERCIAL,37.62,80,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,BLUE CROSS ANTHEM,COMMERCIAL,3244.03,80,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,BLUE CROSS ANTHEM,COMMERCIAL,3244.03,80,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,2510300,CDM,636,RC,,BOTH,,,4055.04,1622.02,BLUE CROSS ANTHEM,COMMERCIAL,3244.03,80,,,OTHER,3041.28,3973.94,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,BLUE CROSS ANTHEM,COMMERCIAL,14305.35,80,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,BLUE CROSS ANTHEM,COMMERCIAL,14305.35,80,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,BLUE CROSS ANTHEM,COMMERCIAL,14305.35,80,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,BLUE CROSS ANTHEM,COMMERCIAL,14305.35,80,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,J2350,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,BLUE CROSS ANTHEM,COMMERCIAL,27607.09,80,,,OTHER,61.7,33818.69,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,C9494,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,BLUE CROSS ANTHEM,COMMERCIAL,27607.09,80,,,OTHER,25881.65,33818.69,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,BLUE CROSS ANTHEM,COMMERCIAL,613.54,80,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,BLUE CROSS ANTHEM,COMMERCIAL,613.54,80,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,BLUE CROSS ANTHEM,COMMERCIAL,10490.46,80,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,BLUE CROSS ANTHEM,COMMERCIAL,10490.46,80,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,BLUE CROSS ANTHEM,COMMERCIAL,23701.42,80,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,BLUE CROSS ANTHEM,COMMERCIAL,23701.42,80,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,BLUE CROSS ANTHEM,COMMERCIAL,23701.42,80,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,BLUE CROSS ANTHEM,COMMERCIAL,23701.42,80,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,BLUE CROSS ANTHEM,COMMERCIAL,3887.84,80,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,BLUE CROSS ANTHEM,COMMERCIAL,3887.84,80,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512030,CDM,636,RC,,BOTH,1,ME,4859.8,1943.92,BLUE CROSS ANTHEM,COMMERCIAL,3887.84,80,,,OTHER,3644.85,4762.61,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,BLUE CROSS ANTHEM,COMMERCIAL,14264.87,80,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,BLUE CROSS ANTHEM,COMMERCIAL,14264.87,80,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,2504050,CDM,636,RC,,BOTH,30,ML,17831.08,7132.43,BLUE CROSS ANTHEM,COMMERCIAL,14264.87,80,,,OTHER,13373.31,17474.46,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,BLUE CROSS ANTHEM,COMMERCIAL,758.94,80,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,BLUE CROSS ANTHEM,COMMERCIAL,758.94,80,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J2724,HCPCS,636,RC,,BOTH,,,2217.07,886.83,BLUE CROSS ANTHEM,COMMERCIAL,1773.66,80,,,OTHER,15.78,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,BLUE CROSS ANTHEM,COMMERCIAL,1773.66,80,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,BLUE CROSS ANTHEM,COMMERCIAL,1773.66,80,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,C9132,HCPCS,636,RC,,BOTH,,,2217.07,886.83,BLUE CROSS ANTHEM,COMMERCIAL,1773.66,80,,,OTHER,1662.8,2172.73,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,BLUE CROSS ANTHEM,COMMERCIAL,5383.98,80,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,BLUE CROSS ANTHEM,COMMERCIAL,5383.98,80,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,2512120,CDM,636,RC,,BOTH,500,ML,6729.98,2691.99,BLUE CROSS ANTHEM,COMMERCIAL,5383.98,80,,,OTHER,5047.49,6595.38,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,BLUE CROSS ANTHEM,COMMERCIAL,595.03,80,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,BLUE CROSS ANTHEM,COMMERCIAL,595.03,80,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,2510490,CDM,636,RC,,BOTH,500,ME,743.79,297.51,BLUE CROSS ANTHEM,COMMERCIAL,595.03,80,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,BLUE CROSS ANTHEM,COMMERCIAL,1541.6,80,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,BLUE CROSS ANTHEM,COMMERCIAL,1541.6,80,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,BLUE CROSS ANTHEM,COMMERCIAL,1547.3,80,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,BLUE CROSS ANTHEM,COMMERCIAL,1547.3,80,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,2517300,CDM,636,RC,,BOTH,750,ME,1934.12,773.65,BLUE CROSS ANTHEM,COMMERCIAL,1547.3,80,,,OTHER,1450.59,1895.44,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,2519870,CDM,636,RC,,BOTH,,,10377.46,4150.98,BLUE CROSS ANTHEM,COMMERCIAL,8301.97,80,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,C9159,HCPCS,636,RC,,BOTH,,,10377.46,4150.98,BLUE CROSS ANTHEM,COMMERCIAL,8301.97,80,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J2724,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,BLUE CROSS ANTHEM,COMMERCIAL,5865.71,80,,,OTHER,15.78,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,BLUE CROSS ANTHEM,COMMERCIAL,5865.71,80,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,BLUE CROSS ANTHEM,COMMERCIAL,5865.71,80,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,C9132,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,BLUE CROSS ANTHEM,COMMERCIAL,5865.71,80,,,OTHER,5499.1,7185.5,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,BLUE CROSS ANTHEM,COMMERCIAL,117.58,80,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,BLUE CROSS ANTHEM,COMMERCIAL,117.58,80,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
PNEUMOCOCCAL VACCINE 0.5ML,2518440,CDM,636,RC,,BOTH,0.5,ML,295.08,118.03,BLUE CROSS ANTHEM,COMMERCIAL,236.06,80,,,OTHER,221.31,289.18,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,2511640,CDM,636,RC,,BOTH,,,146.98,58.79,BLUE CROSS ANTHEM,COMMERCIAL,117.58,80,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,BLUE CROSS ANTHEM,COMMERCIAL,970.46,80,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,BLUE CROSS ANTHEM,COMMERCIAL,970.46,80,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
FLU VACCINE HIGH DOSE,2514130,CDM,636,RC,,BOTH,,,179.64,71.86,BLUE CROSS ANTHEM,COMMERCIAL,143.71,80,,,OTHER,134.73,176.05,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,Q2036,HCPCS,636,RC,,BOTH,,,64.97,25.99,BLUE CROSS ANTHEM,COMMERCIAL,51.97,80,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,2511440,CDM,636,RC,,BOTH,,,64.97,25.99,BLUE CROSS ANTHEM,COMMERCIAL,51.97,80,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,BLUE CROSS ANTHEM,COMMERCIAL,31.42,80,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,BLUE CROSS ANTHEM,COMMERCIAL,31.42,80,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,2510770,CDM,250,RC,,BOTH,,,39.27,15.71,BLUE CROSS ANTHEM,COMMERCIAL,31.42,80,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
METHYLNALTREXONE BROMIDE,J2212,HCPCS,636,RC,,BOTH,0.1,ME,347.96,139.18,BLUE CROSS ANTHEM,COMMERCIAL,278.37,80,,,OTHER,1.21,341,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,BLUE CROSS ANTHEM,COMMERCIAL,52.85,80,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,BLUE CROSS ANTHEM,COMMERCIAL,52.85,80,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,BLUE CROSS ANTHEM,COMMERCIAL,54.54,80,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,BLUE CROSS ANTHEM,COMMERCIAL,54.54,80,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
RABIES IMM GLOB 1500U/ML 5ML,2515770,CDM,636,RC,,BOTH,5,ML,5629.18,2251.67,BLUE CROSS ANTHEM,COMMERCIAL,4503.34,80,,,OTHER,299.93,5516.59,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,BLUE CROSS ANTHEM,COMMERCIAL,12.43,80,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,BLUE CROSS ANTHEM,COMMERCIAL,12.43,80,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,2518680,CDM,636,RC,,BOTH,0.5,ML,110.93,44.37,BLUE CROSS ANTHEM,COMMERCIAL,88.74,80,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,BLUE CROSS ANTHEM,COMMERCIAL,88.74,80,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,BLUE CROSS ANTHEM,COMMERCIAL,88.74,80,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,BLUE CROSS ANTHEM,COMMERCIAL,17.55,80,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,BLUE CROSS ANTHEM,COMMERCIAL,17.55,80,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
RABIES VACCINE,2520290,CDM,636,RC,,BOTH,,,870.92,348.37,BLUE CROSS ANTHEM,COMMERCIAL,696.74,80,,,OTHER,338.91,853.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,BLUE CROSS ANTHEM,COMMERCIAL,17.26,80,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,BLUE CROSS ANTHEM,COMMERCIAL,17.26,80,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,60,80,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,BLUE CROSS ANTHEM,COMMERCIAL,60,80,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,24.4,80,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,BLUE CROSS ANTHEM,COMMERCIAL,24.4,80,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,BLUE CROSS ANTHEM,COMMERCIAL,44.99,80,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,BLUE CROSS ANTHEM,COMMERCIAL,44.99,80,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
HALOPERIDOL 5 MG/ML AMP,J1630,HCPCS,636,RC,,BOTH,5,ME,88.26,35.3,BLUE CROSS ANTHEM,COMMERCIAL,70.6,80,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,BLUE CROSS ANTHEM,COMMERCIAL,47.22,80,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,BLUE CROSS ANTHEM,COMMERCIAL,47.22,80,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,BLUE CROSS ANTHEM,COMMERCIAL,4.89,80,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,BLUE CROSS ANTHEM,COMMERCIAL,4.89,80,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,2519130,CDM,636,RC,,BOTH,3,ME,6.12,2.45,BLUE CROSS ANTHEM,COMMERCIAL,4.89,80,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,BLUE CROSS ANTHEM,COMMERCIAL,251.35,80,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,BLUE CROSS ANTHEM,COMMERCIAL,251.35,80,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,BLUE CROSS ANTHEM,COMMERCIAL,251.35,80,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,BLUE CROSS ANTHEM,COMMERCIAL,251.35,80,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
LR 1000 ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,90.88,36.35,MONUMENT,COMMERCIAL,68.16,75,,,OTHER,68.16,89.07,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,MONUMENT,COMMERCIAL,65.77,75,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,MONUMENT,COMMERCIAL,65.77,75,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,MONUMENT,COMMERCIAL,90105.68,75,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,MONUMENT,COMMERCIAL,90105.68,75,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,2516780,CDM,636,RC,,BOTH,,,120140.9,48056.36,MONUMENT,COMMERCIAL,90105.68,75,,,OTHER,90105.68,117738.08,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,MONUMENT,COMMERCIAL,55.5,75,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,MONUMENT,COMMERCIAL,55.5,75,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,MONUMENT,COMMERCIAL,53.19,75,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,MONUMENT,COMMERCIAL,53.19,75,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,MONUMENT,COMMERCIAL,58.58,75,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,MONUMENT,COMMERCIAL,58.58,75,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS KCL 20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,98.13,39.25,MONUMENT,COMMERCIAL,73.6,75,,,OTHER,73.6,96.17,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,MONUMENT,COMMERCIAL,61.27,75,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,MONUMENT,COMMERCIAL,61.27,75,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,MONUMENT,COMMERCIAL,2.08,75,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,MONUMENT,COMMERCIAL,2.08,75,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,MONUMENT,COMMERCIAL,2.24,75,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,MONUMENT,COMMERCIAL,2.24,75,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,2510250,CDM,636,RC,,BOTH,1,ML,2.98,1.19,MONUMENT,COMMERCIAL,2.24,75,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,MONUMENT,COMMERCIAL,48.79,75,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,MONUMENT,COMMERCIAL,48.79,75,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,MONUMENT,COMMERCIAL,15.95,75,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,MONUMENT,COMMERCIAL,15.95,75,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,MONUMENT,COMMERCIAL,49.91,75,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,MONUMENT,COMMERCIAL,49.91,75,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,MONUMENT,COMMERCIAL,39.79,75,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,MONUMENT,COMMERCIAL,39.79,75,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,MONUMENT,COMMERCIAL,6.26,75,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,MONUMENT,COMMERCIAL,6.26,75,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMULIN R) 3 ML VIAL,J1815,HCPCS,636,RC,,BOTH,3,ML,10.78,4.31,MONUMENT,COMMERCIAL,8.09,75,,,OTHER,8.09,10.57,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,66.25,26.5,MONUMENT,COMMERCIAL,49.69,75,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 1MG INJ,J1170,HCPCS,636,RC,,BOTH,1,ME,53.73,21.49,MONUMENT,COMMERCIAL,40.3,75,,,OTHER,40.3,52.66,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.4 MG/ML,J2310,HCPCS,636,RC,,BOTH,0.4,ML,72.54,29.02,MONUMENT,COMMERCIAL,54.4,75,,,OTHER,54.4,71.09,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,MONUMENT,COMMERCIAL,74.61,75,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,MONUMENT,COMMERCIAL,74.61,75,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
NS  100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,63.3,25.32,MONUMENT,COMMERCIAL,47.48,75,,,OTHER,47.48,62.04,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 0.5% 50ML VIAL   MD,J2001,HCPCS,636,RC,,BOTH,50,ML,53.6,21.44,MONUMENT,COMMERCIAL,40.2,75,,,OTHER,40.2,52.53,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,61.36,24.54,MONUMENT,COMMERCIAL,46.02,75,,,OTHER,46.02,60.13,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J7507,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,MONUMENT,COMMERCIAL,2.88,75,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J3490,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,MONUMENT,COMMERCIAL,2.88,75,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,MONUMENT,COMMERCIAL,67.18,75,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,MONUMENT,COMMERCIAL,67.18,75,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7070,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,MONUMENT,COMMERCIAL,67.18,75,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITAL 130MG/ML VIAL,J2560,HCPCS,636,RC,,BOTH,130,ME,190.89,76.36,MONUMENT,COMMERCIAL,143.17,75,,,OTHER,143.17,187.07,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 2 MG SYRINGE,J1170,HCPCS,636,RC,,BOTH,2,ME,57.58,23.03,MONUMENT,COMMERCIAL,43.19,75,,,OTHER,43.19,56.43,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,MONUMENT,COMMERCIAL,70.77,75,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,MONUMENT,COMMERCIAL,70.77,75,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE 25 MG AMP,J2550,HCPCS,636,RC,,BOTH,25,ME,48.33,19.33,MONUMENT,COMMERCIAL,36.25,75,,,OTHER,36.25,47.36,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,MONUMENT,COMMERCIAL,49.1,75,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,MONUMENT,COMMERCIAL,49.1,75,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,2515450,CDM,636,RC,,BOTH,2,GR,115.87,46.35,MONUMENT,COMMERCIAL,86.9,75,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,MONUMENT,COMMERCIAL,745.59,75,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,MONUMENT,COMMERCIAL,745.59,75,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 2.5MG,J8610,HCPCS,636,RC,,BOTH,2.5,ME,25.39,10.16,MONUMENT,COMMERCIAL,19.04,75,,,OTHER,19.04,24.88,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,MONUMENT,COMMERCIAL,745.59,75,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,MONUMENT,COMMERCIAL,16.93,75,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,MONUMENT,COMMERCIAL,16.93,75,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,J3490,HCPCS,636,RC,,BOTH,2,GR,115.87,46.35,MONUMENT,COMMERCIAL,86.9,75,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 1G VIAL,J3490,HCPCS,250,RC,,BOTH,1,GR,131.96,52.78,MONUMENT,COMMERCIAL,98.97,75,,,OTHER,98.97,129.32,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,MONUMENT,COMMERCIAL,49.1,75,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,MONUMENT,COMMERCIAL,49.1,75,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,2508230,CDM,250,RC,,BOTH,1.25,ME,22.57,9.03,MONUMENT,COMMERCIAL,16.93,75,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,MONUMENT,COMMERCIAL,745.59,75,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J1162,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,MONUMENT,COMMERCIAL,6883.56,75,,,OTHER,5016.31,8994.52,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,MONUMENT,COMMERCIAL,33.27,75,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,MONUMENT,COMMERCIAL,33.27,75,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J2150,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,MONUMENT,COMMERCIAL,136.91,75,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,MONUMENT,COMMERCIAL,85.57,75,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,MONUMENT,COMMERCIAL,85.57,75,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J7799,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,MONUMENT,COMMERCIAL,136.91,75,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J3490,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,MONUMENT,COMMERCIAL,6883.56,75,,,OTHER,6883.56,8994.52,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B IMM. GLOBULIN 5 ML,2510180,CDM,636,RC,,BOTH,5,ML,333.07,133.23,MONUMENT,COMMERCIAL,249.81,75,,,OTHER,148.18,326.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,MONUMENT,COMMERCIAL,52.35,75,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,MONUMENT,COMMERCIAL,52.35,75,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,MONUMENT,COMMERCIAL,3535.14,75,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,MONUMENT,COMMERCIAL,3535.14,75,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,MONUMENT,COMMERCIAL,57.86,75,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,MONUMENT,COMMERCIAL,57.86,75,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
ARIPIPRAZOLE 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,67.81,27.12,MONUMENT,COMMERCIAL,50.86,75,,,OTHER,50.86,66.45,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,MONUMENT,COMMERCIAL,50.49,75,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,MONUMENT,COMMERCIAL,50.49,75,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2274,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,MONUMENT,COMMERCIAL,101.24,75,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2270,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,MONUMENT,COMMERCIAL,101.24,75,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
NALBUPHINE 10MG/ML AMP,J2300,HCPCS,636,RC,,BOTH,10,ME,51.33,20.53,MONUMENT,COMMERCIAL,38.5,75,,,OTHER,38.5,50.3,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 2.5MG TAB,2515000,CDM,636,RC,,BOTH,2.5,ME,15.69,6.28,MONUMENT,COMMERCIAL,11.77,75,,,OTHER,11.77,15.37,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 250MG/50ML,J1956,HCPCS,636,RC,,BOTH,50,ML,81.19,32.48,MONUMENT,COMMERCIAL,60.89,75,,,OTHER,60.89,79.57,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,MONUMENT,COMMERCIAL,64.86,75,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,MONUMENT,COMMERCIAL,64.86,75,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,MONUMENT,COMMERCIAL,51.76,75,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,MONUMENT,COMMERCIAL,51.76,75,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,MONUMENT,COMMERCIAL,65.35,75,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,MONUMENT,COMMERCIAL,65.35,75,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE,J3490,HCPCS,250,RC,,BOTH,,,37.19,14.87,MONUMENT,COMMERCIAL,27.89,75,,,OTHER,27.89,36.44,PERCENT OF TOTAL BILLED CHARGES
PROPRANOLOL 1MG AMP,J1800,HCPCS,636,RC,,BOTH,1,ME,82.46,32.98,MONUMENT,COMMERCIAL,61.85,75,,,OTHER,61.85,80.81,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,MONUMENT,COMMERCIAL,30.83,75,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,MONUMENT,COMMERCIAL,30.83,75,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,MONUMENT,COMMERCIAL,51.93,75,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,MONUMENT,COMMERCIAL,51.93,75,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,2504940,CDM,250,RC,,BOTH,50,ME,41.1,16.44,MONUMENT,COMMERCIAL,30.83,75,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,MONUMENT,COMMERCIAL,9.33,75,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,MONUMENT,COMMERCIAL,9.33,75,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,2506040,CDM,250,RC,,BOTH,,,12.43,4.97,MONUMENT,COMMERCIAL,9.33,75,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J0280,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,MONUMENT,COMMERCIAL,17.03,75,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J0694,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,MONUMENT,COMMERCIAL,80.06,75,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,MONUMENT,COMMERCIAL,156.87,75,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,MONUMENT,COMMERCIAL,156.87,75,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,MONUMENT,COMMERCIAL,1311.84,75,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,MONUMENT,COMMERCIAL,1311.84,75,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,MONUMENT,COMMERCIAL,15.7,75,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,MONUMENT,COMMERCIAL,15.7,75,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,MONUMENT,COMMERCIAL,80.06,75,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J3490,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,MONUMENT,COMMERCIAL,17.03,75,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 2G VIAL,J3490,HCPCS,250,RC,,BOTH,2,GR,107.37,42.95,MONUMENT,COMMERCIAL,80.53,75,,,OTHER,80.53,105.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,2504480,CDM,636,RC,,BOTH,7.5,ME,1749.12,699.65,MONUMENT,COMMERCIAL,1311.84,75,,,OTHER,1311.84,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,2508220,CDM,250,RC,,BOTH,0.3,ME,20.93,8.37,MONUMENT,COMMERCIAL,15.7,75,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J7626,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,MONUMENT,COMMERCIAL,29.55,75,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J7674,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,MONUMENT,COMMERCIAL,34.42,75,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J3490,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,MONUMENT,COMMERCIAL,34.42,75,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,MONUMENT,COMMERCIAL,29.55,75,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,MONUMENT,COMMERCIAL,18.22,75,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,MONUMENT,COMMERCIAL,18.22,75,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,2504400,CDM,250,RC,,BOTH,4,GR,24.29,9.72,MONUMENT,COMMERCIAL,18.22,75,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,MONUMENT,COMMERCIAL,16.87,75,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,MONUMENT,COMMERCIAL,16.87,75,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,2502460,CDM,250,RC,,BOTH,,,22.49,9,MONUMENT,COMMERCIAL,16.87,75,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,MONUMENT,COMMERCIAL,62.51,75,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,MONUMENT,COMMERCIAL,62.51,75,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,MONUMENT,COMMERCIAL,94.83,75,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,MONUMENT,COMMERCIAL,94.83,75,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,MONUMENT,COMMERCIAL,94.83,75,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,MONUMENT,COMMERCIAL,94.83,75,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 5MG TAB,2519250,CDM,636,RC,,BOTH,5,ME,14.15,5.66,MONUMENT,COMMERCIAL,10.61,75,,,OTHER,10.61,13.86,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,MONUMENT,COMMERCIAL,132.6,75,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,MONUMENT,COMMERCIAL,132.6,75,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,2505390,CDM,636,RC,,BOTH,0.25,ME,176.81,70.72,MONUMENT,COMMERCIAL,132.6,75,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,MONUMENT,COMMERCIAL,17.48,75,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,MONUMENT,COMMERCIAL,17.48,75,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,MONUMENT,COMMERCIAL,11.99,75,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,MONUMENT,COMMERCIAL,11.99,75,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,2504300,CDM,250,RC,,BOTH,,,23.31,9.32,MONUMENT,COMMERCIAL,17.48,75,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,2504920,CDM,250,RC,,BOTH,,,15.98,6.39,MONUMENT,COMMERCIAL,11.99,75,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,MONUMENT,COMMERCIAL,42.51,75,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,MONUMENT,COMMERCIAL,42.51,75,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,J3490,HCPCS,250,RC,,BOTH,,,126.41,50.56,MONUMENT,COMMERCIAL,94.81,75,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,2515370,CDM,250,RC,,BOTH,,,126.41,50.56,MONUMENT,COMMERCIAL,94.81,75,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 20ML,J2001,HCPCS,636,RC,,BOTH,20,ML,62.37,24.95,MONUMENT,COMMERCIAL,46.78,75,,,OTHER,46.78,61.12,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,MONUMENT,COMMERCIAL,144.47,75,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,MONUMENT,COMMERCIAL,144.47,75,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
METHOCARBAMOL 100MG VIAL,J2800,HCPCS,636,RC,,BOTH,100,ME,204.62,81.85,MONUMENT,COMMERCIAL,153.47,75,,,OTHER,153.47,200.53,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 10 U/ML INJ,J2590,HCPCS,636,RC,,BOTH,10,UN,50.06,20.02,MONUMENT,COMMERCIAL,37.55,75,,,OTHER,37.55,49.06,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,MONUMENT,COMMERCIAL,44.42,75,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,MONUMENT,COMMERCIAL,44.42,75,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,2501130,CDM,636,RC,,BOTH,1.5,GR,59.23,23.69,MONUMENT,COMMERCIAL,44.42,75,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,J3490,HCPCS,250,RC,,BOTH,1000,ME,16.62,6.65,MONUMENT,COMMERCIAL,12.47,75,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,2516900,CDM,250,RC,,BOTH,1000,ME,16.62,6.65,MONUMENT,COMMERCIAL,12.47,75,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,MONUMENT,COMMERCIAL,46.39,75,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,MONUMENT,COMMERCIAL,46.39,75,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,MONUMENT,COMMERCIAL,66.56,75,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,MONUMENT,COMMERCIAL,66.56,75,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2274,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,MONUMENT,COMMERCIAL,39.69,75,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2270,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,MONUMENT,COMMERCIAL,39.69,75,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,MONUMENT,COMMERCIAL,62.94,75,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,MONUMENT,COMMERCIAL,62.94,75,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,J3490,HCPCS,250,RC,,BOTH,50,ME,17.65,7.06,MONUMENT,COMMERCIAL,13.24,75,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,2510700,CDM,250,RC,,BOTH,50,ME,17.65,7.06,MONUMENT,COMMERCIAL,13.24,75,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
NS 500ML,J7030,HCPCS,636,RC,,BOTH,500,ML,81.62,32.65,MONUMENT,COMMERCIAL,61.22,75,,,OTHER,61.22,79.99,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,MONUMENT,COMMERCIAL,3853.18,75,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,MONUMENT,COMMERCIAL,3853.18,75,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,2509490,CDM,636,RC,,BOTH,1,ME,472.36,188.94,MONUMENT,COMMERCIAL,354.27,75,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,MONUMENT,COMMERCIAL,354.27,75,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,MONUMENT,COMMERCIAL,354.27,75,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,J3490,HCPCS,250,RC,,BOTH,0.125,ME,48.04,19.22,MONUMENT,COMMERCIAL,36.03,75,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,MONUMENT,COMMERCIAL,3853.18,75,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,MONUMENT,COMMERCIAL,3853.18,75,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,2506740,CDM,250,RC,,BOTH,0.125,ME,48.04,19.22,MONUMENT,COMMERCIAL,36.03,75,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,MONUMENT,COMMERCIAL,376.2,75,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,MONUMENT,COMMERCIAL,376.2,75,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,2508270,CDM,250,RC,,BOTH,,,501.6,200.64,MONUMENT,COMMERCIAL,376.2,75,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,MONUMENT,COMMERCIAL,30.5,75,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,MONUMENT,COMMERCIAL,30.5,75,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,MONUMENT,COMMERCIAL,55.58,75,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,MONUMENT,COMMERCIAL,55.58,75,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,MONUMENT,COMMERCIAL,55.58,75,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,MONUMENT,COMMERCIAL,55.58,75,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,MONUMENT,COMMERCIAL,14.83,75,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,MONUMENT,COMMERCIAL,14.83,75,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,2505500,CDM,250,RC,,BOTH,5,ME,19.78,7.91,MONUMENT,COMMERCIAL,14.83,75,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,MONUMENT,COMMERCIAL,203.01,75,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,MONUMENT,COMMERCIAL,203.01,75,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,2509880,CDM,250,RC,,BOTH,,,270.68,108.27,MONUMENT,COMMERCIAL,203.01,75,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,MONUMENT,COMMERCIAL,50.84,75,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,MONUMENT,COMMERCIAL,50.84,75,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,2505960,CDM,636,RC,,BOTH,500,ME,67.78,27.11,MONUMENT,COMMERCIAL,50.84,75,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% 50ML MDV,J0665,HCPCS,636,RC,,BOTH,50,ML,42.7,17.08,MONUMENT,COMMERCIAL,32.02,75,,,OTHER,0.02,41.84,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 1MG AMP,J3430,HCPCS,636,RC,,BOTH,1,ME,96.12,38.45,MONUMENT,COMMERCIAL,72.09,75,,,OTHER,72.09,94.2,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,MONUMENT,COMMERCIAL,47.43,75,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,MONUMENT,COMMERCIAL,47.43,75,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,MONUMENT,COMMERCIAL,18.03,75,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,MONUMENT,COMMERCIAL,18.03,75,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,2507500,CDM,250,RC,,BOTH,50,ME,24.03,9.61,MONUMENT,COMMERCIAL,18.03,75,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,MONUMENT,COMMERCIAL,36.99,75,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,MONUMENT,COMMERCIAL,36.99,75,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3370,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,MONUMENT,COMMERCIAL,36.99,75,,,OTHER,36.99,48.33,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,MONUMENT,COMMERCIAL,37.82,75,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
METOCLOPRAMIDE 5MG/ML VIAL,J2765,HCPCS,636,RC,,BOTH,5,ME,45.92,18.37,MONUMENT,COMMERCIAL,34.44,75,,,OTHER,34.44,45.01,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,MONUMENT,COMMERCIAL,16.77,75,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,MONUMENT,COMMERCIAL,16.77,75,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,2507510,CDM,250,RC,,BOTH,12.5,ME,22.35,8.94,MONUMENT,COMMERCIAL,16.77,75,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,J3490,HCPCS,255,RC,,BOTH,30,ML,110.55,44.22,MONUMENT,COMMERCIAL,82.91,75,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,2508130,CDM,255,RC,,BOTH,30,ML,110.55,44.22,MONUMENT,COMMERCIAL,82.91,75,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 0.9% NACL,J1580,HCPCS,636,RC,,BOTH,80,ME,68.12,27.25,MONUMENT,COMMERCIAL,51.09,75,,,OTHER,51.09,66.75,PERCENT OF TOTAL BILLED CHARGES
SPIRONOLACTONE 25 MG TAB,J3490,HCPCS,250,RC,,BOTH,25,ME,17.63,7.05,MONUMENT,COMMERCIAL,13.22,75,,,OTHER,13.22,17.27,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,MONUMENT,COMMERCIAL,25.19,75,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,MONUMENT,COMMERCIAL,25.19,75,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,J3490,HCPCS,250,RC,,BOTH,180,ME,59.19,23.67,MONUMENT,COMMERCIAL,44.39,75,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,2506840,CDM,250,RC,,BOTH,180,ME,59.19,23.67,MONUMENT,COMMERCIAL,44.39,75,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,MONUMENT,COMMERCIAL,108.71,75,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,MONUMENT,COMMERCIAL,108.71,75,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
MENTHOL ZINCOX,J3490,HCPCS,250,RC,,BOTH,,,26.42,10.57,MONUMENT,COMMERCIAL,19.82,75,,,OTHER,19.82,25.89,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,MONUMENT,COMMERCIAL,236.33,75,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,MONUMENT,COMMERCIAL,236.33,75,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,2508790,CDM,636,RC,,BOTH,50,ME,125,50,MONUMENT,COMMERCIAL,93.75,75,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,MONUMENT,COMMERCIAL,90.36,75,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,MONUMENT,COMMERCIAL,90.36,75,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,MONUMENT,COMMERCIAL,90.36,75,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,MONUMENT,COMMERCIAL,90.36,75,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
GLYCOPYRROLATE 0.2 MG/ML,2509510,CDM,250,RC,,BOTH,0.2,ML,74.12,29.65,MONUMENT,COMMERCIAL,55.59,75,,,OTHER,55.59,72.64,PERCENT OF TOTAL BILLED CHARGES
HYDROCORT SOD.SUCC. 100MG VIAL,J1720,HCPCS,636,RC,,BOTH,100,ME,71.91,28.76,MONUMENT,COMMERCIAL,53.93,75,,,OTHER,53.93,70.47,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 40MG VIAL,J2920,HCPCS,636,RC,,BOTH,40,ME,58,23.2,MONUMENT,COMMERCIAL,43.5,75,,,OTHER,43.5,56.84,PERCENT OF TOTAL BILLED CHARGES
NS 250ML GLASS BOTTLE,J7030,HCPCS,636,RC,,BOTH,250,ML,79.33,31.73,MONUMENT,COMMERCIAL,59.5,75,,,OTHER,59.5,77.75,PERCENT OF TOTAL BILLED CHARGES
PROCHLORPERAZINE 10 MG VIAL,J0780,HCPCS,636,RC,,BOTH,10,ME,74.3,29.72,MONUMENT,COMMERCIAL,55.73,75,,,OTHER,55.73,72.81,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,MONUMENT,COMMERCIAL,12.44,75,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,MONUMENT,COMMERCIAL,12.44,75,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,2522260,CDM,250,RC,,BOTH,100,ME,16.59,6.64,MONUMENT,COMMERCIAL,12.44,75,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2371,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,MONUMENT,COMMERCIAL,42.88,75,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2370,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,MONUMENT,COMMERCIAL,42.88,75,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,MONUMENT,COMMERCIAL,75.97,75,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,MONUMENT,COMMERCIAL,75.97,75,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
FOLIC ACID 1 MG TAB,J3490,HCPCS,250,RC,,BOTH,1,ME,17.34,6.94,MONUMENT,COMMERCIAL,13.01,75,,,OTHER,13.01,17,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,MONUMENT,COMMERCIAL,63.08,75,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,MONUMENT,COMMERCIAL,63.08,75,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
HYDRALAZINE 20 MG/ML VIAL,J0360,HCPCS,636,RC,,BOTH,20,ME,142.58,57.03,MONUMENT,COMMERCIAL,106.94,75,,,OTHER,106.94,139.73,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,MONUMENT,COMMERCIAL,34.59,75,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,MONUMENT,COMMERCIAL,34.59,75,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
PATIENTS OWN MED,J3490,HCPCS,636,RC,,BOTH,,,0.52,0.21,MONUMENT,COMMERCIAL,0.39,75,,,OTHER,0.39,0.51,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,MONUMENT,COMMERCIAL,14.71,75,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,MONUMENT,COMMERCIAL,14.71,75,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,2504830,CDM,250,RC,,BOTH,10,ME,19.61,7.84,MONUMENT,COMMERCIAL,14.71,75,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,MONUMENT,COMMERCIAL,44.47,75,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,MONUMENT,COMMERCIAL,44.47,75,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,MONUMENT,COMMERCIAL,104.37,75,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,MONUMENT,COMMERCIAL,104.37,75,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,MONUMENT,COMMERCIAL,12.98,75,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,MONUMENT,COMMERCIAL,12.98,75,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,2509260,CDM,250,RC,,BOTH,40,ME,17.31,6.92,MONUMENT,COMMERCIAL,12.98,75,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,MONUMENT,COMMERCIAL,41.02,75,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,MONUMENT,COMMERCIAL,41.02,75,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,MONUMENT,COMMERCIAL,34.87,75,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,MONUMENT,COMMERCIAL,34.87,75,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 60MG/0.9% NS 50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,64.59,25.84,MONUMENT,COMMERCIAL,48.44,75,,,OTHER,48.44,63.3,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,MONUMENT,COMMERCIAL,50.48,75,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,MONUMENT,COMMERCIAL,50.48,75,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,2511540,CDM,636,RC,,BOTH,,,146.98,58.79,MONUMENT,COMMERCIAL,110.24,75,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,90715,HCPCS,636,RC,,BOTH,,,146.98,58.79,MONUMENT,COMMERCIAL,110.24,75,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 80MG VIAL,J1580,HCPCS,636,RC,,BOTH,80,ME,47.86,19.14,MONUMENT,COMMERCIAL,35.89,75,,,OTHER,35.89,46.9,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 4MEQ/ML 2ML VIAL,J3475,HCPCS,636,RC,,BOTH,2,ML,34.27,13.71,MONUMENT,COMMERCIAL,25.7,75,,,OTHER,25.7,33.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,MONUMENT,COMMERCIAL,41.93,75,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,MONUMENT,COMMERCIAL,41.93,75,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,MONUMENT,COMMERCIAL,41.93,75,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,MONUMENT,COMMERCIAL,41.93,75,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,MONUMENT,COMMERCIAL,48.5,75,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,MONUMENT,COMMERCIAL,48.5,75,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,2513040,CDM,636,RC,,BOTH,20,ME,44.88,17.95,MONUMENT,COMMERCIAL,33.66,75,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,MONUMENT,COMMERCIAL,33.66,75,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,MONUMENT,COMMERCIAL,33.66,75,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT 4MG,J3490,HCPCS,636,RC,,BOTH,4,ME,23.2,9.28,MONUMENT,COMMERCIAL,17.4,75,,,OTHER,17.4,22.74,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J0665,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,MONUMENT,COMMERCIAL,39.09,75,,,OTHER,0.02,51.08,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,MONUMENT,COMMERCIAL,39.09,75,,,OTHER,39.09,51.08,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,MONUMENT,COMMERCIAL,33.84,75,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,MONUMENT,COMMERCIAL,33.84,75,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,2506990,CDM,636,RC,,BOTH,50,ME,45.11,18.05,MONUMENT,COMMERCIAL,33.84,75,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
METHLYPREDNISOLONE 125MG VIAL,J2930,HCPCS,636,RC,,BOTH,125,ME,66.23,26.49,MONUMENT,COMMERCIAL,49.67,75,,,OTHER,49.67,64.91,PERCENT OF TOTAL BILLED CHARGES
LORAZEPAM 2 MG/ML VIAL,J2060,HCPCS,636,RC,,BOTH,2,ME,55.93,22.37,MONUMENT,COMMERCIAL,41.94,75,,,OTHER,41.94,54.81,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,S0164,HCPCS,636,RC,,BOTH,40,ME,74.08,29.63,MONUMENT,COMMERCIAL,55.56,75,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,2507670,CDM,636,RC,,BOTH,40,ME,74.08,29.63,MONUMENT,COMMERCIAL,55.56,75,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
NS  500ML,J7040,HCPCS,636,RC,,BOTH,500,ML,175.19,70.08,MONUMENT,COMMERCIAL,131.39,75,,,OTHER,131.39,171.69,PERCENT OF TOTAL BILLED CHARGES
NON FORMULARY MED REC,2504941,CDM,636,RC,,BOTH,,,0.05,0.02,MONUMENT,COMMERCIAL,0.03,75,,,OTHER,0.03,0.05,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 15MG VIAL,J1885,HCPCS,636,RC,,BOTH,15,ME,49.58,19.83,MONUMENT,COMMERCIAL,37.18,75,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
DUONEB 0.5MG/3.ML,J7620,HCPCS,636,RC,,BOTH,3,ML,2.22,0.89,MONUMENT,COMMERCIAL,1.66,75,,,OTHER,1.66,2.17,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,MONUMENT,COMMERCIAL,39.3,75,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,MONUMENT,COMMERCIAL,39.3,75,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
NS  250ML,J7050,HCPCS,636,RC,,BOTH,250,ML,83.9,33.56,MONUMENT,COMMERCIAL,62.93,75,,,OTHER,62.93,82.22,PERCENT OF TOTAL BILLED CHARGES
NS  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,122.12,48.85,MONUMENT,COMMERCIAL,91.59,75,,,OTHER,91.59,119.67,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,MONUMENT,COMMERCIAL,596.7,75,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,MONUMENT,COMMERCIAL,596.7,75,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,MONUMENT,COMMERCIAL,38.09,75,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,MONUMENT,COMMERCIAL,38.09,75,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,MONUMENT,COMMERCIAL,54.81,75,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,MONUMENT,COMMERCIAL,54.81,75,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,MONUMENT,COMMERCIAL,57.98,75,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,MONUMENT,COMMERCIAL,57.98,75,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
NEOSTIGMINE 1MG/ML INJ,J2710,HCPCS,636,RC,,BOTH,1,ME,81.21,32.48,MONUMENT,COMMERCIAL,60.91,75,,,OTHER,60.91,79.59,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 100 MG/2 ML VIAL,J1165,HCPCS,636,RC,,BOTH,100,ME,31.36,12.54,MONUMENT,COMMERCIAL,23.52,75,,,OTHER,23.52,30.73,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,MONUMENT,COMMERCIAL,69.09,75,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,MONUMENT,COMMERCIAL,69.09,75,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,MONUMENT,COMMERCIAL,195.26,75,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,MONUMENT,COMMERCIAL,195.26,75,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,MONUMENT,COMMERCIAL,352.95,75,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,MONUMENT,COMMERCIAL,352.95,75,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,2509110,CDM,636,RC,,BOTH,30,UN,470.6,188.24,MONUMENT,COMMERCIAL,352.95,75,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,MONUMENT,COMMERCIAL,62.37,75,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,MONUMENT,COMMERCIAL,62.37,75,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.2MG AMP,J2310,HCPCS,636,RC,,BOTH,0.2,ME,117.05,46.82,MONUMENT,COMMERCIAL,87.79,75,,,OTHER,87.79,114.71,PERCENT OF TOTAL BILLED CHARGES
HYDROXYZINE HCL 50 MG/ML VIAL ,J3410,HCPCS,636,RC,,BOTH,50,ME,101.36,40.54,MONUMENT,COMMERCIAL,76.02,75,,,OTHER,76.02,99.33,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,MONUMENT,COMMERCIAL,50.01,75,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,MONUMENT,COMMERCIAL,50.01,75,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,MONUMENT,COMMERCIAL,92.25,75,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,MONUMENT,COMMERCIAL,92.25,75,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,MONUMENT,COMMERCIAL,102.8,75,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,MONUMENT,COMMERCIAL,102.8,75,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 500MG INJ,J1956,HCPCS,636,RC,,BOTH,500,ME,67.61,27.04,MONUMENT,COMMERCIAL,50.71,75,,,OTHER,50.71,66.26,PERCENT OF TOTAL BILLED CHARGES
PERFLUTREN  SDV,Q9957,HCPCS,636,RC,,BOTH,,,813.57,325.43,MONUMENT,COMMERCIAL,610.18,75,,,OTHER,610.18,797.3,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,MONUMENT,COMMERCIAL,46.88,75,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,MONUMENT,COMMERCIAL,46.88,75,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,2513380,CDM,636,RC,,BOTH,100,ME,62.5,25,MONUMENT,COMMERCIAL,46.88,75,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,MONUMENT,COMMERCIAL,33.81,75,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,MONUMENT,COMMERCIAL,33.81,75,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,MONUMENT,COMMERCIAL,97.49,75,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,MONUMENT,COMMERCIAL,97.49,75,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,MONUMENT,COMMERCIAL,97.49,75,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,MONUMENT,COMMERCIAL,97.49,75,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7060,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,MONUMENT,COMMERCIAL,63.02,75,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,MONUMENT,COMMERCIAL,63.02,75,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,MONUMENT,COMMERCIAL,63.02,75,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,MONUMENT,COMMERCIAL,311.59,75,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,MONUMENT,COMMERCIAL,311.59,75,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,MONUMENT,COMMERCIAL,347.6,75,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,MONUMENT,COMMERCIAL,347.6,75,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,MONUMENT,COMMERCIAL,1.65,75,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,MONUMENT,COMMERCIAL,1.65,75,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,2512600,CDM,636,RC,,BOTH,100,ME,2.21,0.88,MONUMENT,COMMERCIAL,1.65,75,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 1000U/ML 2ML VIAL,J1644,HCPCS,636,RC,,BOTH,2,ML,78.89,31.56,MONUMENT,COMMERCIAL,59.17,75,,,OTHER,59.17,77.31,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 20U/LR 1000 ML,J2590,HCPCS,636,RC,,BOTH,1000,ML,276.21,110.48,MONUMENT,COMMERCIAL,207.15,75,,,OTHER,207.15,270.68,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,MONUMENT,COMMERCIAL,57.27,75,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,MONUMENT,COMMERCIAL,57.27,75,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,MONUMENT,COMMERCIAL,63.88,75,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,MONUMENT,COMMERCIAL,63.88,75,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,MONUMENT,COMMERCIAL,63.88,75,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,MONUMENT,COMMERCIAL,230.78,75,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,MONUMENT,COMMERCIAL,230.78,75,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,MONUMENT,COMMERCIAL,89.24,75,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,MONUMENT,COMMERCIAL,89.24,75,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 2.25G VIAL,J2543,HCPCS,636,RC,,BOTH,2.25,GR,72.92,29.17,MONUMENT,COMMERCIAL,54.69,75,,,OTHER,54.69,71.46,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,MONUMENT,COMMERCIAL,80.68,75,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,MONUMENT,COMMERCIAL,80.68,75,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,MONUMENT,COMMERCIAL,80.68,75,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,MONUMENT,COMMERCIAL,80.68,75,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,MONUMENT,COMMERCIAL,25.11,75,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,MONUMENT,COMMERCIAL,25.11,75,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,2507710,CDM,636,RC,,BOTH,20,ML,33.48,13.39,MONUMENT,COMMERCIAL,25.11,75,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% SDV 2ML,J2001,HCPCS,636,RC,,BOTH,2,ML,48.52,19.41,MONUMENT,COMMERCIAL,36.39,75,,,OTHER,36.39,47.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,MONUMENT,COMMERCIAL,69.92,75,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,MONUMENT,COMMERCIAL,69.92,75,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,2501270,CDM,636,RC,,BOTH,3,GR,93.22,37.29,MONUMENT,COMMERCIAL,69.92,75,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,MONUMENT,COMMERCIAL,69.92,75,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 30MG VIAL,J1885,HCPCS,636,RC,,BOTH,30,ME,57.77,23.11,MONUMENT,COMMERCIAL,43.33,75,,,OTHER,43.33,56.62,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40MG VIAL,J1940,HCPCS,636,RC,,BOTH,40,ME,45.24,18.09,MONUMENT,COMMERCIAL,33.93,75,,,OTHER,33.93,44.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,MONUMENT,COMMERCIAL,58.12,75,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,MONUMENT,COMMERCIAL,58.12,75,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3370,HCPCS,636,RC,,BOTH,1,GR,77.49,31,MONUMENT,COMMERCIAL,58.12,75,,,OTHER,58.12,75.94,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM,J2250,HCPCS,636,RC,,BOTH,1,ME,50.03,20.01,MONUMENT,COMMERCIAL,37.52,75,,,OTHER,37.52,49.03,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,MONUMENT,COMMERCIAL,44.46,75,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,MONUMENT,COMMERCIAL,44.46,75,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,MONUMENT,COMMERCIAL,275.63,75,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,MONUMENT,COMMERCIAL,275.63,75,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,MONUMENT,COMMERCIAL,275.63,75,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,MONUMENT,COMMERCIAL,275.63,75,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,MONUMENT,COMMERCIAL,139.58,75,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,MONUMENT,COMMERCIAL,139.58,75,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3372,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,MONUMENT,COMMERCIAL,85.7,75,,,OTHER,6.72,111.99,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3490,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,MONUMENT,COMMERCIAL,85.7,75,,,OTHER,85.7,111.99,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J7517,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,MONUMENT,COMMERCIAL,3.9,75,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J3490,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,MONUMENT,COMMERCIAL,3.9,75,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,MONUMENT,COMMERCIAL,36.82,75,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,MONUMENT,COMMERCIAL,36.82,75,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J7613,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,MONUMENT,COMMERCIAL,0.6,75,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J3490,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,MONUMENT,COMMERCIAL,0.6,75,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,MONUMENT,COMMERCIAL,683,75,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,MONUMENT,COMMERCIAL,683,75,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,2511380,CDM,636,RC,,BOTH,1,ME,910.67,364.27,MONUMENT,COMMERCIAL,683,75,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,MONUMENT,COMMERCIAL,3275.94,75,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,MONUMENT,COMMERCIAL,3275.94,75,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,MONUMENT,COMMERCIAL,1328.19,75,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,MONUMENT,COMMERCIAL,1328.19,75,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,2505151,CDM,636,RC,,BOTH,0.5,ME,1770.92,708.37,MONUMENT,COMMERCIAL,1328.19,75,,,OTHER,1328.19,1735.5,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,MONUMENT,COMMERCIAL,591.76,75,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,MONUMENT,COMMERCIAL,591.76,75,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3372,HCPCS,636,RC,,BOTH,300,ML,129.54,51.82,MONUMENT,COMMERCIAL,97.15,75,,,OTHER,6.72,126.95,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3490,HCPCS,636,RC,,BOTH,200,ML,129.54,51.82,MONUMENT,COMMERCIAL,97.15,75,,,OTHER,97.15,126.95,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 750MG/150ML PB,J1956,HCPCS,636,RC,,BOTH,750,ME,108,43.2,MONUMENT,COMMERCIAL,81,75,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,MONUMENT,COMMERCIAL,3246.49,75,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,MONUMENT,COMMERCIAL,3246.49,75,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,2504470,CDM,636,RC,,BOTH,22.5,ME,4328.65,1731.46,MONUMENT,COMMERCIAL,3246.49,75,,,OTHER,3246.49,4242.08,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG/300ML IV,J2020,HCPCS,636,RC,,BOTH,600,ME,207.7,83.08,MONUMENT,COMMERCIAL,155.78,75,,,OTHER,155.78,203.55,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,MONUMENT,COMMERCIAL,76.48,75,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,MONUMENT,COMMERCIAL,76.48,75,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 3.375G VIAL,J2543,HCPCS,636,RC,,BOTH,3.375,GR,166.16,66.46,MONUMENT,COMMERCIAL,124.62,75,,,OTHER,124.62,162.83,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3372,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,MONUMENT,COMMERCIAL,105.26,75,,,OTHER,6.72,137.54,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3490,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,MONUMENT,COMMERCIAL,105.26,75,,,OTHER,105.26,137.54,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,MONUMENT,COMMERCIAL,62.28,75,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,MONUMENT,COMMERCIAL,62.28,75,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,MONUMENT,COMMERCIAL,65.9,75,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,MONUMENT,COMMERCIAL,65.9,75,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,MONUMENT,COMMERCIAL,12.3,75,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,MONUMENT,COMMERCIAL,12.3,75,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,MONUMENT,COMMERCIAL,1211.98,75,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,MONUMENT,COMMERCIAL,1211.98,75,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 500MG VIAL,J2930,HCPCS,636,RC,,BOTH,500,ME,103.65,41.46,MONUMENT,COMMERCIAL,77.74,75,,,OTHER,77.74,101.58,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J2597,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,MONUMENT,COMMERCIAL,117.9,75,,,OTHER,6.58,154.06,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J3490,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,MONUMENT,COMMERCIAL,117.9,75,,,OTHER,117.9,154.06,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,MONUMENT,COMMERCIAL,3.12,75,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,MONUMENT,COMMERCIAL,3.12,75,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,MONUMENT,COMMERCIAL,57.09,75,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,MONUMENT,COMMERCIAL,57.09,75,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 60MG INJ,J1885,HCPCS,636,RC,,BOTH,60,ME,46.32,18.53,MONUMENT,COMMERCIAL,34.74,75,,,OTHER,34.74,45.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3372,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,MONUMENT,COMMERCIAL,107.84,75,,,OTHER,6.72,140.91,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3490,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,MONUMENT,COMMERCIAL,107.84,75,,,OTHER,107.84,140.91,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,MONUMENT,COMMERCIAL,201.4,75,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,MONUMENT,COMMERCIAL,201.4,75,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,2508360,CDM,636,RC,,BOTH,4,ME,268.54,107.42,MONUMENT,COMMERCIAL,201.4,75,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
KENALOG-40 INJ,J3301,HCPCS,636,RC,,BOTH,10,ME,65.27,26.11,MONUMENT,COMMERCIAL,48.96,75,,,OTHER,48.96,63.97,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 2GM PREMIX BAG,J3475,HCPCS,636,RC,,BOTH,2,GR,101.76,40.71,MONUMENT,COMMERCIAL,76.32,75,,,OTHER,76.32,99.73,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,MONUMENT,COMMERCIAL,480.56,75,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,MONUMENT,COMMERCIAL,480.56,75,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,2516870,CDM,636,RC,,BOTH,5,ML,640.74,256.3,MONUMENT,COMMERCIAL,480.56,75,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,MONUMENT,COMMERCIAL,37.18,75,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,MONUMENT,COMMERCIAL,37.18,75,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,MONUMENT,COMMERCIAL,97.09,75,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,MONUMENT,COMMERCIAL,97.09,75,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
PIPERACILLIN/TAZOBAC 4G/0.5 IV,J2543,HCPCS,636,RC,,BOTH,4,GR,166.16,66.47,MONUMENT,COMMERCIAL,124.62,75,,,OTHER,124.62,162.84,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,MONUMENT,COMMERCIAL,42.26,75,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,MONUMENT,COMMERCIAL,42.26,75,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,MONUMENT,COMMERCIAL,92.44,75,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,MONUMENT,COMMERCIAL,92.44,75,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,MONUMENT,COMMERCIAL,175.84,75,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,MONUMENT,COMMERCIAL,175.84,75,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,MONUMENT,COMMERCIAL,36.63,75,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,MONUMENT,COMMERCIAL,36.63,75,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,MONUMENT,COMMERCIAL,34.79,75,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,MONUMENT,COMMERCIAL,34.79,75,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,2502720,CDM,636,RC,,BOTH,4,ME,46.38,18.55,MONUMENT,COMMERCIAL,34.79,75,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,MONUMENT,COMMERCIAL,87.42,75,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,MONUMENT,COMMERCIAL,87.42,75,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J2760,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,MONUMENT,COMMERCIAL,599.48,75,,,OTHER,466.54,783.31,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J3490,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,MONUMENT,COMMERCIAL,599.48,75,,,OTHER,599.48,783.31,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,MONUMENT,COMMERCIAL,67.67,75,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,MONUMENT,COMMERCIAL,67.67,75,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,2500750,CDM,636,RC,,BOTH,2.5,ME,90.23,36.09,MONUMENT,COMMERCIAL,67.67,75,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 500MG INJ,J2185,HCPCS,636,RC,,BOTH,500,ME,64.96,25.98,MONUMENT,COMMERCIAL,48.72,75,,,OTHER,48.72,63.66,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML,J2250,HCPCS,636,RC,,BOTH,5,ML,50.52,20.21,MONUMENT,COMMERCIAL,37.89,75,,,OTHER,37.89,49.51,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML VIAL,J2250,HCPCS,636,RC,,BOTH,5,ME,58.31,23.32,MONUMENT,COMMERCIAL,43.73,75,,,OTHER,43.73,57.14,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,2505240,CDM,636,RC,,BOTH,1,GR,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 250 MG/5 ML VIAL,J1165,HCPCS,636,RC,,BOTH,250,ME,22.1,8.84,MONUMENT,COMMERCIAL,16.57,75,,,OTHER,16.57,21.66,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,MONUMENT,COMMERCIAL,4743.82,75,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,MONUMENT,COMMERCIAL,4743.82,75,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,MONUMENT,COMMERCIAL,140.13,75,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,MONUMENT,COMMERCIAL,140.13,75,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,2504590,CDM,636,RC,,BOTH,10,ME,186.84,74.74,MONUMENT,COMMERCIAL,140.13,75,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,MONUMENT,COMMERCIAL,489.98,75,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,MONUMENT,COMMERCIAL,489.98,75,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,2513160,CDM,636,RC,,BOTH,1,ME,653.31,261.32,MONUMENT,COMMERCIAL,489.98,75,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% VIAL   SD,J2001,HCPCS,636,RC,,BOTH,10,ME,47.14,18.86,MONUMENT,COMMERCIAL,35.35,75,,,OTHER,35.35,46.2,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,MONUMENT,COMMERCIAL,42.41,75,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,MONUMENT,COMMERCIAL,42.41,75,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,MONUMENT,COMMERCIAL,48.96,75,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,MONUMENT,COMMERCIAL,48.96,75,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,2505170,CDM,636,RC,,BOTH,20,ME,65.29,26.11,MONUMENT,COMMERCIAL,48.96,75,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,MONUMENT,COMMERCIAL,97.64,75,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,MONUMENT,COMMERCIAL,97.64,75,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,BOTH,,,51.37,20.55,MONUMENT,COMMERCIAL,38.53,75,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3490,HCPCS,636,RC,,BOTH,,,51.37,20.55,MONUMENT,COMMERCIAL,38.53,75,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,MONUMENT,COMMERCIAL,101.27,75,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,MONUMENT,COMMERCIAL,101.27,75,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 5OOOU/ML INJ,J1644,HCPCS,636,RC,,BOTH,5000,UN,53.84,21.54,MONUMENT,COMMERCIAL,40.38,75,,,OTHER,40.38,52.77,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,MONUMENT,COMMERCIAL,3544.3,75,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,MONUMENT,COMMERCIAL,3544.3,75,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,MONUMENT,COMMERCIAL,37.48,75,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,MONUMENT,COMMERCIAL,37.48,75,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0150,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,MONUMENT,COMMERCIAL,37.48,75,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,MONUMENT,COMMERCIAL,115.32,75,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,MONUMENT,COMMERCIAL,115.32,75,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT HOME PACK,Q0162,HCPCS,636,RC,,BOTH,,,23.75,9.5,MONUMENT,COMMERCIAL,17.81,75,,,OTHER,17.81,23.28,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,MONUMENT,COMMERCIAL,8.42,75,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,MONUMENT,COMMERCIAL,8.42,75,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,MONUMENT,COMMERCIAL,63.94,75,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,MONUMENT,COMMERCIAL,63.94,75,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,2512620,CDM,636,RC,,BOTH,350,ME,85.26,34.1,MONUMENT,COMMERCIAL,63.94,75,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,MONUMENT,COMMERCIAL,54.86,75,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,MONUMENT,COMMERCIAL,54.86,75,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
METHYLPRED 1G VIAL,J2930,HCPCS,636,RC,,BOTH,1,GR,172.48,68.99,MONUMENT,COMMERCIAL,129.36,75,,,OTHER,129.36,169.03,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE,J3475,HCPCS,636,RC,,BOTH,500,ME,77.51,31,MONUMENT,COMMERCIAL,58.13,75,,,OTHER,58.13,75.96,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,MONUMENT,COMMERCIAL,151.46,75,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,MONUMENT,COMMERCIAL,151.46,75,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,2505150,CDM,636,RC,,BOTH,80,ME,201.94,80.78,MONUMENT,COMMERCIAL,151.46,75,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,MONUMENT,COMMERCIAL,58.82,75,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,MONUMENT,COMMERCIAL,58.82,75,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G POTASS 5MMU VIAL,J2540,HCPCS,636,RC,,BOTH,,,76.53,30.61,MONUMENT,COMMERCIAL,57.4,75,,,OTHER,57.4,75,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE 5GM/10ML,J3475,HCPCS,636,RC,,BOTH,10,ML,88.79,35.52,MONUMENT,COMMERCIAL,66.6,75,,,OTHER,66.6,87.02,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,MONUMENT,COMMERCIAL,42.64,75,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,MONUMENT,COMMERCIAL,42.64,75,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,MONUMENT,COMMERCIAL,3293.66,75,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,MONUMENT,COMMERCIAL,3293.66,75,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,2514280,CDM,636,RC,,BOTH,100,ME,4391.55,1756.62,MONUMENT,COMMERCIAL,3293.66,75,,,OTHER,3293.66,4303.72,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,MONUMENT,COMMERCIAL,80.25,75,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,MONUMENT,COMMERCIAL,80.25,75,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,MONUMENT,COMMERCIAL,1574.82,75,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,MONUMENT,COMMERCIAL,1574.82,75,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 10 MG AMP,J3430,HCPCS,636,RC,,BOTH,10,ME,147.4,58.96,MONUMENT,COMMERCIAL,110.55,75,,,OTHER,110.55,144.45,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,MONUMENT,COMMERCIAL,3238.81,75,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,MONUMENT,COMMERCIAL,3238.81,75,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,MONUMENT,COMMERCIAL,255.99,75,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,MONUMENT,COMMERCIAL,255.99,75,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514820,CDM,636,RC,,BOTH,10,ME,341.32,136.53,MONUMENT,COMMERCIAL,255.99,75,,,OTHER,255.99,334.5,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,MONUMENT,COMMERCIAL,71.26,75,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,MONUMENT,COMMERCIAL,71.26,75,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,MONUMENT,COMMERCIAL,191.29,75,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,MONUMENT,COMMERCIAL,191.29,75,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,MONUMENT,COMMERCIAL,191.29,75,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,MONUMENT,COMMERCIAL,191.29,75,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J1805,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,MONUMENT,COMMERCIAL,64.71,75,,,OTHER,0.23,84.55,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J3490,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,MONUMENT,COMMERCIAL,64.71,75,,,OTHER,64.71,84.55,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,MONUMENT,COMMERCIAL,2855.19,75,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,MONUMENT,COMMERCIAL,2855.19,75,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,2514950,CDM,636,RC,,BOTH,1,ME,3806.92,1522.77,MONUMENT,COMMERCIAL,2855.19,75,,,OTHER,2855.19,3730.78,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G VIAL,J2185,HCPCS,636,RC,,BOTH,1,GR,135.9,54.36,MONUMENT,COMMERCIAL,101.93,75,,,OTHER,101.93,133.18,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,MONUMENT,COMMERCIAL,1048.73,75,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,MONUMENT,COMMERCIAL,1048.73,75,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
NITROGLYCERIN 50 MG/D5W100,J2305,HCPCS,636,RC,,BOTH,50,ME,126.32,50.53,MONUMENT,COMMERCIAL,94.74,75,,,OTHER,1.51,123.8,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,MONUMENT,COMMERCIAL,182.99,75,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,MONUMENT,COMMERCIAL,182.99,75,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,2504240,CDM,636,RC,,BOTH,100,ME,243.99,97.59,MONUMENT,COMMERCIAL,182.99,75,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1642,HCPCS,636,RC,,BOTH,10,UN,51.53,20.61,MONUMENT,COMMERCIAL,38.65,75,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1644,HCPCS,636,RC,,BOTH,1000,UN,51.53,20.61,MONUMENT,COMMERCIAL,38.65,75,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,MONUMENT,COMMERCIAL,849.76,75,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,MONUMENT,COMMERCIAL,849.76,75,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,MONUMENT,COMMERCIAL,32.78,75,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,MONUMENT,COMMERCIAL,32.78,75,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,MONUMENT,COMMERCIAL,981.27,75,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,MONUMENT,COMMERCIAL,981.27,75,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,2503770,CDM,636,RC,,BOTH,2,ML,1308.36,523.34,MONUMENT,COMMERCIAL,981.27,75,,,OTHER,981.27,1282.19,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,MONUMENT,COMMERCIAL,1496.29,75,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,MONUMENT,COMMERCIAL,1496.29,75,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,MONUMENT,COMMERCIAL,1345.12,75,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,MONUMENT,COMMERCIAL,1345.12,75,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,MONUMENT,COMMERCIAL,137.13,75,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,MONUMENT,COMMERCIAL,137.13,75,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,2507600,CDM,636,RC,,BOTH,500,ME,182.84,73.13,MONUMENT,COMMERCIAL,137.13,75,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,MONUMENT,COMMERCIAL,64.95,75,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,MONUMENT,COMMERCIAL,64.95,75,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,MONUMENT,COMMERCIAL,203.8,75,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,MONUMENT,COMMERCIAL,203.8,75,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,2514600,CDM,636,RC,,BOTH,2,GR,271.74,108.69,MONUMENT,COMMERCIAL,203.8,75,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,MONUMENT,COMMERCIAL,35.23,75,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,MONUMENT,COMMERCIAL,35.23,75,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,MONUMENT,COMMERCIAL,1084.61,75,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,MONUMENT,COMMERCIAL,1084.61,75,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,MONUMENT,COMMERCIAL,65.9,75,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,MONUMENT,COMMERCIAL,65.9,75,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,MONUMENT,COMMERCIAL,1111.36,75,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,MONUMENT,COMMERCIAL,1111.36,75,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,MONUMENT,COMMERCIAL,17.05,75,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,MONUMENT,COMMERCIAL,17.05,75,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,2505100,CDM,636,RC,,BOTH,10,ME,22.73,9.09,MONUMENT,COMMERCIAL,17.05,75,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,MONUMENT,COMMERCIAL,95.14,75,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,MONUMENT,COMMERCIAL,95.14,75,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,MONUMENT,COMMERCIAL,865.45,75,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,MONUMENT,COMMERCIAL,865.45,75,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,MONUMENT,COMMERCIAL,487.36,75,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,MONUMENT,COMMERCIAL,487.36,75,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,2500420,CDM,636,RC,,BOTH,0.05,ML,649.81,259.92,MONUMENT,COMMERCIAL,487.36,75,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J1836,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,MONUMENT,COMMERCIAL,51.66,75,,,OTHER,0.03,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,MONUMENT,COMMERCIAL,7.88,75,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,MONUMENT,COMMERCIAL,7.88,75,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J3490,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,MONUMENT,COMMERCIAL,51.66,75,,,OTHER,51.66,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,MONUMENT,COMMERCIAL,7.88,75,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,MONUMENT,COMMERCIAL,33.33,75,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,MONUMENT,COMMERCIAL,33.33,75,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,2506180,CDM,636,RC,,BOTH,10,ME,44.44,17.78,MONUMENT,COMMERCIAL,33.33,75,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 100 MG SYRINGE,J2001,HCPCS,636,RC,,BOTH,100,ME,56.99,22.8,MONUMENT,COMMERCIAL,42.74,75,,,OTHER,42.74,55.85,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0136,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,MONUMENT,COMMERCIAL,147.21,75,,,OTHER,0.05,192.36,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0131,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,MONUMENT,COMMERCIAL,147.21,75,,,OTHER,147.21,192.36,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,MONUMENT,COMMERCIAL,5091.08,75,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,MONUMENT,COMMERCIAL,5091.08,75,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PENICILL G BENZ 1.2MMU SYR,J0561,HCPCS,636,RC,,BOTH,,,527.8,211.12,MONUMENT,COMMERCIAL,395.85,75,,,OTHER,23.1,517.24,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,MONUMENT,COMMERCIAL,3570.05,75,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,MONUMENT,COMMERCIAL,3570.05,75,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,MONUMENT,COMMERCIAL,1509.19,75,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,MONUMENT,COMMERCIAL,1509.19,75,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,MONUMENT,COMMERCIAL,1014.83,75,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,MONUMENT,COMMERCIAL,1014.83,75,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,MONUMENT,COMMERCIAL,382.43,75,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,MONUMENT,COMMERCIAL,382.43,75,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,MONUMENT,COMMERCIAL,2659.01,75,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,MONUMENT,COMMERCIAL,2659.01,75,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 4%PF,J2001,HCPCS,636,RC,,BOTH,10,ME,49.11,19.64,MONUMENT,COMMERCIAL,36.83,75,,,OTHER,36.83,48.12,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 2% 10ML AMP,J2001,HCPCS,636,RC,,BOTH,10,ME,50.69,20.28,MONUMENT,COMMERCIAL,38.02,75,,,OTHER,38.02,49.68,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,MONUMENT,COMMERCIAL,1190.36,75,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,MONUMENT,COMMERCIAL,1190.36,75,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J2598,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,MONUMENT,COMMERCIAL,411.27,75,,,OTHER,1.97,537.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J3490,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,MONUMENT,COMMERCIAL,411.27,75,,,OTHER,411.27,537.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,MONUMENT,COMMERCIAL,2390.67,75,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,MONUMENT,COMMERCIAL,2390.67,75,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J2704,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,MONUMENT,COMMERCIAL,44.27,75,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,MONUMENT,COMMERCIAL,44.27,75,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE O.5% 30ML SD,J2001,HCPCS,636,RC,,BOTH,30,ML,70.78,28.31,MONUMENT,COMMERCIAL,53.09,75,,,OTHER,53.09,69.36,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,MONUMENT,COMMERCIAL,1949.05,75,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,MONUMENT,COMMERCIAL,1949.05,75,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 25000U BAG,J1644,HCPCS,636,RC,,BOTH,25000,UN,106.82,42.73,MONUMENT,COMMERCIAL,80.11,75,,,OTHER,80.11,104.68,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,MONUMENT,COMMERCIAL,678.24,75,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,MONUMENT,COMMERCIAL,678.24,75,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,MONUMENT,COMMERCIAL,678.24,75,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,MONUMENT,COMMERCIAL,678.24,75,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,MONUMENT,COMMERCIAL,5654.67,75,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,MONUMENT,COMMERCIAL,5654.67,75,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,MONUMENT,COMMERCIAL,7811.81,75,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,MONUMENT,COMMERCIAL,7811.81,75,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 30ML VIAL  SD,J2001,HCPCS,636,RC,,BOTH,30,ML,50.36,20.14,MONUMENT,COMMERCIAL,37.77,75,,,OTHER,37.77,49.35,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,MONUMENT,COMMERCIAL,10394.94,75,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,MONUMENT,COMMERCIAL,10394.94,75,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,MONUMENT,COMMERCIAL,1803.33,75,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,MONUMENT,COMMERCIAL,1803.33,75,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,MONUMENT,COMMERCIAL,4040.84,75,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,MONUMENT,COMMERCIAL,4040.84,75,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,2511210,CDM,636,RC,,BOTH,3.5,ME,5387.78,2155.11,MONUMENT,COMMERCIAL,4040.84,75,,,OTHER,4040.84,5280.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,MONUMENT,COMMERCIAL,6559.93,75,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,MONUMENT,COMMERCIAL,6559.93,75,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,MONUMENT,COMMERCIAL,12235.96,75,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,MONUMENT,COMMERCIAL,12235.96,75,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,2514290,CDM,636,RC,,BOTH,400,ME,16314.61,6525.84,MONUMENT,COMMERCIAL,12235.96,75,,,OTHER,12235.96,15988.32,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,2509810,CDM,636,RC,,BOTH,4,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MAG SULF/WATER,J3475,HCPCS,636,RC,,BOTH,500,ME,473.17,189.27,MONUMENT,COMMERCIAL,354.87,75,,,OTHER,354.87,463.7,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,MONUMENT,COMMERCIAL,17560.19,75,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,MONUMENT,COMMERCIAL,17560.19,75,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,MONUMENT,COMMERCIAL,731.3,75,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,MONUMENT,COMMERCIAL,731.3,75,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,MONUMENT,COMMERCIAL,2543.29,75,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,C9476,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,MONUMENT,COMMERCIAL,3742.49,75,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,MONUMENT,COMMERCIAL,6024.5,75,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,MONUMENT,COMMERCIAL,6024.5,75,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,MONUMENT,COMMERCIAL,3557.09,75,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,MONUMENT,COMMERCIAL,3557.09,75,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,MONUMENT,COMMERCIAL,403.14,75,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,MONUMENT,COMMERCIAL,403.14,75,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,MONUMENT,COMMERCIAL,3533.6,75,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,MONUMENT,COMMERCIAL,3533.6,75,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,MONUMENT,COMMERCIAL,7628.95,75,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,MONUMENT,COMMERCIAL,7628.95,75,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,2506310,CDM,636,RC,,BOTH,50,ME,10171.93,4068.77,MONUMENT,COMMERCIAL,7628.95,75,,,OTHER,7628.95,9968.49,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,MONUMENT,COMMERCIAL,1299.46,75,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,MONUMENT,COMMERCIAL,1299.46,75,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514790,CDM,636,RC,,BOTH,10,ME,1732.61,693.04,MONUMENT,COMMERCIAL,1299.46,75,,,OTHER,1299.46,1697.96,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,MONUMENT,COMMERCIAL,6824.72,75,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,MONUMENT,COMMERCIAL,6824.72,75,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,2513220,CDM,636,RC,,BOTH,1,ME,250,100,MONUMENT,COMMERCIAL,187.5,75,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,MONUMENT,COMMERCIAL,5699.44,75,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,MONUMENT,COMMERCIAL,5699.44,75,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM 500MG/5ML VIAL,J1953,HCPCS,636,RC,,BOTH,500,ME,35.72,14.29,MONUMENT,COMMERCIAL,26.79,75,,,OTHER,26.79,35.01,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,MONUMENT,COMMERCIAL,37.69,75,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,MONUMENT,COMMERCIAL,37.69,75,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0690,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,MONUMENT,COMMERCIAL,37.69,75,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,MONUMENT,COMMERCIAL,37.69,75,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,MONUMENT,COMMERCIAL,62.9,75,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,MONUMENT,COMMERCIAL,62.9,75,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,MONUMENT,COMMERCIAL,62.9,75,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,MONUMENT,COMMERCIAL,62.9,75,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,2514960,CDM,636,RC,,BOTH,50,ML,83.87,33.55,MONUMENT,COMMERCIAL,62.9,75,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) 75/25 PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,87.37,34.95,MONUMENT,COMMERCIAL,65.53,75,,,OTHER,65.53,85.62,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALIN N) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,134.82,53.93,MONUMENT,COMMERCIAL,101.12,75,,,OTHER,101.12,132.12,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,MONUMENT,COMMERCIAL,14659.54,75,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,MONUMENT,COMMERCIAL,14659.54,75,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,MONUMENT,COMMERCIAL,14659.54,75,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,MONUMENT,COMMERCIAL,14659.54,75,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,MONUMENT,COMMERCIAL,5568.26,75,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,MONUMENT,COMMERCIAL,5568.26,75,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,2510900,CDM,636,RC,,BOTH,60,ME,7424.35,2969.74,MONUMENT,COMMERCIAL,5568.26,75,,,OTHER,5568.26,7275.86,PERCENT OF TOTAL BILLED CHARGES
INSULIN (LANTUS SOLOSTAR) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,240.94,96.38,MONUMENT,COMMERCIAL,180.71,75,,,OTHER,180.71,236.12,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,MONUMENT,COMMERCIAL,2032.88,75,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,MONUMENT,COMMERCIAL,2032.88,75,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,MONUMENT,COMMERCIAL,2032.88,75,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,MONUMENT,COMMERCIAL,2032.88,75,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,MONUMENT,COMMERCIAL,2032.88,75,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,303.8,121.52,MONUMENT,COMMERCIAL,227.85,75,,,OTHER,227.85,297.72,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,MONUMENT,COMMERCIAL,1591.68,75,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,MONUMENT,COMMERCIAL,1591.68,75,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,2514210,CDM,636,RC,,BOTH,15,ME,2122.24,848.9,MONUMENT,COMMERCIAL,1591.68,75,,,OTHER,1591.68,2079.8,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,MONUMENT,COMMERCIAL,5228.48,75,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,MONUMENT,COMMERCIAL,5228.48,75,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,MONUMENT,COMMERCIAL,661.75,75,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,MONUMENT,COMMERCIAL,661.75,75,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,MONUMENT,COMMERCIAL,102.27,75,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,MONUMENT,COMMERCIAL,102.27,75,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,MONUMENT,COMMERCIAL,102.27,75,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,MONUMENT,COMMERCIAL,102.27,75,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,2514590,CDM,636,RC,,BOTH,80,ME,136.36,54.55,MONUMENT,COMMERCIAL,102.27,75,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,MONUMENT,COMMERCIAL,801.16,75,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,MONUMENT,COMMERCIAL,801.16,75,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2511990,CDM,636,RC,,BOTH,1,ME,1068.21,427.28,MONUMENT,COMMERCIAL,801.16,75,,,OTHER,801.16,1046.85,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,2501680,CDM,636,RC,,BOTH,1,ME,70.21,28.08,MONUMENT,COMMERCIAL,52.66,75,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,MONUMENT,COMMERCIAL,52.66,75,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,MONUMENT,COMMERCIAL,52.66,75,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,MONUMENT,COMMERCIAL,6186.99,75,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,MONUMENT,COMMERCIAL,6186.99,75,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,MONUMENT,COMMERCIAL,13757.71,75,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,MONUMENT,COMMERCIAL,13757.71,75,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,MONUMENT,COMMERCIAL,2696.89,75,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,MONUMENT,COMMERCIAL,2696.89,75,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,MONUMENT,COMMERCIAL,26218.31,75,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,MONUMENT,COMMERCIAL,26218.31,75,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,MONUMENT,COMMERCIAL,18849.76,75,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,MONUMENT,COMMERCIAL,18849.76,75,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,2500530,CDM,636,RC,,BOTH,100,ME,25133.01,10053.2,MONUMENT,COMMERCIAL,18849.76,75,,,OTHER,18849.76,24630.35,PERCENT OF TOTAL BILLED CHARGES
ONABOTULINUMTOXINA (BOTOX),J0585,HCPCS,636,RC,,BOTH,1,UN,1172.09,468.84,MONUMENT,COMMERCIAL,879.07,75,,,OTHER,6.64,1148.65,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,MONUMENT,COMMERCIAL,1502.08,75,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,MONUMENT,COMMERCIAL,1502.08,75,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,2511840,CDM,636,RC,,BOTH,1,ME,2002.77,801.11,MONUMENT,COMMERCIAL,1502.08,75,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,MONUMENT,COMMERCIAL,11027.46,75,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,MONUMENT,COMMERCIAL,11027.46,75,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,MONUMENT,COMMERCIAL,4490.51,75,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,MONUMENT,COMMERCIAL,4490.51,75,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,MONUMENT,COMMERCIAL,4.36,75,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,MONUMENT,COMMERCIAL,4.36,75,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,2513120,CDM,636,RC,,BOTH,0.5,ME,5.81,2.33,MONUMENT,COMMERCIAL,4.36,75,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,MONUMENT,COMMERCIAL,52.46,75,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,MONUMENT,COMMERCIAL,52.46,75,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,2505020,CDM,636,RC,,BOTH,0.1,ME,69.94,27.98,MONUMENT,COMMERCIAL,52.46,75,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,MONUMENT,COMMERCIAL,6421.83,75,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,MONUMENT,COMMERCIAL,3413.38,75,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,MONUMENT,COMMERCIAL,3413.38,75,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,2512870,CDM,636,RC,,BOTH,1,ME,4551.17,1820.47,MONUMENT,COMMERCIAL,3413.38,75,,,OTHER,3413.38,4460.15,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,MONUMENT,COMMERCIAL,855.85,75,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,MONUMENT,COMMERCIAL,855.85,75,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,J2182,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,MONUMENT,COMMERCIAL,4708.32,75,,,OTHER,32,6152.2,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,C9473,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,MONUMENT,COMMERCIAL,4708.32,75,,,OTHER,4708.32,6152.2,PERCENT OF TOTAL BILLED CHARGES
PEMBROLIZUMAB 100MG/4ML,J9271,HCPCS,636,RC,,BOTH,4,ML,9937.15,3974.86,MONUMENT,COMMERCIAL,7452.86,75,,,OTHER,60.18,9738.4,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,MONUMENT,COMMERCIAL,71.84,75,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,MONUMENT,COMMERCIAL,71.84,75,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,2504150,CDM,636,RC,,BOTH,20,ML,95.78,38.31,MONUMENT,COMMERCIAL,71.84,75,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J2704,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,MONUMENT,COMMERCIAL,116.02,75,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J3490,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,MONUMENT,COMMERCIAL,116.02,75,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,MONUMENT,COMMERCIAL,2382.78,75,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,MONUMENT,COMMERCIAL,14253.31,75,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,MONUMENT,COMMERCIAL,11219.28,75,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,MONUMENT,COMMERCIAL,11219.28,75,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1930,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,MONUMENT,COMMERCIAL,11219.28,75,,,OTHER,50.4,14659.86,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,MONUMENT,COMMERCIAL,3987.48,75,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,MONUMENT,COMMERCIAL,3987.48,75,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,2514240,CDM,636,RC,,BOTH,120,ME,5316.64,2126.66,MONUMENT,COMMERCIAL,3987.48,75,,,OTHER,3987.48,5210.31,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,MONUMENT,COMMERCIAL,425.67,75,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,MONUMENT,COMMERCIAL,425.67,75,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,MONUMENT,COMMERCIAL,25678,75,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,MONUMENT,COMMERCIAL,25678,75,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,MONUMENT,COMMERCIAL,38.14,75,,,OTHER,0.02,49.83,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,MONUMENT,COMMERCIAL,38.14,75,,,OTHER,38.14,49.83,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,MONUMENT,COMMERCIAL,135.73,75,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,MONUMENT,COMMERCIAL,135.73,75,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,2515510,CDM,636,RC,,BOTH,1,ME,180.98,72.39,MONUMENT,COMMERCIAL,135.73,75,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,MONUMENT,COMMERCIAL,12756.14,75,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,MONUMENT,COMMERCIAL,12756.14,75,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1G BAG,J2001,HCPCS,636,RC,,BOTH,1,GR,104.73,41.89,MONUMENT,COMMERCIAL,78.55,75,,,OTHER,78.55,102.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,MONUMENT,COMMERCIAL,1905.71,75,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,MONUMENT,COMMERCIAL,1905.71,75,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,MONUMENT,COMMERCIAL,1840.7,75,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,MONUMENT,COMMERCIAL,1840.7,75,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512020,CDM,636,RC,,BOTH,1,ME,2454.27,981.71,MONUMENT,COMMERCIAL,1840.7,75,,,OTHER,1840.7,2405.18,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,MONUMENT,COMMERCIAL,2219.29,75,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,MONUMENT,COMMERCIAL,2219.29,75,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,2504290,CDM,636,RC,,BOTH,,,2959.05,1183.62,MONUMENT,COMMERCIAL,2219.29,75,,,OTHER,2219.29,2899.87,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,MONUMENT,COMMERCIAL,138.97,75,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,MONUMENT,COMMERCIAL,138.97,75,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,2501950,CDM,636,RC,,BOTH,100,ME,185.29,74.12,MONUMENT,COMMERCIAL,138.97,75,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,MONUMENT,COMMERCIAL,3413.4,75,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,MONUMENT,COMMERCIAL,3413.4,75,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,MONUMENT,COMMERCIAL,3413.4,75,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,MONUMENT,COMMERCIAL,3413.4,75,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,MONUMENT,COMMERCIAL,5921.84,75,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,MONUMENT,COMMERCIAL,5921.84,75,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,MONUMENT,COMMERCIAL,1553.55,75,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,MONUMENT,COMMERCIAL,1553.55,75,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,MONUMENT,COMMERCIAL,693.64,75,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,MONUMENT,COMMERCIAL,693.64,75,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,MONUMENT,COMMERCIAL,5378.27,75,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,MONUMENT,COMMERCIAL,5378.27,75,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,MONUMENT,COMMERCIAL,35.27,75,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,MONUMENT,COMMERCIAL,35.27,75,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,MONUMENT,COMMERCIAL,3041.28,75,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,MONUMENT,COMMERCIAL,3041.28,75,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,2510300,CDM,636,RC,,BOTH,,,4055.04,1622.02,MONUMENT,COMMERCIAL,3041.28,75,,,OTHER,3041.28,3973.94,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,MONUMENT,COMMERCIAL,13411.27,75,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,MONUMENT,COMMERCIAL,13411.27,75,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,MONUMENT,COMMERCIAL,13411.27,75,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,MONUMENT,COMMERCIAL,13411.27,75,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,J2350,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,MONUMENT,COMMERCIAL,25881.65,75,,,OTHER,61.7,33818.69,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,C9494,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,MONUMENT,COMMERCIAL,25881.65,75,,,OTHER,25881.65,33818.69,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,MONUMENT,COMMERCIAL,575.2,75,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,MONUMENT,COMMERCIAL,575.2,75,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,MONUMENT,COMMERCIAL,9834.81,75,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,MONUMENT,COMMERCIAL,9834.81,75,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,MONUMENT,COMMERCIAL,22220.09,75,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,MONUMENT,COMMERCIAL,22220.09,75,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,MONUMENT,COMMERCIAL,22220.09,75,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,MONUMENT,COMMERCIAL,22220.09,75,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,MONUMENT,COMMERCIAL,3644.85,75,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,MONUMENT,COMMERCIAL,3644.85,75,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512030,CDM,636,RC,,BOTH,1,ME,4859.8,1943.92,MONUMENT,COMMERCIAL,3644.85,75,,,OTHER,3644.85,4762.61,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,MONUMENT,COMMERCIAL,13373.31,75,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,MONUMENT,COMMERCIAL,13373.31,75,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,2504050,CDM,636,RC,,BOTH,30,ML,17831.08,7132.43,MONUMENT,COMMERCIAL,13373.31,75,,,OTHER,13373.31,17474.46,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,MONUMENT,COMMERCIAL,711.51,75,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,MONUMENT,COMMERCIAL,711.51,75,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J2724,HCPCS,636,RC,,BOTH,,,2217.07,886.83,MONUMENT,COMMERCIAL,1662.8,75,,,OTHER,15.78,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,MONUMENT,COMMERCIAL,1662.8,75,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,MONUMENT,COMMERCIAL,1662.8,75,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,C9132,HCPCS,636,RC,,BOTH,,,2217.07,886.83,MONUMENT,COMMERCIAL,1662.8,75,,,OTHER,1662.8,2172.73,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,MONUMENT,COMMERCIAL,5047.49,75,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,MONUMENT,COMMERCIAL,5047.49,75,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,2512120,CDM,636,RC,,BOTH,500,ML,6729.98,2691.99,MONUMENT,COMMERCIAL,5047.49,75,,,OTHER,5047.49,6595.38,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,MONUMENT,COMMERCIAL,557.84,75,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,MONUMENT,COMMERCIAL,557.84,75,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,2510490,CDM,636,RC,,BOTH,500,ME,743.79,297.51,MONUMENT,COMMERCIAL,557.84,75,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,MONUMENT,COMMERCIAL,1445.25,75,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,MONUMENT,COMMERCIAL,1445.25,75,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,MONUMENT,COMMERCIAL,1450.59,75,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,MONUMENT,COMMERCIAL,1450.59,75,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,2517300,CDM,636,RC,,BOTH,750,ME,1934.12,773.65,MONUMENT,COMMERCIAL,1450.59,75,,,OTHER,1450.59,1895.44,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,2519870,CDM,636,RC,,BOTH,,,10377.46,4150.98,MONUMENT,COMMERCIAL,7783.1,75,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,C9159,HCPCS,636,RC,,BOTH,,,10377.46,4150.98,MONUMENT,COMMERCIAL,7783.1,75,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J2724,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,MONUMENT,COMMERCIAL,5499.1,75,,,OTHER,15.78,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,MONUMENT,COMMERCIAL,5499.1,75,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,MONUMENT,COMMERCIAL,5499.1,75,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,C9132,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,MONUMENT,COMMERCIAL,5499.1,75,,,OTHER,5499.1,7185.5,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,MONUMENT,COMMERCIAL,110.24,75,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,MONUMENT,COMMERCIAL,110.24,75,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
PNEUMOCOCCAL VACCINE 0.5ML,2518440,CDM,636,RC,,BOTH,0.5,ML,295.08,118.03,MONUMENT,COMMERCIAL,221.31,75,,,OTHER,221.31,289.18,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,2511640,CDM,636,RC,,BOTH,,,146.98,58.79,MONUMENT,COMMERCIAL,110.24,75,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,MONUMENT,COMMERCIAL,909.81,75,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,MONUMENT,COMMERCIAL,909.81,75,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
FLU VACCINE HIGH DOSE,2514130,CDM,636,RC,,BOTH,,,179.64,71.86,MONUMENT,COMMERCIAL,134.73,75,,,OTHER,134.73,176.05,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,Q2036,HCPCS,636,RC,,BOTH,,,64.97,25.99,MONUMENT,COMMERCIAL,48.72,75,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,2511440,CDM,636,RC,,BOTH,,,64.97,25.99,MONUMENT,COMMERCIAL,48.72,75,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,MONUMENT,COMMERCIAL,29.45,75,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,MONUMENT,COMMERCIAL,29.45,75,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,2510770,CDM,250,RC,,BOTH,,,39.27,15.71,MONUMENT,COMMERCIAL,29.45,75,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
METHYLNALTREXONE BROMIDE,J2212,HCPCS,636,RC,,BOTH,0.1,ME,347.96,139.18,MONUMENT,COMMERCIAL,260.97,75,,,OTHER,1.21,341,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,MONUMENT,COMMERCIAL,49.55,75,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,MONUMENT,COMMERCIAL,49.55,75,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,MONUMENT,COMMERCIAL,51.13,75,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,MONUMENT,COMMERCIAL,51.13,75,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
RABIES IMM GLOB 1500U/ML 5ML,2515770,CDM,636,RC,,BOTH,5,ML,5629.18,2251.67,MONUMENT,COMMERCIAL,4221.88,75,,,OTHER,299.93,5516.59,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,MONUMENT,COMMERCIAL,11.65,75,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,MONUMENT,COMMERCIAL,11.65,75,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,2518680,CDM,636,RC,,BOTH,0.5,ML,110.93,44.37,MONUMENT,COMMERCIAL,83.2,75,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,MONUMENT,COMMERCIAL,83.2,75,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,MONUMENT,COMMERCIAL,83.2,75,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,MONUMENT,COMMERCIAL,16.46,75,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,MONUMENT,COMMERCIAL,16.46,75,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
RABIES VACCINE,2520290,CDM,636,RC,,BOTH,,,870.92,348.37,MONUMENT,COMMERCIAL,653.19,75,,,OTHER,338.91,853.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,MONUMENT,COMMERCIAL,16.18,75,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,MONUMENT,COMMERCIAL,16.18,75,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,MONUMENT,COMMERCIAL,56.25,75,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,MONUMENT,COMMERCIAL,56.25,75,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,MONUMENT,COMMERCIAL,22.88,75,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,MONUMENT,COMMERCIAL,22.88,75,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,MONUMENT,COMMERCIAL,42.18,75,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,MONUMENT,COMMERCIAL,42.18,75,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
HALOPERIDOL 5 MG/ML AMP,J1630,HCPCS,636,RC,,BOTH,5,ME,88.26,35.3,MONUMENT,COMMERCIAL,66.19,75,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,MONUMENT,COMMERCIAL,44.27,75,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,MONUMENT,COMMERCIAL,44.27,75,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,MONUMENT,COMMERCIAL,4.59,75,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,MONUMENT,COMMERCIAL,4.59,75,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,2519130,CDM,636,RC,,BOTH,3,ME,6.12,2.45,MONUMENT,COMMERCIAL,4.59,75,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,MONUMENT,COMMERCIAL,235.64,75,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,MONUMENT,COMMERCIAL,235.64,75,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,MONUMENT,COMMERCIAL,235.64,75,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,MONUMENT,COMMERCIAL,235.64,75,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
LR 1000 ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,90.88,36.35,UNITED HEALTH,UNITED COMMERCIAL,77.25,85,,,OTHER,68.16,89.07,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,UNITED HEALTH,UNITED COMMERCIAL,74.53,85,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,UNITED HEALTH,UNITED COMMERCIAL,74.53,85,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,UNITED HEALTH,UNITED COMMERCIAL,102119.77,85,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,UNITED HEALTH,UNITED COMMERCIAL,102119.77,85,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,2516780,CDM,636,RC,,BOTH,,,120140.9,48056.36,UNITED HEALTH,UNITED COMMERCIAL,102119.77,85,,,OTHER,90105.68,117738.08,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,62.9,85,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,UNITED HEALTH,UNITED COMMERCIAL,62.9,85,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,UNITED HEALTH,UNITED COMMERCIAL,60.28,85,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,UNITED HEALTH,UNITED COMMERCIAL,60.28,85,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,UNITED HEALTH,UNITED COMMERCIAL,66.39,85,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,UNITED HEALTH,UNITED COMMERCIAL,66.39,85,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS KCL 20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,98.13,39.25,UNITED HEALTH,UNITED COMMERCIAL,83.41,85,,,OTHER,73.6,96.17,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,UNITED HEALTH,UNITED COMMERCIAL,69.44,85,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,UNITED HEALTH,UNITED COMMERCIAL,69.44,85,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,UNITED HEALTH,UNITED COMMERCIAL,2.36,85,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,UNITED HEALTH,UNITED COMMERCIAL,2.36,85,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,UNITED HEALTH,UNITED COMMERCIAL,2.54,85,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,UNITED HEALTH,UNITED COMMERCIAL,2.54,85,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,2510250,CDM,636,RC,,BOTH,1,ML,2.98,1.19,UNITED HEALTH,UNITED COMMERCIAL,2.54,85,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,UNITED HEALTH,UNITED COMMERCIAL,55.3,85,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,UNITED HEALTH,UNITED COMMERCIAL,55.3,85,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,UNITED HEALTH,UNITED COMMERCIAL,18.08,85,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,UNITED HEALTH,UNITED COMMERCIAL,18.08,85,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,UNITED HEALTH,UNITED COMMERCIAL,56.56,85,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,UNITED HEALTH,UNITED COMMERCIAL,56.56,85,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,UNITED HEALTH,UNITED COMMERCIAL,45.09,85,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,UNITED HEALTH,UNITED COMMERCIAL,45.09,85,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,UNITED HEALTH,UNITED COMMERCIAL,7.09,85,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,UNITED HEALTH,UNITED COMMERCIAL,7.09,85,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMULIN R) 3 ML VIAL,J1815,HCPCS,636,RC,,BOTH,3,ML,10.78,4.31,UNITED HEALTH,UNITED COMMERCIAL,9.16,85,,,OTHER,8.09,10.57,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,66.25,26.5,UNITED HEALTH,UNITED COMMERCIAL,56.31,85,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 1MG INJ,J1170,HCPCS,636,RC,,BOTH,1,ME,53.73,21.49,UNITED HEALTH,UNITED COMMERCIAL,45.67,85,,,OTHER,40.3,52.66,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.4 MG/ML,J2310,HCPCS,636,RC,,BOTH,0.4,ML,72.54,29.02,UNITED HEALTH,UNITED COMMERCIAL,61.66,85,,,OTHER,54.4,71.09,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,UNITED HEALTH,UNITED COMMERCIAL,84.56,85,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,UNITED HEALTH,UNITED COMMERCIAL,84.56,85,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
NS  100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,63.3,25.32,UNITED HEALTH,UNITED COMMERCIAL,53.81,85,,,OTHER,47.48,62.04,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 0.5% 50ML VIAL   MD,J2001,HCPCS,636,RC,,BOTH,50,ML,53.6,21.44,UNITED HEALTH,UNITED COMMERCIAL,45.56,85,,,OTHER,40.2,52.53,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,61.36,24.54,UNITED HEALTH,UNITED COMMERCIAL,52.16,85,,,OTHER,46.02,60.13,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J7507,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,UNITED HEALTH,UNITED COMMERCIAL,3.27,85,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J3490,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,UNITED HEALTH,UNITED COMMERCIAL,3.27,85,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UNITED HEALTH,UNITED COMMERCIAL,76.14,85,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UNITED HEALTH,UNITED COMMERCIAL,76.14,85,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7070,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UNITED HEALTH,UNITED COMMERCIAL,76.14,85,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITAL 130MG/ML VIAL,J2560,HCPCS,636,RC,,BOTH,130,ME,190.89,76.36,UNITED HEALTH,UNITED COMMERCIAL,162.25,85,,,OTHER,143.17,187.07,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 2 MG SYRINGE,J1170,HCPCS,636,RC,,BOTH,2,ME,57.58,23.03,UNITED HEALTH,UNITED COMMERCIAL,48.94,85,,,OTHER,43.19,56.43,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,UNITED HEALTH,UNITED COMMERCIAL,80.21,85,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,UNITED HEALTH,UNITED COMMERCIAL,80.21,85,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE 25 MG AMP,J2550,HCPCS,636,RC,,BOTH,25,ME,48.33,19.33,UNITED HEALTH,UNITED COMMERCIAL,41.08,85,,,OTHER,36.25,47.36,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,UNITED HEALTH,UNITED COMMERCIAL,55.64,85,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,UNITED HEALTH,UNITED COMMERCIAL,55.64,85,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,2515450,CDM,636,RC,,BOTH,2,GR,115.87,46.35,UNITED HEALTH,UNITED COMMERCIAL,98.49,85,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,UNITED HEALTH,UNITED COMMERCIAL,845,85,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,UNITED HEALTH,UNITED COMMERCIAL,845,85,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 2.5MG,J8610,HCPCS,636,RC,,BOTH,2.5,ME,25.39,10.16,UNITED HEALTH,UNITED COMMERCIAL,21.58,85,,,OTHER,19.04,24.88,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,UNITED HEALTH,UNITED COMMERCIAL,845,85,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,UNITED HEALTH,UNITED COMMERCIAL,19.18,85,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,UNITED HEALTH,UNITED COMMERCIAL,19.18,85,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,J3490,HCPCS,636,RC,,BOTH,2,GR,115.87,46.35,UNITED HEALTH,UNITED COMMERCIAL,98.49,85,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 1G VIAL,J3490,HCPCS,250,RC,,BOTH,1,GR,131.96,52.78,UNITED HEALTH,UNITED COMMERCIAL,112.17,85,,,OTHER,98.97,129.32,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,UNITED HEALTH,UNITED COMMERCIAL,55.64,85,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,UNITED HEALTH,UNITED COMMERCIAL,55.64,85,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,2508230,CDM,250,RC,,BOTH,1.25,ME,22.57,9.03,UNITED HEALTH,UNITED COMMERCIAL,19.18,85,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,UNITED HEALTH,UNITED COMMERCIAL,845,85,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J1162,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,UNITED HEALTH,UNITED COMMERCIAL,7801.37,85,,,OTHER,5016.31,8994.52,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,UNITED HEALTH,UNITED COMMERCIAL,37.71,85,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,UNITED HEALTH,UNITED COMMERCIAL,37.71,85,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J2150,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,UNITED HEALTH,UNITED COMMERCIAL,155.17,85,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,UNITED HEALTH,UNITED COMMERCIAL,96.98,85,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,UNITED HEALTH,UNITED COMMERCIAL,96.98,85,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J7799,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,UNITED HEALTH,UNITED COMMERCIAL,155.17,85,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J3490,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,UNITED HEALTH,UNITED COMMERCIAL,7801.37,85,,,OTHER,6883.56,8994.52,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B IMM. GLOBULIN 5 ML,2510180,CDM,636,RC,,BOTH,5,ML,333.07,133.23,UNITED HEALTH,UNITED COMMERCIAL,283.11,85,,,OTHER,148.18,326.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,UNITED HEALTH,UNITED COMMERCIAL,59.33,85,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,UNITED HEALTH,UNITED COMMERCIAL,59.33,85,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,UNITED HEALTH,UNITED COMMERCIAL,4006.49,85,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,UNITED HEALTH,UNITED COMMERCIAL,4006.49,85,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,UNITED HEALTH,UNITED COMMERCIAL,65.57,85,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,UNITED HEALTH,UNITED COMMERCIAL,65.57,85,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
ARIPIPRAZOLE 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,67.81,27.12,UNITED HEALTH,UNITED COMMERCIAL,57.64,85,,,OTHER,50.86,66.45,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,UNITED HEALTH,UNITED COMMERCIAL,57.22,85,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,UNITED HEALTH,UNITED COMMERCIAL,57.22,85,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2274,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,UNITED HEALTH,UNITED COMMERCIAL,114.73,85,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2270,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,UNITED HEALTH,UNITED COMMERCIAL,114.73,85,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
NALBUPHINE 10MG/ML AMP,J2300,HCPCS,636,RC,,BOTH,10,ME,51.33,20.53,UNITED HEALTH,UNITED COMMERCIAL,43.63,85,,,OTHER,38.5,50.3,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 2.5MG TAB,2515000,CDM,636,RC,,BOTH,2.5,ME,15.69,6.28,UNITED HEALTH,UNITED COMMERCIAL,13.33,85,,,OTHER,11.77,15.37,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 250MG/50ML,J1956,HCPCS,636,RC,,BOTH,50,ML,81.19,32.48,UNITED HEALTH,UNITED COMMERCIAL,69.01,85,,,OTHER,60.89,79.57,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,UNITED HEALTH,UNITED COMMERCIAL,73.51,85,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,UNITED HEALTH,UNITED COMMERCIAL,73.51,85,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,UNITED HEALTH,UNITED COMMERCIAL,58.66,85,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,UNITED HEALTH,UNITED COMMERCIAL,58.66,85,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,UNITED HEALTH,UNITED COMMERCIAL,74.06,85,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,UNITED HEALTH,UNITED COMMERCIAL,74.06,85,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE,J3490,HCPCS,250,RC,,BOTH,,,37.19,14.87,UNITED HEALTH,UNITED COMMERCIAL,31.61,85,,,OTHER,27.89,36.44,PERCENT OF TOTAL BILLED CHARGES
PROPRANOLOL 1MG AMP,J1800,HCPCS,636,RC,,BOTH,1,ME,82.46,32.98,UNITED HEALTH,UNITED COMMERCIAL,70.09,85,,,OTHER,61.85,80.81,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,UNITED HEALTH,UNITED COMMERCIAL,34.94,85,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,UNITED HEALTH,UNITED COMMERCIAL,34.94,85,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,UNITED HEALTH,UNITED COMMERCIAL,58.86,85,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,UNITED HEALTH,UNITED COMMERCIAL,58.86,85,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,2504940,CDM,250,RC,,BOTH,50,ME,41.1,16.44,UNITED HEALTH,UNITED COMMERCIAL,34.94,85,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.86,85,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.86,85,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,UNITED HEALTH,UNITED COMMERCIAL,10.57,85,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,UNITED HEALTH,UNITED COMMERCIAL,10.57,85,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,2506040,CDM,250,RC,,BOTH,,,12.43,4.97,UNITED HEALTH,UNITED COMMERCIAL,10.57,85,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J0280,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,UNITED HEALTH,UNITED COMMERCIAL,19.3,85,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J0694,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,UNITED HEALTH,UNITED COMMERCIAL,90.73,85,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,UNITED HEALTH,UNITED COMMERCIAL,177.79,85,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,UNITED HEALTH,UNITED COMMERCIAL,177.79,85,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,UNITED HEALTH,UNITED COMMERCIAL,1486.75,85,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,UNITED HEALTH,UNITED COMMERCIAL,1486.75,85,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,UNITED HEALTH,UNITED COMMERCIAL,17.79,85,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,UNITED HEALTH,UNITED COMMERCIAL,17.79,85,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,UNITED HEALTH,UNITED COMMERCIAL,90.73,85,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J3490,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,UNITED HEALTH,UNITED COMMERCIAL,19.3,85,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 2G VIAL,J3490,HCPCS,250,RC,,BOTH,2,GR,107.37,42.95,UNITED HEALTH,UNITED COMMERCIAL,91.26,85,,,OTHER,80.53,105.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,2504480,CDM,636,RC,,BOTH,7.5,ME,1749.12,699.65,UNITED HEALTH,UNITED COMMERCIAL,1486.75,85,,,OTHER,1311.84,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,2508220,CDM,250,RC,,BOTH,0.3,ME,20.93,8.37,UNITED HEALTH,UNITED COMMERCIAL,17.79,85,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J7626,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,UNITED HEALTH,UNITED COMMERCIAL,33.49,85,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J7674,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,UNITED HEALTH,UNITED COMMERCIAL,39.01,85,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J3490,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,UNITED HEALTH,UNITED COMMERCIAL,39.01,85,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,UNITED HEALTH,UNITED COMMERCIAL,33.49,85,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,UNITED HEALTH,UNITED COMMERCIAL,20.65,85,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,UNITED HEALTH,UNITED COMMERCIAL,20.65,85,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,2504400,CDM,250,RC,,BOTH,4,GR,24.29,9.72,UNITED HEALTH,UNITED COMMERCIAL,20.65,85,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,UNITED HEALTH,UNITED COMMERCIAL,19.12,85,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,UNITED HEALTH,UNITED COMMERCIAL,19.12,85,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,2502460,CDM,250,RC,,BOTH,,,22.49,9,UNITED HEALTH,UNITED COMMERCIAL,19.12,85,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,UNITED HEALTH,UNITED COMMERCIAL,70.85,85,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,UNITED HEALTH,UNITED COMMERCIAL,70.85,85,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UNITED HEALTH,UNITED COMMERCIAL,107.47,85,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UNITED HEALTH,UNITED COMMERCIAL,107.47,85,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UNITED HEALTH,UNITED COMMERCIAL,107.47,85,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UNITED HEALTH,UNITED COMMERCIAL,107.47,85,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 5MG TAB,2519250,CDM,636,RC,,BOTH,5,ME,14.15,5.66,UNITED HEALTH,UNITED COMMERCIAL,12.02,85,,,OTHER,10.61,13.86,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,UNITED HEALTH,UNITED COMMERCIAL,150.28,85,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,UNITED HEALTH,UNITED COMMERCIAL,150.28,85,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,2505390,CDM,636,RC,,BOTH,0.25,ME,176.81,70.72,UNITED HEALTH,UNITED COMMERCIAL,150.28,85,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,UNITED HEALTH,UNITED COMMERCIAL,19.81,85,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,UNITED HEALTH,UNITED COMMERCIAL,19.81,85,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,UNITED HEALTH,UNITED COMMERCIAL,13.59,85,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,UNITED HEALTH,UNITED COMMERCIAL,13.59,85,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,2504300,CDM,250,RC,,BOTH,,,23.31,9.32,UNITED HEALTH,UNITED COMMERCIAL,19.81,85,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,2504920,CDM,250,RC,,BOTH,,,15.98,6.39,UNITED HEALTH,UNITED COMMERCIAL,13.59,85,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,UNITED HEALTH,UNITED COMMERCIAL,48.18,85,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,UNITED HEALTH,UNITED COMMERCIAL,48.18,85,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,J3490,HCPCS,250,RC,,BOTH,,,126.41,50.56,UNITED HEALTH,UNITED COMMERCIAL,107.45,85,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,2515370,CDM,250,RC,,BOTH,,,126.41,50.56,UNITED HEALTH,UNITED COMMERCIAL,107.45,85,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 20ML,J2001,HCPCS,636,RC,,BOTH,20,ML,62.37,24.95,UNITED HEALTH,UNITED COMMERCIAL,53.01,85,,,OTHER,46.78,61.12,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,UNITED HEALTH,UNITED COMMERCIAL,163.74,85,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,UNITED HEALTH,UNITED COMMERCIAL,163.74,85,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
METHOCARBAMOL 100MG VIAL,J2800,HCPCS,636,RC,,BOTH,100,ME,204.62,81.85,UNITED HEALTH,UNITED COMMERCIAL,173.93,85,,,OTHER,153.47,200.53,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 10 U/ML INJ,J2590,HCPCS,636,RC,,BOTH,10,UN,50.06,20.02,UNITED HEALTH,UNITED COMMERCIAL,42.55,85,,,OTHER,37.55,49.06,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,UNITED HEALTH,UNITED COMMERCIAL,50.35,85,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,UNITED HEALTH,UNITED COMMERCIAL,50.35,85,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,2501130,CDM,636,RC,,BOTH,1.5,GR,59.23,23.69,UNITED HEALTH,UNITED COMMERCIAL,50.35,85,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,J3490,HCPCS,250,RC,,BOTH,1000,ME,16.62,6.65,UNITED HEALTH,UNITED COMMERCIAL,14.13,85,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,2516900,CDM,250,RC,,BOTH,1000,ME,16.62,6.65,UNITED HEALTH,UNITED COMMERCIAL,14.13,85,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,UNITED HEALTH,UNITED COMMERCIAL,52.57,85,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,UNITED HEALTH,UNITED COMMERCIAL,52.57,85,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,UNITED HEALTH,UNITED COMMERCIAL,75.43,85,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,UNITED HEALTH,UNITED COMMERCIAL,75.43,85,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2274,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,UNITED HEALTH,UNITED COMMERCIAL,44.98,85,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2270,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,UNITED HEALTH,UNITED COMMERCIAL,44.98,85,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,UNITED HEALTH,UNITED COMMERCIAL,71.33,85,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,UNITED HEALTH,UNITED COMMERCIAL,71.33,85,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,J3490,HCPCS,250,RC,,BOTH,50,ME,17.65,7.06,UNITED HEALTH,UNITED COMMERCIAL,15,85,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,2510700,CDM,250,RC,,BOTH,50,ME,17.65,7.06,UNITED HEALTH,UNITED COMMERCIAL,15,85,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
NS 500ML,J7030,HCPCS,636,RC,,BOTH,500,ML,81.62,32.65,UNITED HEALTH,UNITED COMMERCIAL,69.38,85,,,OTHER,61.22,79.99,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UNITED HEALTH,UNITED COMMERCIAL,4366.93,85,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UNITED HEALTH,UNITED COMMERCIAL,4366.93,85,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,2509490,CDM,636,RC,,BOTH,1,ME,472.36,188.94,UNITED HEALTH,UNITED COMMERCIAL,401.51,85,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,UNITED HEALTH,UNITED COMMERCIAL,401.51,85,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,UNITED HEALTH,UNITED COMMERCIAL,401.51,85,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,J3490,HCPCS,250,RC,,BOTH,0.125,ME,48.04,19.22,UNITED HEALTH,UNITED COMMERCIAL,40.83,85,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UNITED HEALTH,UNITED COMMERCIAL,4366.93,85,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UNITED HEALTH,UNITED COMMERCIAL,4366.93,85,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,2506740,CDM,250,RC,,BOTH,0.125,ME,48.04,19.22,UNITED HEALTH,UNITED COMMERCIAL,40.83,85,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,UNITED HEALTH,UNITED COMMERCIAL,426.36,85,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,UNITED HEALTH,UNITED COMMERCIAL,426.36,85,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,2508270,CDM,250,RC,,BOTH,,,501.6,200.64,UNITED HEALTH,UNITED COMMERCIAL,426.36,85,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,UNITED HEALTH,UNITED COMMERCIAL,34.57,85,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,UNITED HEALTH,UNITED COMMERCIAL,34.57,85,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UNITED HEALTH,UNITED COMMERCIAL,62.99,85,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UNITED HEALTH,UNITED COMMERCIAL,62.99,85,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UNITED HEALTH,UNITED COMMERCIAL,62.99,85,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UNITED HEALTH,UNITED COMMERCIAL,62.99,85,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,UNITED HEALTH,UNITED COMMERCIAL,16.81,85,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,UNITED HEALTH,UNITED COMMERCIAL,16.81,85,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,2505500,CDM,250,RC,,BOTH,5,ME,19.78,7.91,UNITED HEALTH,UNITED COMMERCIAL,16.81,85,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,UNITED HEALTH,UNITED COMMERCIAL,230.08,85,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,UNITED HEALTH,UNITED COMMERCIAL,230.08,85,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,2509880,CDM,250,RC,,BOTH,,,270.68,108.27,UNITED HEALTH,UNITED COMMERCIAL,230.08,85,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,UNITED HEALTH,UNITED COMMERCIAL,57.62,85,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,UNITED HEALTH,UNITED COMMERCIAL,57.62,85,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,2505960,CDM,636,RC,,BOTH,500,ME,67.78,27.11,UNITED HEALTH,UNITED COMMERCIAL,57.62,85,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% 50ML MDV,J0665,HCPCS,636,RC,,BOTH,50,ML,42.7,17.08,UNITED HEALTH,UNITED COMMERCIAL,36.29,85,,,OTHER,0.02,41.84,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 1MG AMP,J3430,HCPCS,636,RC,,BOTH,1,ME,96.12,38.45,UNITED HEALTH,UNITED COMMERCIAL,81.7,85,,,OTHER,72.09,94.2,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,UNITED HEALTH,UNITED COMMERCIAL,53.75,85,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,UNITED HEALTH,UNITED COMMERCIAL,53.75,85,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,UNITED HEALTH,UNITED COMMERCIAL,20.43,85,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,UNITED HEALTH,UNITED COMMERCIAL,20.43,85,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,2507500,CDM,250,RC,,BOTH,50,ME,24.03,9.61,UNITED HEALTH,UNITED COMMERCIAL,20.43,85,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UNITED HEALTH,UNITED COMMERCIAL,41.92,85,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UNITED HEALTH,UNITED COMMERCIAL,41.92,85,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3370,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UNITED HEALTH,UNITED COMMERCIAL,41.92,85,,,OTHER,36.99,48.33,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.87,85,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.87,85,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.87,85,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UNITED HEALTH,UNITED COMMERCIAL,42.87,85,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
METOCLOPRAMIDE 5MG/ML VIAL,J2765,HCPCS,636,RC,,BOTH,5,ME,45.92,18.37,UNITED HEALTH,UNITED COMMERCIAL,39.04,85,,,OTHER,34.44,45.01,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,UNITED HEALTH,UNITED COMMERCIAL,19,85,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,UNITED HEALTH,UNITED COMMERCIAL,19,85,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,2507510,CDM,250,RC,,BOTH,12.5,ME,22.35,8.94,UNITED HEALTH,UNITED COMMERCIAL,19,85,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,J3490,HCPCS,255,RC,,BOTH,30,ML,110.55,44.22,UNITED HEALTH,UNITED COMMERCIAL,93.96,85,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,2508130,CDM,255,RC,,BOTH,30,ML,110.55,44.22,UNITED HEALTH,UNITED COMMERCIAL,93.96,85,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 0.9% NACL,J1580,HCPCS,636,RC,,BOTH,80,ME,68.12,27.25,UNITED HEALTH,UNITED COMMERCIAL,57.9,85,,,OTHER,51.09,66.75,PERCENT OF TOTAL BILLED CHARGES
SPIRONOLACTONE 25 MG TAB,J3490,HCPCS,250,RC,,BOTH,25,ME,17.63,7.05,UNITED HEALTH,UNITED COMMERCIAL,14.98,85,,,OTHER,13.22,17.27,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,UNITED HEALTH,UNITED COMMERCIAL,28.55,85,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,UNITED HEALTH,UNITED COMMERCIAL,28.55,85,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,J3490,HCPCS,250,RC,,BOTH,180,ME,59.19,23.67,UNITED HEALTH,UNITED COMMERCIAL,50.31,85,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,2506840,CDM,250,RC,,BOTH,180,ME,59.19,23.67,UNITED HEALTH,UNITED COMMERCIAL,50.31,85,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,UNITED HEALTH,UNITED COMMERCIAL,123.21,85,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,UNITED HEALTH,UNITED COMMERCIAL,123.21,85,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
MENTHOL ZINCOX,J3490,HCPCS,250,RC,,BOTH,,,26.42,10.57,UNITED HEALTH,UNITED COMMERCIAL,22.46,85,,,OTHER,19.82,25.89,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,UNITED HEALTH,UNITED COMMERCIAL,267.84,85,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,UNITED HEALTH,UNITED COMMERCIAL,267.84,85,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,2508790,CDM,636,RC,,BOTH,50,ME,125,50,UNITED HEALTH,UNITED COMMERCIAL,106.25,85,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,UNITED HEALTH,UNITED COMMERCIAL,102.41,85,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,UNITED HEALTH,UNITED COMMERCIAL,102.41,85,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,UNITED HEALTH,UNITED COMMERCIAL,102.41,85,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,UNITED HEALTH,UNITED COMMERCIAL,102.41,85,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
GLYCOPYRROLATE 0.2 MG/ML,J3490,HCPCS,250,RC,,BOTH,0.2,ML,74.12,29.65,UNITED HEALTH,UNITED COMMERCIAL,63,85,,,OTHER,55.59,72.64,PERCENT OF TOTAL BILLED CHARGES
HYDROCORT SOD.SUCC. 100MG VIAL,J1720,HCPCS,636,RC,,BOTH,100,ME,71.91,28.76,UNITED HEALTH,UNITED COMMERCIAL,61.12,85,,,OTHER,53.93,70.47,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 40MG VIAL,J2920,HCPCS,636,RC,,BOTH,40,ME,58,23.2,UNITED HEALTH,UNITED COMMERCIAL,49.3,85,,,OTHER,43.5,56.84,PERCENT OF TOTAL BILLED CHARGES
NS 250ML GLASS BOTTLE,J7030,HCPCS,636,RC,,BOTH,250,ML,79.33,31.73,UNITED HEALTH,UNITED COMMERCIAL,67.43,85,,,OTHER,59.5,77.75,PERCENT OF TOTAL BILLED CHARGES
PROCHLORPERAZINE 10 MG VIAL,J0780,HCPCS,636,RC,,BOTH,10,ME,74.3,29.72,UNITED HEALTH,UNITED COMMERCIAL,63.16,85,,,OTHER,55.73,72.81,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,UNITED HEALTH,UNITED COMMERCIAL,14.1,85,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,UNITED HEALTH,UNITED COMMERCIAL,14.1,85,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,2522260,CDM,250,RC,,BOTH,100,ME,16.59,6.64,UNITED HEALTH,UNITED COMMERCIAL,14.1,85,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2371,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,UNITED HEALTH,UNITED COMMERCIAL,48.6,85,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2370,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,UNITED HEALTH,UNITED COMMERCIAL,48.6,85,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,UNITED HEALTH,UNITED COMMERCIAL,86.1,85,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,UNITED HEALTH,UNITED COMMERCIAL,86.1,85,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
FOLIC ACID 1 MG TAB,J3490,HCPCS,250,RC,,BOTH,1,ME,17.34,6.94,UNITED HEALTH,UNITED COMMERCIAL,14.74,85,,,OTHER,13.01,17,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,UNITED HEALTH,UNITED COMMERCIAL,71.49,85,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,UNITED HEALTH,UNITED COMMERCIAL,71.49,85,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
HYDRALAZINE 20 MG/ML VIAL,J0360,HCPCS,636,RC,,BOTH,20,ME,142.58,57.03,UNITED HEALTH,UNITED COMMERCIAL,121.19,85,,,OTHER,106.94,139.73,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,UNITED HEALTH,UNITED COMMERCIAL,39.2,85,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,UNITED HEALTH,UNITED COMMERCIAL,39.2,85,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
PATIENTS OWN MED,J3490,HCPCS,636,RC,,BOTH,,,0.52,0.21,UNITED HEALTH,UNITED COMMERCIAL,0.44,85,,,OTHER,0.39,0.51,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,UNITED HEALTH,UNITED COMMERCIAL,16.67,85,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,UNITED HEALTH,UNITED COMMERCIAL,16.67,85,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,2504830,CDM,250,RC,,BOTH,10,ME,19.61,7.84,UNITED HEALTH,UNITED COMMERCIAL,16.67,85,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,UNITED HEALTH,UNITED COMMERCIAL,50.39,85,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,UNITED HEALTH,UNITED COMMERCIAL,50.39,85,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,UNITED HEALTH,UNITED COMMERCIAL,118.29,85,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,UNITED HEALTH,UNITED COMMERCIAL,118.29,85,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,UNITED HEALTH,UNITED COMMERCIAL,14.71,85,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,UNITED HEALTH,UNITED COMMERCIAL,14.71,85,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,2509260,CDM,250,RC,,BOTH,40,ME,17.31,6.92,UNITED HEALTH,UNITED COMMERCIAL,14.71,85,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,UNITED HEALTH,UNITED COMMERCIAL,46.49,85,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,UNITED HEALTH,UNITED COMMERCIAL,46.49,85,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,39.52,85,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,UNITED HEALTH,UNITED COMMERCIAL,39.52,85,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 60MG/0.9% NS 50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,64.59,25.84,UNITED HEALTH,UNITED COMMERCIAL,54.9,85,,,OTHER,48.44,63.3,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,UNITED HEALTH,UNITED COMMERCIAL,57.22,85,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,UNITED HEALTH,UNITED COMMERCIAL,57.22,85,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,2511540,CDM,636,RC,,BOTH,,,146.98,58.79,UNITED HEALTH,UNITED COMMERCIAL,124.93,85,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,90715,HCPCS,636,RC,,BOTH,,,146.98,58.79,UNITED HEALTH,UNITED COMMERCIAL,124.93,85,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 80MG VIAL,J1580,HCPCS,636,RC,,BOTH,80,ME,47.86,19.14,UNITED HEALTH,UNITED COMMERCIAL,40.68,85,,,OTHER,35.89,46.9,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 4MEQ/ML 2ML VIAL,J3475,HCPCS,636,RC,,BOTH,2,ML,34.27,13.71,UNITED HEALTH,UNITED COMMERCIAL,29.13,85,,,OTHER,25.7,33.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,UNITED HEALTH,UNITED COMMERCIAL,47.52,85,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,UNITED HEALTH,UNITED COMMERCIAL,47.52,85,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,UNITED HEALTH,UNITED COMMERCIAL,47.52,85,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,UNITED HEALTH,UNITED COMMERCIAL,47.52,85,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,UNITED HEALTH,UNITED COMMERCIAL,54.97,85,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,UNITED HEALTH,UNITED COMMERCIAL,54.97,85,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,2513040,CDM,636,RC,,BOTH,20,ME,44.88,17.95,UNITED HEALTH,UNITED COMMERCIAL,38.15,85,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,UNITED HEALTH,UNITED COMMERCIAL,38.15,85,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,UNITED HEALTH,UNITED COMMERCIAL,38.15,85,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT 4MG,J3490,HCPCS,636,RC,,BOTH,4,ME,23.2,9.28,UNITED HEALTH,UNITED COMMERCIAL,19.72,85,,,OTHER,17.4,22.74,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J0665,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,UNITED HEALTH,UNITED COMMERCIAL,44.3,85,,,OTHER,0.02,51.08,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,UNITED HEALTH,UNITED COMMERCIAL,44.3,85,,,OTHER,39.09,51.08,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,UNITED HEALTH,UNITED COMMERCIAL,38.35,85,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,UNITED HEALTH,UNITED COMMERCIAL,38.35,85,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,2506990,CDM,636,RC,,BOTH,50,ME,45.11,18.05,UNITED HEALTH,UNITED COMMERCIAL,38.35,85,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
METHLYPREDNISOLONE 125MG VIAL,J2930,HCPCS,636,RC,,BOTH,125,ME,66.23,26.49,UNITED HEALTH,UNITED COMMERCIAL,56.3,85,,,OTHER,49.67,64.91,PERCENT OF TOTAL BILLED CHARGES
LORAZEPAM 2 MG/ML VIAL,J2060,HCPCS,636,RC,,BOTH,2,ME,55.93,22.37,UNITED HEALTH,UNITED COMMERCIAL,47.54,85,,,OTHER,41.94,54.81,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,S0164,HCPCS,636,RC,,BOTH,40,ME,74.08,29.63,UNITED HEALTH,UNITED COMMERCIAL,62.97,85,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,2507670,CDM,636,RC,,BOTH,40,ME,74.08,29.63,UNITED HEALTH,UNITED COMMERCIAL,62.97,85,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
NS  500ML,J7040,HCPCS,636,RC,,BOTH,500,ML,175.19,70.08,UNITED HEALTH,UNITED COMMERCIAL,148.91,85,,,OTHER,131.39,171.69,PERCENT OF TOTAL BILLED CHARGES
NON FORMULARY MED REC,2504941,CDM,636,RC,,BOTH,,,0.05,0.02,UNITED HEALTH,UNITED COMMERCIAL,0.04,85,,,OTHER,0.03,0.05,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 15MG VIAL,J1885,HCPCS,636,RC,,BOTH,15,ME,49.58,19.83,UNITED HEALTH,UNITED COMMERCIAL,42.14,85,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
DUONEB 0.5MG/3.ML,J7620,HCPCS,636,RC,,BOTH,3,ML,2.22,0.89,UNITED HEALTH,UNITED COMMERCIAL,1.88,85,,,OTHER,1.66,2.17,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,UNITED HEALTH,UNITED COMMERCIAL,44.54,85,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,UNITED HEALTH,UNITED COMMERCIAL,44.54,85,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
NS  250ML,J7050,HCPCS,636,RC,,BOTH,250,ML,83.9,33.56,UNITED HEALTH,UNITED COMMERCIAL,71.32,85,,,OTHER,62.93,82.22,PERCENT OF TOTAL BILLED CHARGES
NS  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,122.12,48.85,UNITED HEALTH,UNITED COMMERCIAL,103.8,85,,,OTHER,91.59,119.67,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,UNITED HEALTH,UNITED COMMERCIAL,676.26,85,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,UNITED HEALTH,UNITED COMMERCIAL,676.26,85,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,UNITED HEALTH,UNITED COMMERCIAL,43.17,85,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,UNITED HEALTH,UNITED COMMERCIAL,43.17,85,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,UNITED HEALTH,UNITED COMMERCIAL,62.12,85,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,UNITED HEALTH,UNITED COMMERCIAL,62.12,85,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,UNITED HEALTH,UNITED COMMERCIAL,65.71,85,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,UNITED HEALTH,UNITED COMMERCIAL,65.71,85,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
NEOSTIGMINE 1MG/ML INJ,J2710,HCPCS,636,RC,,BOTH,1,ME,81.21,32.48,UNITED HEALTH,UNITED COMMERCIAL,69.03,85,,,OTHER,60.91,79.59,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 100 MG/2 ML VIAL,J1165,HCPCS,636,RC,,BOTH,100,ME,31.36,12.54,UNITED HEALTH,UNITED COMMERCIAL,26.65,85,,,OTHER,23.52,30.73,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,UNITED HEALTH,UNITED COMMERCIAL,78.3,85,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,UNITED HEALTH,UNITED COMMERCIAL,78.3,85,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,UNITED HEALTH,UNITED COMMERCIAL,221.3,85,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,UNITED HEALTH,UNITED COMMERCIAL,221.3,85,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,UNITED HEALTH,UNITED COMMERCIAL,400.01,85,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,UNITED HEALTH,UNITED COMMERCIAL,400.01,85,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,2509110,CDM,636,RC,,BOTH,30,UN,470.6,188.24,UNITED HEALTH,UNITED COMMERCIAL,400.01,85,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,UNITED HEALTH,UNITED COMMERCIAL,70.68,85,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,UNITED HEALTH,UNITED COMMERCIAL,70.68,85,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.2MG AMP,J2310,HCPCS,636,RC,,BOTH,0.2,ME,117.05,46.82,UNITED HEALTH,UNITED COMMERCIAL,99.49,85,,,OTHER,87.79,114.71,PERCENT OF TOTAL BILLED CHARGES
HYDROXYZINE HCL 50 MG/ML VIAL ,J3410,HCPCS,636,RC,,BOTH,50,ME,101.36,40.54,UNITED HEALTH,UNITED COMMERCIAL,86.16,85,,,OTHER,76.02,99.33,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,UNITED HEALTH,UNITED COMMERCIAL,56.68,85,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,UNITED HEALTH,UNITED COMMERCIAL,56.68,85,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,UNITED HEALTH,UNITED COMMERCIAL,104.56,85,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,UNITED HEALTH,UNITED COMMERCIAL,104.56,85,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,UNITED HEALTH,UNITED COMMERCIAL,116.51,85,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,UNITED HEALTH,UNITED COMMERCIAL,116.51,85,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 500MG INJ,J1956,HCPCS,636,RC,,BOTH,500,ME,67.61,27.04,UNITED HEALTH,UNITED COMMERCIAL,57.47,85,,,OTHER,50.71,66.26,PERCENT OF TOTAL BILLED CHARGES
PERFLUTREN  SDV,Q9957,HCPCS,636,RC,,BOTH,,,813.57,325.43,UNITED HEALTH,UNITED COMMERCIAL,691.53,85,,,OTHER,610.18,797.3,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,UNITED HEALTH,UNITED COMMERCIAL,53.13,85,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,UNITED HEALTH,UNITED COMMERCIAL,53.13,85,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,2513380,CDM,636,RC,,BOTH,100,ME,62.5,25,UNITED HEALTH,UNITED COMMERCIAL,53.13,85,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,UNITED HEALTH,UNITED COMMERCIAL,38.32,85,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,UNITED HEALTH,UNITED COMMERCIAL,38.32,85,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UNITED HEALTH,UNITED COMMERCIAL,110.48,85,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UNITED HEALTH,UNITED COMMERCIAL,110.48,85,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UNITED HEALTH,UNITED COMMERCIAL,110.48,85,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UNITED HEALTH,UNITED COMMERCIAL,110.48,85,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7060,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UNITED HEALTH,UNITED COMMERCIAL,71.43,85,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UNITED HEALTH,UNITED COMMERCIAL,71.43,85,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UNITED HEALTH,UNITED COMMERCIAL,71.43,85,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,UNITED HEALTH,UNITED COMMERCIAL,353.13,85,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,UNITED HEALTH,UNITED COMMERCIAL,353.13,85,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,UNITED HEALTH,UNITED COMMERCIAL,393.94,85,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,UNITED HEALTH,UNITED COMMERCIAL,393.94,85,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,UNITED HEALTH,UNITED COMMERCIAL,1.87,85,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,UNITED HEALTH,UNITED COMMERCIAL,1.87,85,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,2512600,CDM,636,RC,,BOTH,100,ME,2.21,0.88,UNITED HEALTH,UNITED COMMERCIAL,1.87,85,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 1000U/ML 2ML VIAL,J1644,HCPCS,636,RC,,BOTH,2,ML,78.89,31.56,UNITED HEALTH,UNITED COMMERCIAL,67.06,85,,,OTHER,59.17,77.31,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 20U/LR 1000 ML,J2590,HCPCS,636,RC,,BOTH,1000,ML,276.21,110.48,UNITED HEALTH,UNITED COMMERCIAL,234.77,85,,,OTHER,207.15,270.68,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,UNITED HEALTH,UNITED COMMERCIAL,64.91,85,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,UNITED HEALTH,UNITED COMMERCIAL,64.91,85,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UNITED HEALTH,UNITED COMMERCIAL,72.4,85,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UNITED HEALTH,UNITED COMMERCIAL,72.4,85,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UNITED HEALTH,UNITED COMMERCIAL,72.4,85,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,UNITED HEALTH,UNITED COMMERCIAL,261.55,85,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,UNITED HEALTH,UNITED COMMERCIAL,261.55,85,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,UNITED HEALTH,UNITED COMMERCIAL,101.14,85,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,UNITED HEALTH,UNITED COMMERCIAL,101.14,85,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 2.25G VIAL,J2543,HCPCS,636,RC,,BOTH,2.25,GR,72.92,29.17,UNITED HEALTH,UNITED COMMERCIAL,61.98,85,,,OTHER,54.69,71.46,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UNITED HEALTH,UNITED COMMERCIAL,91.44,85,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UNITED HEALTH,UNITED COMMERCIAL,91.44,85,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UNITED HEALTH,UNITED COMMERCIAL,91.44,85,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UNITED HEALTH,UNITED COMMERCIAL,91.44,85,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,UNITED HEALTH,UNITED COMMERCIAL,28.46,85,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,UNITED HEALTH,UNITED COMMERCIAL,28.46,85,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,2507710,CDM,636,RC,,BOTH,20,ML,33.48,13.39,UNITED HEALTH,UNITED COMMERCIAL,28.46,85,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% SDV 2ML,J2001,HCPCS,636,RC,,BOTH,2,ML,48.52,19.41,UNITED HEALTH,UNITED COMMERCIAL,41.24,85,,,OTHER,36.39,47.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UNITED HEALTH,UNITED COMMERCIAL,79.24,85,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UNITED HEALTH,UNITED COMMERCIAL,79.24,85,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,2501270,CDM,636,RC,,BOTH,3,GR,93.22,37.29,UNITED HEALTH,UNITED COMMERCIAL,79.24,85,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UNITED HEALTH,UNITED COMMERCIAL,79.24,85,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 30MG VIAL,J1885,HCPCS,636,RC,,BOTH,30,ME,57.77,23.11,UNITED HEALTH,UNITED COMMERCIAL,49.11,85,,,OTHER,43.33,56.62,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40MG VIAL,J1940,HCPCS,636,RC,,BOTH,40,ME,45.24,18.09,UNITED HEALTH,UNITED COMMERCIAL,38.45,85,,,OTHER,33.93,44.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UNITED HEALTH,UNITED COMMERCIAL,65.87,85,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UNITED HEALTH,UNITED COMMERCIAL,65.87,85,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3370,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UNITED HEALTH,UNITED COMMERCIAL,65.87,85,,,OTHER,58.12,75.94,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM,J2250,HCPCS,636,RC,,BOTH,1,ME,50.03,20.01,UNITED HEALTH,UNITED COMMERCIAL,42.53,85,,,OTHER,37.52,49.03,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,UNITED HEALTH,UNITED COMMERCIAL,50.39,85,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,UNITED HEALTH,UNITED COMMERCIAL,50.39,85,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UNITED HEALTH,UNITED COMMERCIAL,312.38,85,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UNITED HEALTH,UNITED COMMERCIAL,312.38,85,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UNITED HEALTH,UNITED COMMERCIAL,312.38,85,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UNITED HEALTH,UNITED COMMERCIAL,312.38,85,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,UNITED HEALTH,UNITED COMMERCIAL,158.19,85,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,UNITED HEALTH,UNITED COMMERCIAL,158.19,85,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3372,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,UNITED HEALTH,UNITED COMMERCIAL,97.13,85,,,OTHER,6.72,111.99,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3490,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,UNITED HEALTH,UNITED COMMERCIAL,97.13,85,,,OTHER,85.7,111.99,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J7517,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,UNITED HEALTH,UNITED COMMERCIAL,4.42,85,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J3490,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,UNITED HEALTH,UNITED COMMERCIAL,4.42,85,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,UNITED HEALTH,UNITED COMMERCIAL,41.73,85,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,UNITED HEALTH,UNITED COMMERCIAL,41.73,85,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J7613,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,UNITED HEALTH,UNITED COMMERCIAL,0.68,85,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J3490,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,UNITED HEALTH,UNITED COMMERCIAL,0.68,85,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,UNITED HEALTH,UNITED COMMERCIAL,774.07,85,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,UNITED HEALTH,UNITED COMMERCIAL,774.07,85,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,2511380,CDM,636,RC,,BOTH,1,ME,910.67,364.27,UNITED HEALTH,UNITED COMMERCIAL,774.07,85,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,UNITED HEALTH,UNITED COMMERCIAL,3712.74,85,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,UNITED HEALTH,UNITED COMMERCIAL,3712.74,85,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,UNITED HEALTH,UNITED COMMERCIAL,1505.28,85,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,UNITED HEALTH,UNITED COMMERCIAL,1505.28,85,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,2505151,CDM,636,RC,,BOTH,0.5,ME,1770.92,708.37,UNITED HEALTH,UNITED COMMERCIAL,1505.28,85,,,OTHER,1328.19,1735.5,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,UNITED HEALTH,UNITED COMMERCIAL,670.66,85,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,UNITED HEALTH,UNITED COMMERCIAL,670.66,85,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3372,HCPCS,636,RC,,BOTH,300,ML,129.54,51.82,UNITED HEALTH,UNITED COMMERCIAL,110.11,85,,,OTHER,6.72,126.95,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3490,HCPCS,636,RC,,BOTH,200,ML,129.54,51.82,UNITED HEALTH,UNITED COMMERCIAL,110.11,85,,,OTHER,97.15,126.95,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 750MG/150ML PB,J1956,HCPCS,636,RC,,BOTH,750,ME,108,43.2,UNITED HEALTH,UNITED COMMERCIAL,91.8,85,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UNITED HEALTH,UNITED COMMERCIAL,3679.35,85,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UNITED HEALTH,UNITED COMMERCIAL,3679.35,85,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,2504470,CDM,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UNITED HEALTH,UNITED COMMERCIAL,3679.35,85,,,OTHER,3246.49,4242.08,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG/300ML IV,J2020,HCPCS,636,RC,,BOTH,600,ME,207.7,83.08,UNITED HEALTH,UNITED COMMERCIAL,176.55,85,,,OTHER,155.78,203.55,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,UNITED HEALTH,UNITED COMMERCIAL,86.68,85,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,UNITED HEALTH,UNITED COMMERCIAL,86.68,85,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 3.375G VIAL,J2543,HCPCS,636,RC,,BOTH,3.375,GR,166.16,66.46,UNITED HEALTH,UNITED COMMERCIAL,141.23,85,,,OTHER,124.62,162.83,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3372,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,UNITED HEALTH,UNITED COMMERCIAL,119.3,85,,,OTHER,6.72,137.54,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3490,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,UNITED HEALTH,UNITED COMMERCIAL,119.3,85,,,OTHER,105.26,137.54,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,UNITED HEALTH,UNITED COMMERCIAL,70.58,85,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,UNITED HEALTH,UNITED COMMERCIAL,70.58,85,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,UNITED HEALTH,UNITED COMMERCIAL,74.69,85,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,UNITED HEALTH,UNITED COMMERCIAL,74.69,85,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,UNITED HEALTH,UNITED COMMERCIAL,13.94,85,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,UNITED HEALTH,UNITED COMMERCIAL,13.94,85,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,UNITED HEALTH,UNITED COMMERCIAL,1373.57,85,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,UNITED HEALTH,UNITED COMMERCIAL,1373.57,85,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 500MG VIAL,J2930,HCPCS,636,RC,,BOTH,500,ME,103.65,41.46,UNITED HEALTH,UNITED COMMERCIAL,88.1,85,,,OTHER,77.74,101.58,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J2597,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,UNITED HEALTH,UNITED COMMERCIAL,133.62,85,,,OTHER,6.58,154.06,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J3490,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,UNITED HEALTH,UNITED COMMERCIAL,133.62,85,,,OTHER,117.9,154.06,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,UNITED HEALTH,UNITED COMMERCIAL,3.54,85,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,UNITED HEALTH,UNITED COMMERCIAL,3.54,85,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,UNITED HEALTH,UNITED COMMERCIAL,64.7,85,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,UNITED HEALTH,UNITED COMMERCIAL,64.7,85,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 60MG INJ,J1885,HCPCS,636,RC,,BOTH,60,ME,46.32,18.53,UNITED HEALTH,UNITED COMMERCIAL,39.37,85,,,OTHER,34.74,45.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3372,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,UNITED HEALTH,UNITED COMMERCIAL,122.22,85,,,OTHER,6.72,140.91,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3490,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,UNITED HEALTH,UNITED COMMERCIAL,122.22,85,,,OTHER,107.84,140.91,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,UNITED HEALTH,UNITED COMMERCIAL,228.26,85,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,UNITED HEALTH,UNITED COMMERCIAL,228.26,85,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,2508360,CDM,636,RC,,BOTH,4,ME,268.54,107.42,UNITED HEALTH,UNITED COMMERCIAL,228.26,85,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
KENALOG-40 INJ,J3301,HCPCS,636,RC,,BOTH,10,ME,65.27,26.11,UNITED HEALTH,UNITED COMMERCIAL,55.48,85,,,OTHER,48.96,63.97,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 2GM PREMIX BAG,J3475,HCPCS,636,RC,,BOTH,2,GR,101.76,40.71,UNITED HEALTH,UNITED COMMERCIAL,86.5,85,,,OTHER,76.32,99.73,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,UNITED HEALTH,UNITED COMMERCIAL,544.63,85,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,UNITED HEALTH,UNITED COMMERCIAL,544.63,85,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,2516870,CDM,636,RC,,BOTH,5,ML,640.74,256.3,UNITED HEALTH,UNITED COMMERCIAL,544.63,85,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,UNITED HEALTH,UNITED COMMERCIAL,42.14,85,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,UNITED HEALTH,UNITED COMMERCIAL,42.14,85,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,UNITED HEALTH,UNITED COMMERCIAL,110.04,85,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,UNITED HEALTH,UNITED COMMERCIAL,110.04,85,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
PIPERACILLIN/TAZOBAC 4G/0.5 IV,J2543,HCPCS,636,RC,,BOTH,4,GR,166.16,66.47,UNITED HEALTH,UNITED COMMERCIAL,141.24,85,,,OTHER,124.62,162.84,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,UNITED HEALTH,UNITED COMMERCIAL,47.89,85,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,UNITED HEALTH,UNITED COMMERCIAL,47.89,85,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,UNITED HEALTH,UNITED COMMERCIAL,104.76,85,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,UNITED HEALTH,UNITED COMMERCIAL,104.76,85,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,UNITED HEALTH,UNITED COMMERCIAL,199.28,85,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,UNITED HEALTH,UNITED COMMERCIAL,199.28,85,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,UNITED HEALTH,UNITED COMMERCIAL,41.52,85,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,UNITED HEALTH,UNITED COMMERCIAL,41.52,85,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,UNITED HEALTH,UNITED COMMERCIAL,39.42,85,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,UNITED HEALTH,UNITED COMMERCIAL,39.42,85,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,2502720,CDM,636,RC,,BOTH,4,ME,46.38,18.55,UNITED HEALTH,UNITED COMMERCIAL,39.42,85,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,UNITED HEALTH,UNITED COMMERCIAL,99.08,85,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,UNITED HEALTH,UNITED COMMERCIAL,99.08,85,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J2760,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,UNITED HEALTH,UNITED COMMERCIAL,679.41,85,,,OTHER,466.54,783.31,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J3490,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,UNITED HEALTH,UNITED COMMERCIAL,679.41,85,,,OTHER,599.48,783.31,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,UNITED HEALTH,UNITED COMMERCIAL,76.7,85,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,UNITED HEALTH,UNITED COMMERCIAL,76.7,85,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,2500750,CDM,636,RC,,BOTH,2.5,ME,90.23,36.09,UNITED HEALTH,UNITED COMMERCIAL,76.7,85,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 500MG INJ,J2185,HCPCS,636,RC,,BOTH,500,ME,64.96,25.98,UNITED HEALTH,UNITED COMMERCIAL,55.22,85,,,OTHER,48.72,63.66,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML,J2250,HCPCS,636,RC,,BOTH,5,ML,50.52,20.21,UNITED HEALTH,UNITED COMMERCIAL,42.94,85,,,OTHER,37.89,49.51,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML VIAL,J2250,HCPCS,636,RC,,BOTH,5,ME,58.31,23.32,UNITED HEALTH,UNITED COMMERCIAL,49.56,85,,,OTHER,43.73,57.14,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,2505240,CDM,636,RC,,BOTH,1,GR,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 250 MG/5 ML VIAL,J1165,HCPCS,636,RC,,BOTH,250,ME,22.1,8.84,UNITED HEALTH,UNITED COMMERCIAL,18.78,85,,,OTHER,16.57,21.66,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,UNITED HEALTH,UNITED COMMERCIAL,5376.32,85,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,UNITED HEALTH,UNITED COMMERCIAL,5376.32,85,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,UNITED HEALTH,UNITED COMMERCIAL,158.81,85,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,UNITED HEALTH,UNITED COMMERCIAL,158.81,85,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,2504590,CDM,636,RC,,BOTH,10,ME,186.84,74.74,UNITED HEALTH,UNITED COMMERCIAL,158.81,85,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,UNITED HEALTH,UNITED COMMERCIAL,555.31,85,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,UNITED HEALTH,UNITED COMMERCIAL,555.31,85,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,2513160,CDM,636,RC,,BOTH,1,ME,653.31,261.32,UNITED HEALTH,UNITED COMMERCIAL,555.31,85,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% VIAL   SD,J2001,HCPCS,636,RC,,BOTH,10,ME,47.14,18.86,UNITED HEALTH,UNITED COMMERCIAL,40.07,85,,,OTHER,35.35,46.2,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,UNITED HEALTH,UNITED COMMERCIAL,48.06,85,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,UNITED HEALTH,UNITED COMMERCIAL,48.06,85,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,UNITED HEALTH,UNITED COMMERCIAL,55.49,85,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,UNITED HEALTH,UNITED COMMERCIAL,55.49,85,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,2505170,CDM,636,RC,,BOTH,20,ME,65.29,26.11,UNITED HEALTH,UNITED COMMERCIAL,55.49,85,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,UNITED HEALTH,UNITED COMMERCIAL,110.66,85,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,UNITED HEALTH,UNITED COMMERCIAL,110.66,85,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,BOTH,,,51.37,20.55,UNITED HEALTH,UNITED COMMERCIAL,43.67,85,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3490,HCPCS,636,RC,,BOTH,,,51.37,20.55,UNITED HEALTH,UNITED COMMERCIAL,43.67,85,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,UNITED HEALTH,UNITED COMMERCIAL,114.77,85,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,UNITED HEALTH,UNITED COMMERCIAL,114.77,85,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 5OOOU/ML INJ,J1644,HCPCS,636,RC,,BOTH,5000,UN,53.84,21.54,UNITED HEALTH,UNITED COMMERCIAL,45.77,85,,,OTHER,40.38,52.77,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,UNITED HEALTH,UNITED COMMERCIAL,4016.87,85,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,UNITED HEALTH,UNITED COMMERCIAL,4016.87,85,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UNITED HEALTH,UNITED COMMERCIAL,42.47,85,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UNITED HEALTH,UNITED COMMERCIAL,42.47,85,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0150,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UNITED HEALTH,UNITED COMMERCIAL,42.47,85,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,UNITED HEALTH,UNITED COMMERCIAL,130.7,85,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,UNITED HEALTH,UNITED COMMERCIAL,130.7,85,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT HOME PACK,Q0162,HCPCS,636,RC,,BOTH,,,23.75,9.5,UNITED HEALTH,UNITED COMMERCIAL,20.19,85,,,OTHER,17.81,23.28,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,UNITED HEALTH,UNITED COMMERCIAL,9.54,85,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,UNITED HEALTH,UNITED COMMERCIAL,9.54,85,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,UNITED HEALTH,UNITED COMMERCIAL,72.47,85,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,UNITED HEALTH,UNITED COMMERCIAL,72.47,85,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,2512620,CDM,636,RC,,BOTH,350,ME,85.26,34.1,UNITED HEALTH,UNITED COMMERCIAL,72.47,85,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,UNITED HEALTH,UNITED COMMERCIAL,62.17,85,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,UNITED HEALTH,UNITED COMMERCIAL,62.17,85,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
METHYLPRED 1G VIAL,J2930,HCPCS,636,RC,,BOTH,1,GR,172.48,68.99,UNITED HEALTH,UNITED COMMERCIAL,146.6,85,,,OTHER,129.36,169.03,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE,J3475,HCPCS,636,RC,,BOTH,500,ME,77.51,31,UNITED HEALTH,UNITED COMMERCIAL,65.88,85,,,OTHER,58.13,75.96,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,UNITED HEALTH,UNITED COMMERCIAL,171.65,85,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,UNITED HEALTH,UNITED COMMERCIAL,171.65,85,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,2505150,CDM,636,RC,,BOTH,80,ME,201.94,80.78,UNITED HEALTH,UNITED COMMERCIAL,171.65,85,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,UNITED HEALTH,UNITED COMMERCIAL,66.66,85,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,UNITED HEALTH,UNITED COMMERCIAL,66.66,85,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G POTASS 5MMU VIAL,J2540,HCPCS,636,RC,,BOTH,,,76.53,30.61,UNITED HEALTH,UNITED COMMERCIAL,65.05,85,,,OTHER,57.4,75,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE 5GM/10ML,J3475,HCPCS,636,RC,,BOTH,10,ML,88.79,35.52,UNITED HEALTH,UNITED COMMERCIAL,75.47,85,,,OTHER,66.6,87.02,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,UNITED HEALTH,UNITED COMMERCIAL,48.32,85,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,UNITED HEALTH,UNITED COMMERCIAL,48.32,85,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,UNITED HEALTH,UNITED COMMERCIAL,3732.82,85,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,UNITED HEALTH,UNITED COMMERCIAL,3732.82,85,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,2514280,CDM,636,RC,,BOTH,100,ME,4391.55,1756.62,UNITED HEALTH,UNITED COMMERCIAL,3732.82,85,,,OTHER,3293.66,4303.72,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,UNITED HEALTH,UNITED COMMERCIAL,90.94,85,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,UNITED HEALTH,UNITED COMMERCIAL,90.94,85,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,UNITED HEALTH,UNITED COMMERCIAL,1784.8,85,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,UNITED HEALTH,UNITED COMMERCIAL,1784.8,85,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 10 MG AMP,J3430,HCPCS,636,RC,,BOTH,10,ME,147.4,58.96,UNITED HEALTH,UNITED COMMERCIAL,125.29,85,,,OTHER,110.55,144.45,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,UNITED HEALTH,UNITED COMMERCIAL,3670.65,85,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,UNITED HEALTH,UNITED COMMERCIAL,3670.65,85,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,UNITED HEALTH,UNITED COMMERCIAL,290.13,85,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,UNITED HEALTH,UNITED COMMERCIAL,290.13,85,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514820,CDM,636,RC,,BOTH,10,ME,341.32,136.53,UNITED HEALTH,UNITED COMMERCIAL,290.13,85,,,OTHER,255.99,334.5,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,UNITED HEALTH,UNITED COMMERCIAL,80.76,85,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,UNITED HEALTH,UNITED COMMERCIAL,80.76,85,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,UNITED HEALTH,UNITED COMMERCIAL,216.79,85,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,UNITED HEALTH,UNITED COMMERCIAL,216.79,85,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,UNITED HEALTH,UNITED COMMERCIAL,216.79,85,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,UNITED HEALTH,UNITED COMMERCIAL,216.79,85,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J1805,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,UNITED HEALTH,UNITED COMMERCIAL,73.34,85,,,OTHER,0.23,84.55,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J3490,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,UNITED HEALTH,UNITED COMMERCIAL,73.34,85,,,OTHER,64.71,84.55,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,UNITED HEALTH,UNITED COMMERCIAL,3235.88,85,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,UNITED HEALTH,UNITED COMMERCIAL,3235.88,85,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,2514950,CDM,636,RC,,BOTH,1,ME,3806.92,1522.77,UNITED HEALTH,UNITED COMMERCIAL,3235.88,85,,,OTHER,2855.19,3730.78,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G VIAL,J2185,HCPCS,636,RC,,BOTH,1,GR,135.9,54.36,UNITED HEALTH,UNITED COMMERCIAL,115.52,85,,,OTHER,101.93,133.18,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,UNITED HEALTH,UNITED COMMERCIAL,1188.57,85,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,UNITED HEALTH,UNITED COMMERCIAL,1188.57,85,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
NITROGLYCERIN 50 MG/D5W100,J2305,HCPCS,636,RC,,BOTH,50,ME,126.32,50.53,UNITED HEALTH,UNITED COMMERCIAL,107.37,85,,,OTHER,1.51,123.8,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,UNITED HEALTH,UNITED COMMERCIAL,207.39,85,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,UNITED HEALTH,UNITED COMMERCIAL,207.39,85,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,2504240,CDM,636,RC,,BOTH,100,ME,243.99,97.59,UNITED HEALTH,UNITED COMMERCIAL,207.39,85,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1642,HCPCS,636,RC,,BOTH,10,UN,51.53,20.61,UNITED HEALTH,UNITED COMMERCIAL,43.8,85,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1644,HCPCS,636,RC,,BOTH,1000,UN,51.53,20.61,UNITED HEALTH,UNITED COMMERCIAL,43.8,85,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,UNITED HEALTH,UNITED COMMERCIAL,963.06,85,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,UNITED HEALTH,UNITED COMMERCIAL,963.06,85,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,UNITED HEALTH,UNITED COMMERCIAL,37.15,85,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,UNITED HEALTH,UNITED COMMERCIAL,37.15,85,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,UNITED HEALTH,UNITED COMMERCIAL,1112.1,85,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,UNITED HEALTH,UNITED COMMERCIAL,1112.1,85,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,2503770,CDM,636,RC,,BOTH,2,ML,1308.36,523.34,UNITED HEALTH,UNITED COMMERCIAL,1112.1,85,,,OTHER,981.27,1282.19,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,UNITED HEALTH,UNITED COMMERCIAL,1695.79,85,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,UNITED HEALTH,UNITED COMMERCIAL,1695.79,85,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,UNITED HEALTH,UNITED COMMERCIAL,1524.47,85,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,UNITED HEALTH,UNITED COMMERCIAL,1524.47,85,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,UNITED HEALTH,UNITED COMMERCIAL,155.41,85,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,UNITED HEALTH,UNITED COMMERCIAL,155.41,85,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,2507600,CDM,636,RC,,BOTH,500,ME,182.84,73.13,UNITED HEALTH,UNITED COMMERCIAL,155.41,85,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,UNITED HEALTH,UNITED COMMERCIAL,73.61,85,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,UNITED HEALTH,UNITED COMMERCIAL,73.61,85,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,UNITED HEALTH,UNITED COMMERCIAL,230.97,85,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,UNITED HEALTH,UNITED COMMERCIAL,230.97,85,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,2514600,CDM,636,RC,,BOTH,2,GR,271.74,108.69,UNITED HEALTH,UNITED COMMERCIAL,230.97,85,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,UNITED HEALTH,UNITED COMMERCIAL,39.93,85,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,UNITED HEALTH,UNITED COMMERCIAL,39.93,85,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,UNITED HEALTH,UNITED COMMERCIAL,1229.22,85,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,UNITED HEALTH,UNITED COMMERCIAL,1229.22,85,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,UNITED HEALTH,UNITED COMMERCIAL,74.68,85,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,UNITED HEALTH,UNITED COMMERCIAL,74.68,85,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,UNITED HEALTH,UNITED COMMERCIAL,1259.54,85,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,UNITED HEALTH,UNITED COMMERCIAL,1259.54,85,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,UNITED HEALTH,UNITED COMMERCIAL,19.32,85,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,UNITED HEALTH,UNITED COMMERCIAL,19.32,85,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,2505100,CDM,636,RC,,BOTH,10,ME,22.73,9.09,UNITED HEALTH,UNITED COMMERCIAL,19.32,85,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,UNITED HEALTH,UNITED COMMERCIAL,107.82,85,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,UNITED HEALTH,UNITED COMMERCIAL,107.82,85,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,UNITED HEALTH,UNITED COMMERCIAL,980.85,85,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,UNITED HEALTH,UNITED COMMERCIAL,980.85,85,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,UNITED HEALTH,UNITED COMMERCIAL,552.34,85,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,UNITED HEALTH,UNITED COMMERCIAL,552.34,85,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,2500420,CDM,636,RC,,BOTH,0.05,ML,649.81,259.92,UNITED HEALTH,UNITED COMMERCIAL,552.34,85,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J1836,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,UNITED HEALTH,UNITED COMMERCIAL,58.55,85,,,OTHER,0.03,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UNITED HEALTH,UNITED COMMERCIAL,8.93,85,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UNITED HEALTH,UNITED COMMERCIAL,8.93,85,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J3490,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,UNITED HEALTH,UNITED COMMERCIAL,58.55,85,,,OTHER,51.66,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UNITED HEALTH,UNITED COMMERCIAL,8.93,85,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,UNITED HEALTH,UNITED COMMERCIAL,37.77,85,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,UNITED HEALTH,UNITED COMMERCIAL,37.77,85,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,2506180,CDM,636,RC,,BOTH,10,ME,44.44,17.78,UNITED HEALTH,UNITED COMMERCIAL,37.77,85,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 100 MG SYRINGE,J2001,HCPCS,636,RC,,BOTH,100,ME,56.99,22.8,UNITED HEALTH,UNITED COMMERCIAL,48.44,85,,,OTHER,42.74,55.85,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0136,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,UNITED HEALTH,UNITED COMMERCIAL,166.84,85,,,OTHER,0.05,192.36,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0131,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,UNITED HEALTH,UNITED COMMERCIAL,166.84,85,,,OTHER,147.21,192.36,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,UNITED HEALTH,UNITED COMMERCIAL,5769.89,85,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,UNITED HEALTH,UNITED COMMERCIAL,5769.89,85,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PENICILL G BENZ 1.2MMU SYR,J0561,HCPCS,636,RC,,BOTH,,,527.8,211.12,UNITED HEALTH,UNITED COMMERCIAL,448.63,85,,,OTHER,23.1,517.24,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,UNITED HEALTH,UNITED COMMERCIAL,4046.05,85,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,UNITED HEALTH,UNITED COMMERCIAL,4046.05,85,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,UNITED HEALTH,UNITED COMMERCIAL,1710.41,85,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,UNITED HEALTH,UNITED COMMERCIAL,1710.41,85,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,UNITED HEALTH,UNITED COMMERCIAL,1150.14,85,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,UNITED HEALTH,UNITED COMMERCIAL,1150.14,85,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,UNITED HEALTH,UNITED COMMERCIAL,433.42,85,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,UNITED HEALTH,UNITED COMMERCIAL,433.42,85,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,UNITED HEALTH,UNITED COMMERCIAL,3013.55,85,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,UNITED HEALTH,UNITED COMMERCIAL,3013.55,85,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 4%PF,J2001,HCPCS,636,RC,,BOTH,10,ME,49.11,19.64,UNITED HEALTH,UNITED COMMERCIAL,41.74,85,,,OTHER,36.83,48.12,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 2% 10ML AMP,J2001,HCPCS,636,RC,,BOTH,10,ME,50.69,20.28,UNITED HEALTH,UNITED COMMERCIAL,43.09,85,,,OTHER,38.02,49.68,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,UNITED HEALTH,UNITED COMMERCIAL,1349.07,85,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,UNITED HEALTH,UNITED COMMERCIAL,1349.07,85,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J2598,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,UNITED HEALTH,UNITED COMMERCIAL,466.11,85,,,OTHER,1.97,537.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J3490,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,UNITED HEALTH,UNITED COMMERCIAL,466.11,85,,,OTHER,411.27,537.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,UNITED HEALTH,UNITED COMMERCIAL,2709.42,85,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,UNITED HEALTH,UNITED COMMERCIAL,2709.42,85,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J2704,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,UNITED HEALTH,UNITED COMMERCIAL,50.17,85,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,UNITED HEALTH,UNITED COMMERCIAL,50.17,85,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE O.5% 30ML SD,J2001,HCPCS,636,RC,,BOTH,30,ML,70.78,28.31,UNITED HEALTH,UNITED COMMERCIAL,60.16,85,,,OTHER,53.09,69.36,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,UNITED HEALTH,UNITED COMMERCIAL,2208.92,85,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,UNITED HEALTH,UNITED COMMERCIAL,2208.92,85,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 25000U BAG,J1644,HCPCS,636,RC,,BOTH,25000,UN,106.82,42.73,UNITED HEALTH,UNITED COMMERCIAL,90.79,85,,,OTHER,80.11,104.68,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UNITED HEALTH,UNITED COMMERCIAL,768.68,85,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UNITED HEALTH,UNITED COMMERCIAL,768.68,85,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UNITED HEALTH,UNITED COMMERCIAL,768.68,85,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UNITED HEALTH,UNITED COMMERCIAL,768.68,85,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,UNITED HEALTH,UNITED COMMERCIAL,6408.63,85,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,UNITED HEALTH,UNITED COMMERCIAL,6408.63,85,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,UNITED HEALTH,UNITED COMMERCIAL,8853.39,85,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,UNITED HEALTH,UNITED COMMERCIAL,8853.39,85,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 30ML VIAL  SD,J2001,HCPCS,636,RC,,BOTH,30,ML,50.36,20.14,UNITED HEALTH,UNITED COMMERCIAL,42.81,85,,,OTHER,37.77,49.35,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,UNITED HEALTH,UNITED COMMERCIAL,11780.94,85,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,UNITED HEALTH,UNITED COMMERCIAL,11780.94,85,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,UNITED HEALTH,UNITED COMMERCIAL,2043.77,85,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,UNITED HEALTH,UNITED COMMERCIAL,2043.77,85,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UNITED HEALTH,UNITED COMMERCIAL,4579.61,85,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UNITED HEALTH,UNITED COMMERCIAL,4579.61,85,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,2511210,CDM,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UNITED HEALTH,UNITED COMMERCIAL,4579.61,85,,,OTHER,4040.84,5280.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,UNITED HEALTH,UNITED COMMERCIAL,7434.58,85,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,UNITED HEALTH,UNITED COMMERCIAL,7434.58,85,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,UNITED HEALTH,UNITED COMMERCIAL,13867.42,85,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,UNITED HEALTH,UNITED COMMERCIAL,13867.42,85,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,2514290,CDM,636,RC,,BOTH,400,ME,16314.61,6525.84,UNITED HEALTH,UNITED COMMERCIAL,13867.42,85,,,OTHER,12235.96,15988.32,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,2509810,CDM,636,RC,,BOTH,4,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MAG SULF/WATER,J3475,HCPCS,636,RC,,BOTH,500,ME,473.17,189.27,UNITED HEALTH,UNITED COMMERCIAL,402.19,85,,,OTHER,354.87,463.7,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,UNITED HEALTH,UNITED COMMERCIAL,19901.55,85,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,UNITED HEALTH,UNITED COMMERCIAL,19901.55,85,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,UNITED HEALTH,UNITED COMMERCIAL,828.8,85,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,UNITED HEALTH,UNITED COMMERCIAL,828.8,85,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UNITED HEALTH,UNITED COMMERCIAL,2882.39,85,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,C9476,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UNITED HEALTH,UNITED COMMERCIAL,4241.48,85,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,UNITED HEALTH,UNITED COMMERCIAL,6827.77,85,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,UNITED HEALTH,UNITED COMMERCIAL,6827.77,85,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,UNITED HEALTH,UNITED COMMERCIAL,4031.36,85,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,UNITED HEALTH,UNITED COMMERCIAL,4031.36,85,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,UNITED HEALTH,UNITED COMMERCIAL,456.89,85,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,UNITED HEALTH,UNITED COMMERCIAL,456.89,85,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,UNITED HEALTH,UNITED COMMERCIAL,4004.75,85,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,UNITED HEALTH,UNITED COMMERCIAL,4004.75,85,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,UNITED HEALTH,UNITED COMMERCIAL,8646.14,85,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,UNITED HEALTH,UNITED COMMERCIAL,8646.14,85,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,2506310,CDM,636,RC,,BOTH,50,ME,10171.93,4068.77,UNITED HEALTH,UNITED COMMERCIAL,8646.14,85,,,OTHER,7628.95,9968.49,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,UNITED HEALTH,UNITED COMMERCIAL,1472.72,85,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,UNITED HEALTH,UNITED COMMERCIAL,1472.72,85,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514790,CDM,636,RC,,BOTH,10,ME,1732.61,693.04,UNITED HEALTH,UNITED COMMERCIAL,1472.72,85,,,OTHER,1299.46,1697.96,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,UNITED HEALTH,UNITED COMMERCIAL,7734.69,85,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,UNITED HEALTH,UNITED COMMERCIAL,7734.69,85,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,2513220,CDM,636,RC,,BOTH,1,ME,250,100,UNITED HEALTH,UNITED COMMERCIAL,212.5,85,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,UNITED HEALTH,UNITED COMMERCIAL,6459.36,85,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,UNITED HEALTH,UNITED COMMERCIAL,6459.36,85,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM 500MG/5ML VIAL,J1953,HCPCS,636,RC,,BOTH,500,ME,35.72,14.29,UNITED HEALTH,UNITED COMMERCIAL,30.37,85,,,OTHER,26.79,35.01,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UNITED HEALTH,UNITED COMMERCIAL,42.71,85,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UNITED HEALTH,UNITED COMMERCIAL,42.71,85,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0690,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UNITED HEALTH,UNITED COMMERCIAL,42.71,85,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UNITED HEALTH,UNITED COMMERCIAL,42.71,85,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UNITED HEALTH,UNITED COMMERCIAL,71.29,85,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UNITED HEALTH,UNITED COMMERCIAL,71.29,85,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UNITED HEALTH,UNITED COMMERCIAL,71.29,85,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UNITED HEALTH,UNITED COMMERCIAL,71.29,85,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,2514960,CDM,636,RC,,BOTH,50,ML,83.87,33.55,UNITED HEALTH,UNITED COMMERCIAL,71.29,85,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) 75/25 PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,87.37,34.95,UNITED HEALTH,UNITED COMMERCIAL,74.26,85,,,OTHER,65.53,85.62,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALIN N) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,134.82,53.93,UNITED HEALTH,UNITED COMMERCIAL,114.6,85,,,OTHER,101.12,132.12,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UNITED HEALTH,UNITED COMMERCIAL,16614.14,85,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UNITED HEALTH,UNITED COMMERCIAL,16614.14,85,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UNITED HEALTH,UNITED COMMERCIAL,16614.14,85,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UNITED HEALTH,UNITED COMMERCIAL,16614.14,85,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,UNITED HEALTH,UNITED COMMERCIAL,6310.7,85,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,UNITED HEALTH,UNITED COMMERCIAL,6310.7,85,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,2510900,CDM,636,RC,,BOTH,60,ME,7424.35,2969.74,UNITED HEALTH,UNITED COMMERCIAL,6310.7,85,,,OTHER,5568.26,7275.86,PERCENT OF TOTAL BILLED CHARGES
INSULIN (LANTUS SOLOSTAR) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,240.94,96.38,UNITED HEALTH,UNITED COMMERCIAL,204.8,85,,,OTHER,180.71,236.12,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,UNITED HEALTH,UNITED COMMERCIAL,2303.93,85,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,UNITED HEALTH,UNITED COMMERCIAL,2303.93,85,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UNITED HEALTH,UNITED COMMERCIAL,2303.93,85,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UNITED HEALTH,UNITED COMMERCIAL,2303.93,85,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UNITED HEALTH,UNITED COMMERCIAL,2303.93,85,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,303.8,121.52,UNITED HEALTH,UNITED COMMERCIAL,258.23,85,,,OTHER,227.85,297.72,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,UNITED HEALTH,UNITED COMMERCIAL,1803.9,85,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,UNITED HEALTH,UNITED COMMERCIAL,1803.9,85,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,2514210,CDM,636,RC,,BOTH,15,ME,2122.24,848.9,UNITED HEALTH,UNITED COMMERCIAL,1803.9,85,,,OTHER,1591.68,2079.8,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,UNITED HEALTH,UNITED COMMERCIAL,5925.61,85,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,UNITED HEALTH,UNITED COMMERCIAL,5925.61,85,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,UNITED HEALTH,UNITED COMMERCIAL,749.98,85,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,UNITED HEALTH,UNITED COMMERCIAL,749.98,85,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UNITED HEALTH,UNITED COMMERCIAL,115.91,85,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UNITED HEALTH,UNITED COMMERCIAL,115.91,85,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UNITED HEALTH,UNITED COMMERCIAL,115.91,85,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UNITED HEALTH,UNITED COMMERCIAL,115.91,85,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,2514590,CDM,636,RC,,BOTH,80,ME,136.36,54.55,UNITED HEALTH,UNITED COMMERCIAL,115.91,85,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,UNITED HEALTH,UNITED COMMERCIAL,907.98,85,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,UNITED HEALTH,UNITED COMMERCIAL,907.98,85,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2511990,CDM,636,RC,,BOTH,1,ME,1068.21,427.28,UNITED HEALTH,UNITED COMMERCIAL,907.98,85,,,OTHER,801.16,1046.85,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,2501680,CDM,636,RC,,BOTH,1,ME,70.21,28.08,UNITED HEALTH,UNITED COMMERCIAL,59.68,85,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,UNITED HEALTH,UNITED COMMERCIAL,59.68,85,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,UNITED HEALTH,UNITED COMMERCIAL,59.68,85,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,UNITED HEALTH,UNITED COMMERCIAL,7011.92,85,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,UNITED HEALTH,UNITED COMMERCIAL,7011.92,85,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,UNITED HEALTH,UNITED COMMERCIAL,15592.07,85,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,UNITED HEALTH,UNITED COMMERCIAL,15592.07,85,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,UNITED HEALTH,UNITED COMMERCIAL,3056.47,85,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,UNITED HEALTH,UNITED COMMERCIAL,3056.47,85,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,UNITED HEALTH,UNITED COMMERCIAL,29714.08,85,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,UNITED HEALTH,UNITED COMMERCIAL,29714.08,85,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,UNITED HEALTH,UNITED COMMERCIAL,21363.06,85,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,UNITED HEALTH,UNITED COMMERCIAL,21363.06,85,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,2500530,CDM,636,RC,,BOTH,100,ME,25133.01,10053.2,UNITED HEALTH,UNITED COMMERCIAL,21363.06,85,,,OTHER,18849.76,24630.35,PERCENT OF TOTAL BILLED CHARGES
ONABOTULINUMTOXINA (BOTOX),J0585,HCPCS,636,RC,,BOTH,1,UN,1172.09,468.84,UNITED HEALTH,UNITED COMMERCIAL,996.28,85,,,OTHER,6.64,1148.65,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,UNITED HEALTH,UNITED COMMERCIAL,1702.35,85,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,UNITED HEALTH,UNITED COMMERCIAL,1702.35,85,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,2511840,CDM,636,RC,,BOTH,1,ME,2002.77,801.11,UNITED HEALTH,UNITED COMMERCIAL,1702.35,85,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,UNITED HEALTH,UNITED COMMERCIAL,12497.79,85,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,UNITED HEALTH,UNITED COMMERCIAL,12497.79,85,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,UNITED HEALTH,UNITED COMMERCIAL,5089.24,85,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,UNITED HEALTH,UNITED COMMERCIAL,5089.24,85,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,UNITED HEALTH,UNITED COMMERCIAL,4.94,85,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,UNITED HEALTH,UNITED COMMERCIAL,4.94,85,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,2513120,CDM,636,RC,,BOTH,0.5,ME,5.81,2.33,UNITED HEALTH,UNITED COMMERCIAL,4.94,85,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,UNITED HEALTH,UNITED COMMERCIAL,59.45,85,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,UNITED HEALTH,UNITED COMMERCIAL,59.45,85,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,2505020,CDM,636,RC,,BOTH,0.1,ME,69.94,27.98,UNITED HEALTH,UNITED COMMERCIAL,59.45,85,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UNITED HEALTH,UNITED COMMERCIAL,7278.08,85,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,UNITED HEALTH,UNITED COMMERCIAL,3868.5,85,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,UNITED HEALTH,UNITED COMMERCIAL,3868.5,85,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,2512870,CDM,636,RC,,BOTH,1,ME,4551.17,1820.47,UNITED HEALTH,UNITED COMMERCIAL,3868.5,85,,,OTHER,3413.38,4460.15,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,UNITED HEALTH,UNITED COMMERCIAL,969.96,85,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,UNITED HEALTH,UNITED COMMERCIAL,969.96,85,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,J2182,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,UNITED HEALTH,UNITED COMMERCIAL,5336.1,85,,,OTHER,32,6152.2,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,C9473,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,UNITED HEALTH,UNITED COMMERCIAL,5336.1,85,,,OTHER,4708.32,6152.2,PERCENT OF TOTAL BILLED CHARGES
PEMBROLIZUMAB 100MG/4ML,J9271,HCPCS,636,RC,,BOTH,4,ML,9937.15,3974.86,UNITED HEALTH,UNITED COMMERCIAL,8446.57,85,,,OTHER,60.18,9738.4,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,UNITED HEALTH,UNITED COMMERCIAL,81.42,85,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,UNITED HEALTH,UNITED COMMERCIAL,81.42,85,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,2504150,CDM,636,RC,,BOTH,20,ML,95.78,38.31,UNITED HEALTH,UNITED COMMERCIAL,81.42,85,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J2704,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,UNITED HEALTH,UNITED COMMERCIAL,131.49,85,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J3490,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,UNITED HEALTH,UNITED COMMERCIAL,131.49,85,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UNITED HEALTH,UNITED COMMERCIAL,2700.48,85,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UNITED HEALTH,UNITED COMMERCIAL,16153.75,85,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UNITED HEALTH,UNITED COMMERCIAL,12715.19,85,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UNITED HEALTH,UNITED COMMERCIAL,12715.19,85,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1930,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UNITED HEALTH,UNITED COMMERCIAL,12715.19,85,,,OTHER,50.4,14659.86,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,UNITED HEALTH,UNITED COMMERCIAL,4519.14,85,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,UNITED HEALTH,UNITED COMMERCIAL,4519.14,85,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,2514240,CDM,636,RC,,BOTH,120,ME,5316.64,2126.66,UNITED HEALTH,UNITED COMMERCIAL,4519.14,85,,,OTHER,3987.48,5210.31,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,UNITED HEALTH,UNITED COMMERCIAL,482.43,85,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,UNITED HEALTH,UNITED COMMERCIAL,482.43,85,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,UNITED HEALTH,UNITED COMMERCIAL,29101.73,85,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,UNITED HEALTH,UNITED COMMERCIAL,29101.73,85,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,UNITED HEALTH,UNITED COMMERCIAL,43.22,85,,,OTHER,0.02,49.83,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,UNITED HEALTH,UNITED COMMERCIAL,43.22,85,,,OTHER,38.14,49.83,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,UNITED HEALTH,UNITED COMMERCIAL,153.83,85,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,UNITED HEALTH,UNITED COMMERCIAL,153.83,85,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,2515510,CDM,636,RC,,BOTH,1,ME,180.98,72.39,UNITED HEALTH,UNITED COMMERCIAL,153.83,85,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,UNITED HEALTH,UNITED COMMERCIAL,14456.95,85,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,UNITED HEALTH,UNITED COMMERCIAL,14456.95,85,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1G BAG,J2001,HCPCS,636,RC,,BOTH,1,GR,104.73,41.89,UNITED HEALTH,UNITED COMMERCIAL,89.02,85,,,OTHER,78.55,102.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,UNITED HEALTH,UNITED COMMERCIAL,2159.81,85,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,UNITED HEALTH,UNITED COMMERCIAL,2159.81,85,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,UNITED HEALTH,UNITED COMMERCIAL,2086.13,85,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,UNITED HEALTH,UNITED COMMERCIAL,2086.13,85,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512020,CDM,636,RC,,BOTH,1,ME,2454.27,981.71,UNITED HEALTH,UNITED COMMERCIAL,2086.13,85,,,OTHER,1840.7,2405.18,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,UNITED HEALTH,UNITED COMMERCIAL,2515.19,85,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,UNITED HEALTH,UNITED COMMERCIAL,2515.19,85,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,2504290,CDM,636,RC,,BOTH,,,2959.05,1183.62,UNITED HEALTH,UNITED COMMERCIAL,2515.19,85,,,OTHER,2219.29,2899.87,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,UNITED HEALTH,UNITED COMMERCIAL,157.5,85,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,UNITED HEALTH,UNITED COMMERCIAL,157.5,85,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,2501950,CDM,636,RC,,BOTH,100,ME,185.29,74.12,UNITED HEALTH,UNITED COMMERCIAL,157.5,85,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,UNITED HEALTH,UNITED COMMERCIAL,3868.52,85,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,UNITED HEALTH,UNITED COMMERCIAL,3868.52,85,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,UNITED HEALTH,UNITED COMMERCIAL,3868.52,85,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,UNITED HEALTH,UNITED COMMERCIAL,3868.52,85,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,UNITED HEALTH,UNITED COMMERCIAL,6711.42,85,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,UNITED HEALTH,UNITED COMMERCIAL,6711.42,85,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,UNITED HEALTH,UNITED COMMERCIAL,1760.69,85,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,UNITED HEALTH,UNITED COMMERCIAL,1760.69,85,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,UNITED HEALTH,UNITED COMMERCIAL,786.12,85,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,UNITED HEALTH,UNITED COMMERCIAL,786.12,85,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,UNITED HEALTH,UNITED COMMERCIAL,6095.38,85,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,UNITED HEALTH,UNITED COMMERCIAL,6095.38,85,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,UNITED HEALTH,UNITED COMMERCIAL,39.97,85,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,UNITED HEALTH,UNITED COMMERCIAL,39.97,85,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,UNITED HEALTH,UNITED COMMERCIAL,3446.78,85,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,UNITED HEALTH,UNITED COMMERCIAL,3446.78,85,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,2510300,CDM,636,RC,,BOTH,,,4055.04,1622.02,UNITED HEALTH,UNITED COMMERCIAL,3446.78,85,,,OTHER,3041.28,3973.94,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UNITED HEALTH,UNITED COMMERCIAL,15199.44,85,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UNITED HEALTH,UNITED COMMERCIAL,15199.44,85,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UNITED HEALTH,UNITED COMMERCIAL,15199.44,85,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UNITED HEALTH,UNITED COMMERCIAL,15199.44,85,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,J2350,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,UNITED HEALTH,UNITED COMMERCIAL,29332.54,85,,,OTHER,61.7,33818.69,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,C9494,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,UNITED HEALTH,UNITED COMMERCIAL,29332.54,85,,,OTHER,25881.65,33818.69,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,UNITED HEALTH,UNITED COMMERCIAL,651.89,85,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,UNITED HEALTH,UNITED COMMERCIAL,651.89,85,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,UNITED HEALTH,UNITED COMMERCIAL,11146.12,85,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,UNITED HEALTH,UNITED COMMERCIAL,11146.12,85,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UNITED HEALTH,UNITED COMMERCIAL,25182.76,85,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UNITED HEALTH,UNITED COMMERCIAL,25182.76,85,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UNITED HEALTH,UNITED COMMERCIAL,25182.76,85,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UNITED HEALTH,UNITED COMMERCIAL,25182.76,85,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,UNITED HEALTH,UNITED COMMERCIAL,4130.83,85,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,UNITED HEALTH,UNITED COMMERCIAL,4130.83,85,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512030,CDM,636,RC,,BOTH,1,ME,4859.8,1943.92,UNITED HEALTH,UNITED COMMERCIAL,4130.83,85,,,OTHER,3644.85,4762.61,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,UNITED HEALTH,UNITED COMMERCIAL,15156.42,85,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,UNITED HEALTH,UNITED COMMERCIAL,15156.42,85,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,2504050,CDM,636,RC,,BOTH,30,ML,17831.08,7132.43,UNITED HEALTH,UNITED COMMERCIAL,15156.42,85,,,OTHER,13373.31,17474.46,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,UNITED HEALTH,UNITED COMMERCIAL,806.38,85,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,UNITED HEALTH,UNITED COMMERCIAL,806.38,85,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J2724,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UNITED HEALTH,UNITED COMMERCIAL,1884.51,85,,,OTHER,15.78,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UNITED HEALTH,UNITED COMMERCIAL,1884.51,85,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UNITED HEALTH,UNITED COMMERCIAL,1884.51,85,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,C9132,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UNITED HEALTH,UNITED COMMERCIAL,1884.51,85,,,OTHER,1662.8,2172.73,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,UNITED HEALTH,UNITED COMMERCIAL,5720.48,85,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,UNITED HEALTH,UNITED COMMERCIAL,5720.48,85,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,2512120,CDM,636,RC,,BOTH,500,ML,6729.98,2691.99,UNITED HEALTH,UNITED COMMERCIAL,5720.48,85,,,OTHER,5047.49,6595.38,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,UNITED HEALTH,UNITED COMMERCIAL,632.22,85,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,UNITED HEALTH,UNITED COMMERCIAL,632.22,85,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,2510490,CDM,636,RC,,BOTH,500,ME,743.79,297.51,UNITED HEALTH,UNITED COMMERCIAL,632.22,85,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,UNITED HEALTH,UNITED COMMERCIAL,1637.95,85,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,UNITED HEALTH,UNITED COMMERCIAL,1637.95,85,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,UNITED HEALTH,UNITED COMMERCIAL,1644,85,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,UNITED HEALTH,UNITED COMMERCIAL,1644,85,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,2517300,CDM,636,RC,,BOTH,750,ME,1934.12,773.65,UNITED HEALTH,UNITED COMMERCIAL,1644,85,,,OTHER,1450.59,1895.44,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,2519870,CDM,636,RC,,BOTH,,,10377.46,4150.98,UNITED HEALTH,UNITED COMMERCIAL,8820.84,85,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,C9159,HCPCS,636,RC,,BOTH,,,10377.46,4150.98,UNITED HEALTH,UNITED COMMERCIAL,8820.84,85,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J2724,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UNITED HEALTH,UNITED COMMERCIAL,6232.32,85,,,OTHER,15.78,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UNITED HEALTH,UNITED COMMERCIAL,6232.32,85,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UNITED HEALTH,UNITED COMMERCIAL,6232.32,85,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,C9132,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UNITED HEALTH,UNITED COMMERCIAL,6232.32,85,,,OTHER,5499.1,7185.5,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,UNITED HEALTH,UNITED COMMERCIAL,124.93,85,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,UNITED HEALTH,UNITED COMMERCIAL,124.93,85,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
PNEUMOCOCCAL VACCINE 0.5ML,2518440,CDM,636,RC,,BOTH,0.5,ML,295.08,118.03,UNITED HEALTH,UNITED COMMERCIAL,250.82,85,,,OTHER,221.31,289.18,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,2511640,CDM,636,RC,,BOTH,,,146.98,58.79,UNITED HEALTH,UNITED COMMERCIAL,124.93,85,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,UNITED HEALTH,UNITED COMMERCIAL,1031.12,85,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,UNITED HEALTH,UNITED COMMERCIAL,1031.12,85,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
FLU VACCINE HIGH DOSE,2514130,CDM,636,RC,,BOTH,,,179.64,71.86,UNITED HEALTH,UNITED COMMERCIAL,152.69,85,,,OTHER,134.73,176.05,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,Q2036,HCPCS,636,RC,,BOTH,,,64.97,25.99,UNITED HEALTH,UNITED COMMERCIAL,55.22,85,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,2511440,CDM,636,RC,,BOTH,,,64.97,25.99,UNITED HEALTH,UNITED COMMERCIAL,55.22,85,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,UNITED HEALTH,UNITED COMMERCIAL,33.38,85,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,UNITED HEALTH,UNITED COMMERCIAL,33.38,85,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,2510770,CDM,250,RC,,BOTH,,,39.27,15.71,UNITED HEALTH,UNITED COMMERCIAL,33.38,85,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
METHYLNALTREXONE BROMIDE,J2212,HCPCS,636,RC,,BOTH,0.1,ME,347.96,139.18,UNITED HEALTH,UNITED COMMERCIAL,295.77,85,,,OTHER,1.21,341,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,UNITED HEALTH,UNITED COMMERCIAL,56.16,85,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,UNITED HEALTH,UNITED COMMERCIAL,56.16,85,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,UNITED HEALTH,UNITED COMMERCIAL,57.95,85,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,UNITED HEALTH,UNITED COMMERCIAL,57.95,85,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
RABIES IMM GLOB 1500U/ML 5ML,2515770,CDM,636,RC,,BOTH,5,ML,5629.18,2251.67,UNITED HEALTH,UNITED COMMERCIAL,4784.8,85,,,OTHER,299.93,5516.59,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,UNITED HEALTH,UNITED COMMERCIAL,13.21,85,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,UNITED HEALTH,UNITED COMMERCIAL,13.21,85,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,2518680,CDM,636,RC,,BOTH,0.5,ML,110.93,44.37,UNITED HEALTH,UNITED COMMERCIAL,94.29,85,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,UNITED HEALTH,UNITED COMMERCIAL,94.29,85,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,UNITED HEALTH,UNITED COMMERCIAL,94.29,85,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,UNITED HEALTH,UNITED COMMERCIAL,18.65,85,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,UNITED HEALTH,UNITED COMMERCIAL,18.65,85,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
RABIES VACCINE,2520290,CDM,636,RC,,BOTH,,,870.92,348.37,UNITED HEALTH,UNITED COMMERCIAL,740.28,85,,,OTHER,338.91,853.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,UNITED HEALTH,UNITED COMMERCIAL,18.33,85,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,UNITED HEALTH,UNITED COMMERCIAL,18.33,85,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,63.75,85,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,UNITED HEALTH,UNITED COMMERCIAL,63.75,85,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,25.93,85,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,UNITED HEALTH,UNITED COMMERCIAL,25.93,85,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,UNITED HEALTH,UNITED COMMERCIAL,47.8,85,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,UNITED HEALTH,UNITED COMMERCIAL,47.8,85,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
HALOPERIDOL 5 MG/ML AMP,J1630,HCPCS,636,RC,,BOTH,5,ME,88.26,35.3,UNITED HEALTH,UNITED COMMERCIAL,75.02,85,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,UNITED HEALTH,UNITED COMMERCIAL,50.17,85,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,UNITED HEALTH,UNITED COMMERCIAL,50.17,85,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,UNITED HEALTH,UNITED COMMERCIAL,5.2,85,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,UNITED HEALTH,UNITED COMMERCIAL,5.2,85,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,2519130,CDM,636,RC,,BOTH,3,ME,6.12,2.45,UNITED HEALTH,UNITED COMMERCIAL,5.2,85,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UNITED HEALTH,UNITED COMMERCIAL,267.06,85,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UNITED HEALTH,UNITED COMMERCIAL,267.06,85,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UNITED HEALTH,UNITED COMMERCIAL,267.06,85,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UNITED HEALTH,UNITED COMMERCIAL,267.06,85,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
LR 1000 ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,90.88,36.35,UC HEALTH,UC HEALTH COMMERCIAL,79.07,87,,,OTHER,68.16,89.07,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,UC HEALTH,UC HEALTH COMMERCIAL,76.29,87,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
D5NS  1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,87.69,35.07,UC HEALTH,UC HEALTH COMMERCIAL,76.29,87,,,OTHER,65.77,85.93,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,UC HEALTH,UC HEALTH COMMERCIAL,104522.58,87,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,Q2043,HCPCS,636,RC,,BOTH,,,120140.9,48056.36,UC HEALTH,UC HEALTH COMMERCIAL,104522.58,87,,,OTHER,58226.25,117738.08,PERCENT OF TOTAL BILLED CHARGES
SIPULEUCEL-T/LR,2516780,CDM,636,RC,,BOTH,,,120140.9,48056.36,UC HEALTH,UC HEALTH COMMERCIAL,104522.58,87,,,OTHER,90105.68,117738.08,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHL. 0.9% 150ML,J7050,HCPCS,636,RC,,BOTH,150,ML,74,29.6,UC HEALTH,UC HEALTH COMMERCIAL,64.38,87,,,OTHER,55.5,72.52,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,UC HEALTH,UC HEALTH COMMERCIAL,61.7,87,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
SOD CHLORIDE 0.9% 100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,70.91,28.37,UC HEALTH,UC HEALTH COMMERCIAL,61.7,87,,,OTHER,53.19,69.5,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,UC HEALTH,UC HEALTH COMMERCIAL,67.95,87,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS1/2 KCL20,J3480,HCPCS,636,RC,,BOTH,,,78.1,31.24,UC HEALTH,UC HEALTH COMMERCIAL,67.95,87,,,OTHER,58.58,76.54,PERCENT OF TOTAL BILLED CHARGES
NS KCL 20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,98.13,39.25,UC HEALTH,UC HEALTH COMMERCIAL,85.37,87,,,OTHER,73.6,96.17,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,UC HEALTH,UC HEALTH COMMERCIAL,71.07,87,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
SODIUM CHLORIDE KCL40 MEQ,J3480,HCPCS,636,RC,,BOTH,,,81.69,32.68,UC HEALTH,UC HEALTH COMMERCIAL,71.07,87,,,OTHER,61.27,80.06,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,UC HEALTH,UC HEALTH COMMERCIAL,2.42,87,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 50MG/50ML,J9060,HCPCS,636,RC,,BOTH,50,ML,2.78,1.11,UC HEALTH,UC HEALTH COMMERCIAL,2.42,87,,,OTHER,2.08,2.72,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,UC HEALTH,UC HEALTH COMMERCIAL,2.6,87,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,J9060,HCPCS,636,RC,,BOTH,1,ML,2.98,1.19,UC HEALTH,UC HEALTH COMMERCIAL,2.6,87,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
CISPLATIN 1MG/ML,2510250,CDM,636,RC,,BOTH,1,ML,2.98,1.19,UC HEALTH,UC HEALTH COMMERCIAL,2.6,87,,,OTHER,2.24,2.92,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,UC HEALTH,UC HEALTH COMMERCIAL,56.6,87,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
D5W100,J7060,HCPCS,636,RC,,BOTH,1,UN,65.06,26.02,UC HEALTH,UC HEALTH COMMERCIAL,56.6,87,,,OTHER,48.79,63.75,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,UC HEALTH,UC HEALTH COMMERCIAL,18.5,87,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE 30 ML,J7608,HCPCS,636,RC,,BOTH,30,ML,21.27,8.51,UC HEALTH,UC HEALTH COMMERCIAL,18.5,87,,,OTHER,15.95,20.84,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,UC HEALTH,UC HEALTH COMMERCIAL,57.9,87,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
NS  50ML,J7050,HCPCS,636,RC,,BOTH,50,ML,66.55,26.62,UC HEALTH,UC HEALTH COMMERCIAL,57.9,87,,,OTHER,49.91,65.22,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,UC HEALTH,UC HEALTH COMMERCIAL,46.15,87,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,53.05,21.22,UC HEALTH,UC HEALTH COMMERCIAL,46.15,87,,,OTHER,39.79,51.99,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,UC HEALTH,UC HEALTH COMMERCIAL,7.26,87,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
CARBOPLATIN 10MG/ML 60ML,J9045,HCPCS,636,RC,,BOTH,60,ML,8.34,3.34,UC HEALTH,UC HEALTH COMMERCIAL,7.26,87,,,OTHER,6.26,8.17,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMULIN R) 3 ML VIAL,J1815,HCPCS,636,RC,,BOTH,3,ML,10.78,4.31,UC HEALTH,UC HEALTH COMMERCIAL,9.38,87,,,OTHER,8.09,10.57,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,66.25,26.5,UC HEALTH,UC HEALTH COMMERCIAL,57.64,87,,,OTHER,49.69,64.93,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 1MG INJ,J1170,HCPCS,636,RC,,BOTH,1,ME,53.73,21.49,UC HEALTH,UC HEALTH COMMERCIAL,46.75,87,,,OTHER,40.3,52.66,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.4 MG/ML,J2310,HCPCS,636,RC,,BOTH,0.4,ML,72.54,29.02,UC HEALTH,UC HEALTH COMMERCIAL,63.11,87,,,OTHER,54.4,71.09,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2274,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,UC HEALTH,UC HEALTH COMMERCIAL,86.55,87,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE SYR,J2270,HCPCS,636,RC,,BOTH,10,ME,99.48,39.79,UC HEALTH,UC HEALTH COMMERCIAL,86.55,87,,,OTHER,74.61,97.49,PERCENT OF TOTAL BILLED CHARGES
NS  100ML,J7050,HCPCS,636,RC,,BOTH,100,ML,63.3,25.32,UC HEALTH,UC HEALTH COMMERCIAL,55.07,87,,,OTHER,47.48,62.04,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 0.5% 50ML VIAL   MD,J2001,HCPCS,636,RC,,BOTH,50,ML,53.6,21.44,UC HEALTH,UC HEALTH COMMERCIAL,46.63,87,,,OTHER,40.2,52.53,PERCENT OF TOTAL BILLED CHARGES
MEPERIDINE,J2175,HCPCS,636,RC,,BOTH,100,ME,61.36,24.54,UC HEALTH,UC HEALTH COMMERCIAL,53.38,87,,,OTHER,46.02,60.13,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J7507,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,UC HEALTH,UC HEALTH COMMERCIAL,3.34,87,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
TACROLIMUS 0.5MG CAP,J3490,HCPCS,636,RC,,BOTH,0.5,ME,3.84,1.54,UC HEALTH,UC HEALTH COMMERCIAL,3.34,87,,,OTHER,2.88,3.77,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UC HEALTH,UC HEALTH COMMERCIAL,77.93,87,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7060,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UC HEALTH,UC HEALTH COMMERCIAL,77.93,87,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
D5W  500 ML,J7070,HCPCS,636,RC,,BOTH,500,ML,89.57,35.83,UC HEALTH,UC HEALTH COMMERCIAL,77.93,87,,,OTHER,67.18,87.78,PERCENT OF TOTAL BILLED CHARGES
PHENOBARBITAL 130MG/ML VIAL,J2560,HCPCS,636,RC,,BOTH,130,ME,190.89,76.36,UC HEALTH,UC HEALTH COMMERCIAL,166.07,87,,,OTHER,143.17,187.07,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE 2 MG SYRINGE,J1170,HCPCS,636,RC,,BOTH,2,ME,57.58,23.03,UC HEALTH,UC HEALTH COMMERCIAL,50.09,87,,,OTHER,43.19,56.43,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,UC HEALTH,UC HEALTH COMMERCIAL,82.1,87,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
D5W  250ML,J7060,HCPCS,636,RC,,BOTH,250,ML,94.36,37.74,UC HEALTH,UC HEALTH COMMERCIAL,82.1,87,,,OTHER,70.77,92.48,PERCENT OF TOTAL BILLED CHARGES
PROMETHAZINE 25 MG AMP,J2550,HCPCS,636,RC,,BOTH,25,ME,48.33,19.33,UC HEALTH,UC HEALTH COMMERCIAL,42.05,87,,,OTHER,36.25,47.36,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,UC HEALTH,UC HEALTH COMMERCIAL,56.95,87,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0612,HCPCS,636,RC,,BOTH,10,ME,65.46,26.18,UC HEALTH,UC HEALTH COMMERCIAL,56.95,87,,,OTHER,0.05,64.15,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,2515450,CDM,636,RC,,BOTH,2,GR,115.87,46.35,UC HEALTH,UC HEALTH COMMERCIAL,100.81,87,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,UC HEALTH,UC HEALTH COMMERCIAL,864.88,87,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,J1670,HCPCS,636,RC,,BOTH,250,UN,994.12,397.65,UC HEALTH,UC HEALTH COMMERCIAL,864.88,87,,,OTHER,607.72,974.24,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 2.5MG,J8610,HCPCS,636,RC,,BOTH,2.5,ME,25.39,10.16,UC HEALTH,UC HEALTH COMMERCIAL,22.09,87,,,OTHER,19.04,24.88,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,UC HEALTH,UC HEALTH COMMERCIAL,864.88,87,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,UC HEALTH,UC HEALTH COMMERCIAL,19.64,87,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,22.57,9.03,UC HEALTH,UC HEALTH COMMERCIAL,19.64,87,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
NAFCILLIN 2 GM VIAL,J3490,HCPCS,636,RC,,BOTH,2,GR,115.87,46.35,UC HEALTH,UC HEALTH COMMERCIAL,100.81,87,,,OTHER,86.9,113.55,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 1G VIAL,J3490,HCPCS,250,RC,,BOTH,1,GR,131.96,52.78,UC HEALTH,UC HEALTH COMMERCIAL,114.81,87,,,OTHER,98.97,129.32,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,UC HEALTH,UC HEALTH COMMERCIAL,56.95,87,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
CALCIUM CHLORIDE 10% VIAL,J0610,HCPCS,636,RC,,BOTH,,,65.46,26.18,UC HEALTH,UC HEALTH COMMERCIAL,56.95,87,,,OTHER,49.1,64.15,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN CONJUGATED 1.25MG TAB,2508230,CDM,250,RC,,BOTH,1.25,ME,22.57,9.03,UC HEALTH,UC HEALTH COMMERCIAL,19.64,87,,,OTHER,16.93,22.12,PERCENT OF TOTAL BILLED CHARGES
TETANUS IMMUNE GLOB 250U SYR,2521940,CDM,636,RC,,BOTH,250,UN,994.12,397.65,UC HEALTH,UC HEALTH COMMERCIAL,864.88,87,,,OTHER,745.59,974.24,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J1162,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,UC HEALTH,UC HEALTH COMMERCIAL,7984.93,87,,,OTHER,5016.31,8994.52,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,UC HEALTH,UC HEALTH COMMERCIAL,38.6,87,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
DOBUTAMINE 250 MG VIAL,J1250,HCPCS,636,RC,,BOTH,250,ME,44.37,17.75,UC HEALTH,UC HEALTH COMMERCIAL,38.6,87,,,OTHER,33.27,43.48,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J2150,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,UC HEALTH,UC HEALTH COMMERCIAL,158.82,87,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,UC HEALTH,UC HEALTH COMMERCIAL,99.26,87,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
TERBUTALINE 1 MG AMP,J3105,HCPCS,636,RC,,BOTH,1,ME,114.09,45.64,UC HEALTH,UC HEALTH COMMERCIAL,99.26,87,,,OTHER,85.57,111.81,PERCENT OF TOTAL BILLED CHARGES
MANNITOL 500ML,J7799,HCPCS,636,RC,,BOTH,500,ML,182.55,73.02,UC HEALTH,UC HEALTH COMMERCIAL,158.82,87,,,OTHER,136.91,178.9,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN IMMUNE FAB,J3490,HCPCS,636,RC,,BOTH,,,9178.08,3671.23,UC HEALTH,UC HEALTH COMMERCIAL,7984.93,87,,,OTHER,6883.56,8994.52,PERCENT OF TOTAL BILLED CHARGES
HEPATITIS B IMM. GLOBULIN 5 ML,2510180,CDM,636,RC,,BOTH,5,ML,333.07,133.23,UC HEALTH,UC HEALTH COMMERCIAL,289.77,87,,,OTHER,148.18,326.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,UC HEALTH,UC HEALTH COMMERCIAL,60.73,87,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 200MG/100ML BOT,J1450,HCPCS,636,RC,,BOTH,100,ML,69.8,27.92,UC HEALTH,UC HEALTH COMMERCIAL,60.73,87,,,OTHER,52.35,68.41,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,UC HEALTH,UC HEALTH COMMERCIAL,4100.76,87,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CALCITON  SALMON 400 UNIT/2 ML,J0630,HCPCS,636,RC,,BOTH,2,ML,4713.52,1885.41,UC HEALTH,UC HEALTH COMMERCIAL,4100.76,87,,,OTHER,1156.83,4619.25,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,UC HEALTH,UC HEALTH COMMERCIAL,67.11,87,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 250MG VIAL,J0696,HCPCS,636,RC,,BOTH,250,ME,77.14,30.86,UC HEALTH,UC HEALTH COMMERCIAL,67.11,87,,,OTHER,57.86,75.6,PERCENT OF TOTAL BILLED CHARGES
ARIPIPRAZOLE 1.25MG TAB,J3490,HCPCS,250,RC,,BOTH,1.25,ME,67.81,27.12,UC HEALTH,UC HEALTH COMMERCIAL,58.99,87,,,OTHER,50.86,66.45,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,UC HEALTH,UC HEALTH COMMERCIAL,58.57,87,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1G INJ,J0694,HCPCS,636,RC,,BOTH,1,GR,67.32,26.93,UC HEALTH,UC HEALTH COMMERCIAL,58.57,87,,,OTHER,50.49,65.97,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9260,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2274,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,UC HEALTH,UC HEALTH COMMERCIAL,117.43,87,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE PF AMP,J2270,HCPCS,636,RC,,BOTH,10,ME,134.98,53.99,UC HEALTH,UC HEALTH COMMERCIAL,117.43,87,,,OTHER,101.24,132.28,PERCENT OF TOTAL BILLED CHARGES
NALBUPHINE 10MG/ML AMP,J2300,HCPCS,636,RC,,BOTH,10,ME,51.33,20.53,UC HEALTH,UC HEALTH COMMERCIAL,44.66,87,,,OTHER,38.5,50.3,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
METHOTREXATE 50 MG VIAL,J9250,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 2.5MG TAB,2515000,CDM,636,RC,,BOTH,2.5,ME,15.69,6.28,UC HEALTH,UC HEALTH COMMERCIAL,13.65,87,,,OTHER,11.77,15.37,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 250MG/50ML,J1956,HCPCS,636,RC,,BOTH,50,ML,81.19,32.48,UC HEALTH,UC HEALTH COMMERCIAL,70.64,87,,,OTHER,60.89,79.57,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,UC HEALTH,UC HEALTH COMMERCIAL,75.24,87,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
NACL 3% 500ML,J7799,HCPCS,250,RC,,BOTH,500,ML,86.48,34.59,UC HEALTH,UC HEALTH COMMERCIAL,75.24,87,,,OTHER,64.86,84.75,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,UC HEALTH,UC HEALTH COMMERCIAL,60.04,87,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
METHERGINE 0.2 MG/ML AMPULE,J2210,HCPCS,636,RC,,BOTH,0.2,ME,69.01,27.6,UC HEALTH,UC HEALTH COMMERCIAL,60.04,87,,,OTHER,51.76,67.63,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,UC HEALTH,UC HEALTH COMMERCIAL,75.8,87,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
D51/4   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,87.13,34.85,UC HEALTH,UC HEALTH COMMERCIAL,75.8,87,,,OTHER,65.35,85.39,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE,J3490,HCPCS,250,RC,,BOTH,,,37.19,14.87,UC HEALTH,UC HEALTH COMMERCIAL,32.35,87,,,OTHER,27.89,36.44,PERCENT OF TOTAL BILLED CHARGES
PROPRANOLOL 1MG AMP,J1800,HCPCS,636,RC,,BOTH,1,ME,82.46,32.98,UC HEALTH,UC HEALTH COMMERCIAL,71.74,87,,,OTHER,61.85,80.81,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,UC HEALTH,UC HEALTH COMMERCIAL,35.76,87,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,J3490,HCPCS,250,RC,,BOTH,50,ME,41.1,16.44,UC HEALTH,UC HEALTH COMMERCIAL,35.76,87,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,UC HEALTH,UC HEALTH COMMERCIAL,60.24,87,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
DEPO MEDROL 80 MG/ML VIAL,J1040,HCPCS,636,RC,,BOTH,80,ME,69.24,27.7,UC HEALTH,UC HEALTH COMMERCIAL,60.24,87,,,OTHER,51.93,67.86,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 50MG TAB,2504940,CDM,250,RC,,BOTH,50,ME,41.1,16.44,UC HEALTH,UC HEALTH COMMERCIAL,35.76,87,,,OTHER,30.83,40.28,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUMETAMIDE 0.25MG/ML,J3490,HCPCS,250,RC,,BOTH,0.25,ML,50.42,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,UC HEALTH,UC HEALTH COMMERCIAL,10.82,87,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,J3490,HCPCS,250,RC,,BOTH,,,12.43,4.97,UC HEALTH,UC HEALTH COMMERCIAL,10.82,87,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
VITAMIN E CAPS,2506040,CDM,250,RC,,BOTH,,,12.43,4.97,UC HEALTH,UC HEALTH COMMERCIAL,10.82,87,,,OTHER,9.33,12.19,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J0280,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,UC HEALTH,UC HEALTH COMMERCIAL,19.76,87,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J0694,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,UC HEALTH,UC HEALTH COMMERCIAL,92.86,87,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,UC HEALTH,UC HEALTH COMMERCIAL,181.97,87,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
SUMATRIPTAN 6MG VIAL,J3030,HCPCS,636,RC,,BOTH,6,ME,209.16,83.66,UC HEALTH,UC HEALTH COMMERCIAL,181.97,87,,,OTHER,156.87,204.98,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,UC HEALTH,UC HEALTH COMMERCIAL,1521.73,87,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,J9217,HCPCS,636,RC,,BOTH,7.5,ME,1749.12,699.65,UC HEALTH,UC HEALTH COMMERCIAL,1521.73,87,,,OTHER,194.94,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,UC HEALTH,UC HEALTH COMMERCIAL,18.21,87,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,J3490,HCPCS,250,RC,,BOTH,0.3,ME,20.93,8.37,UC HEALTH,UC HEALTH COMMERCIAL,18.21,87,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 1GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,106.74,42.7,UC HEALTH,UC HEALTH COMMERCIAL,92.86,87,,,OTHER,80.06,104.61,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 250MG,J3490,HCPCS,636,RC,,BOTH,250,ME,22.71,9.08,UC HEALTH,UC HEALTH COMMERCIAL,19.76,87,,,OTHER,17.03,22.26,PERCENT OF TOTAL BILLED CHARGES
CEFOTETAN 2G VIAL,J3490,HCPCS,250,RC,,BOTH,2,GR,107.37,42.95,UC HEALTH,UC HEALTH COMMERCIAL,93.41,87,,,OTHER,80.53,105.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 7.5MG KIT,2504480,CDM,636,RC,,BOTH,7.5,ME,1749.12,699.65,UC HEALTH,UC HEALTH COMMERCIAL,1521.73,87,,,OTHER,1311.84,1714.14,PERCENT OF TOTAL BILLED CHARGES
ESTROGEN  CONJUGATED 0.3MG TAB,2508220,CDM,250,RC,,BOTH,0.3,ME,20.93,8.37,UC HEALTH,UC HEALTH COMMERCIAL,18.21,87,,,OTHER,15.7,20.51,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J7626,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,UC HEALTH,UC HEALTH COMMERCIAL,34.28,87,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J7674,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,UC HEALTH,UC HEALTH COMMERCIAL,39.93,87,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
METHACHOLINE 100MG VIAL.NEB,J3490,HCPCS,636,RC,,BOTH,100,ME,45.9,18.36,UC HEALTH,UC HEALTH COMMERCIAL,39.93,87,,,OTHER,34.42,44.98,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.25MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.25,ME,39.4,15.76,UC HEALTH,UC HEALTH COMMERCIAL,34.28,87,,,OTHER,29.55,38.61,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,UC HEALTH,UC HEALTH COMMERCIAL,21.13,87,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,J3490,HCPCS,250,RC,,BOTH,4,GR,24.29,9.72,UC HEALTH,UC HEALTH COMMERCIAL,21.13,87,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
CHOLESTYRAMINE 4 GM PACKET,2504400,CDM,250,RC,,BOTH,4,GR,24.29,9.72,UC HEALTH,UC HEALTH COMMERCIAL,21.13,87,,,OTHER,18.22,23.8,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,UC HEALTH,UC HEALTH COMMERCIAL,19.57,87,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,J3490,HCPCS,250,RC,,BOTH,,,22.49,9,UC HEALTH,UC HEALTH COMMERCIAL,19.57,87,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
FLEET MINERAL OIL ENEMA,2502460,CDM,250,RC,,BOTH,,,22.49,9,UC HEALTH,UC HEALTH COMMERCIAL,19.57,87,,,OTHER,16.87,22.04,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,UC HEALTH,UC HEALTH COMMERCIAL,72.51,87,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
D5LRK20 1000ML,J7120,HCPCS,636,RC,,BOTH,1000,ML,83.35,33.34,UC HEALTH,UC HEALTH COMMERCIAL,72.51,87,,,OTHER,62.51,81.68,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UC HEALTH,UC HEALTH COMMERCIAL,110,87,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2359,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UC HEALTH,UC HEALTH COMMERCIAL,110,87,,,OTHER,1.01,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UC HEALTH,UC HEALTH COMMERCIAL,110,87,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
OLANZAPINE 10MG VIAL,J2358,HCPCS,250,RC,,BOTH,10,ME,126.44,50.58,UC HEALTH,UC HEALTH COMMERCIAL,110,87,,,OTHER,3.06,123.91,PERCENT OF TOTAL BILLED CHARGES
PREDNISONE 5MG TAB,2519250,CDM,636,RC,,BOTH,5,ME,14.15,5.66,UC HEALTH,UC HEALTH COMMERCIAL,12.31,87,,,OTHER,10.61,13.86,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,UC HEALTH,UC HEALTH COMMERCIAL,153.82,87,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,J0834,HCPCS,636,RC,,BOTH,0.25,ME,176.81,70.72,UC HEALTH,UC HEALTH COMMERCIAL,153.82,87,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
COSYNTROPIN 0.25 MG VIAL,2505390,CDM,636,RC,,BOTH,0.25,ME,176.81,70.72,UC HEALTH,UC HEALTH COMMERCIAL,153.82,87,,,OTHER,132.6,173.27,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,UC HEALTH,UC HEALTH COMMERCIAL,20.28,87,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,J3490,HCPCS,250,RC,,BOTH,,,23.31,9.32,UC HEALTH,UC HEALTH COMMERCIAL,20.28,87,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,UC HEALTH,UC HEALTH COMMERCIAL,13.91,87,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,J3490,HCPCS,250,RC,,BOTH,,,15.98,6.39,UC HEALTH,UC HEALTH COMMERCIAL,13.91,87,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
CHLORASEPTIC SPRAY,2504300,CDM,250,RC,,BOTH,,,23.31,9.32,UC HEALTH,UC HEALTH COMMERCIAL,20.28,87,,,OTHER,17.48,22.84,PERCENT OF TOTAL BILLED CHARGES
VITAMIN D CAP,2504920,CDM,250,RC,,BOTH,,,15.98,6.39,UC HEALTH,UC HEALTH COMMERCIAL,13.91,87,,,OTHER,11.99,15.66,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,UC HEALTH,UC HEALTH COMMERCIAL,49.31,87,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 500 MG VIAL,J0290,HCPCS,636,RC,,BOTH,500,ME,56.68,22.67,UC HEALTH,UC HEALTH COMMERCIAL,49.31,87,,,OTHER,42.51,55.55,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,J3490,HCPCS,250,RC,,BOTH,,,126.41,50.56,UC HEALTH,UC HEALTH COMMERCIAL,109.98,87,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
FLUTIICASONE PROPIONATE NASAL,2515370,CDM,250,RC,,BOTH,,,126.41,50.56,UC HEALTH,UC HEALTH COMMERCIAL,109.98,87,,,OTHER,94.81,123.88,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 20ML,J2001,HCPCS,636,RC,,BOTH,20,ML,62.37,24.95,UC HEALTH,UC HEALTH COMMERCIAL,54.26,87,,,OTHER,46.78,61.12,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,UC HEALTH,UC HEALTH COMMERCIAL,167.59,87,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.5 MG/2 ML AMP,J1160,HCPCS,636,RC,,BOTH,0.5,ME,192.63,77.05,UC HEALTH,UC HEALTH COMMERCIAL,167.59,87,,,OTHER,144.47,188.78,PERCENT OF TOTAL BILLED CHARGES
METHOCARBAMOL 100MG VIAL,J2800,HCPCS,636,RC,,BOTH,100,ME,204.62,81.85,UC HEALTH,UC HEALTH COMMERCIAL,178.02,87,,,OTHER,153.47,200.53,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 10 U/ML INJ,J2590,HCPCS,636,RC,,BOTH,10,UN,50.06,20.02,UC HEALTH,UC HEALTH COMMERCIAL,43.55,87,,,OTHER,37.55,49.06,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,UC HEALTH,UC HEALTH COMMERCIAL,51.53,87,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,J0295,HCPCS,636,RC,,BOTH,1.5,GR,59.23,23.69,UC HEALTH,UC HEALTH COMMERCIAL,51.53,87,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 1.5G VIAL,2501130,CDM,636,RC,,BOTH,1.5,GR,59.23,23.69,UC HEALTH,UC HEALTH COMMERCIAL,51.53,87,,,OTHER,44.42,58.05,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,J3490,HCPCS,250,RC,,BOTH,1000,ME,16.62,6.65,UC HEALTH,UC HEALTH COMMERCIAL,14.46,87,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
FISH OIL 1000MG,2516900,CDM,250,RC,,BOTH,1000,ME,16.62,6.65,UC HEALTH,UC HEALTH COMMERCIAL,14.46,87,,,OTHER,12.47,16.29,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,UC HEALTH,UC HEALTH COMMERCIAL,53.81,87,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
CYANOCOBALAMIN 1000 MCG/ML,J3420,HCPCS,636,RC,,BOTH,1000,ML,61.85,24.74,UC HEALTH,UC HEALTH COMMERCIAL,53.81,87,,,OTHER,46.39,60.61,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,UC HEALTH,UC HEALTH COMMERCIAL,77.21,87,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 10% 1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,88.74,35.5,UC HEALTH,UC HEALTH COMMERCIAL,77.21,87,,,OTHER,66.56,86.97,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2274,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,UC HEALTH,UC HEALTH COMMERCIAL,46.04,87,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
MORPHINE SULFATE,J2270,HCPCS,636,RC,,BOTH,10,ME,52.92,21.17,UC HEALTH,UC HEALTH COMMERCIAL,46.04,87,,,OTHER,39.69,51.86,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,UC HEALTH,UC HEALTH COMMERCIAL,73.01,87,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
NS1/2  1000ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,83.92,33.57,UC HEALTH,UC HEALTH COMMERCIAL,73.01,87,,,OTHER,62.94,82.24,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,J3490,HCPCS,250,RC,,BOTH,50,ME,17.65,7.06,UC HEALTH,UC HEALTH COMMERCIAL,15.36,87,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
TOPAMAX 50MG,2510700,CDM,250,RC,,BOTH,50,ME,17.65,7.06,UC HEALTH,UC HEALTH COMMERCIAL,15.36,87,,,OTHER,13.24,17.3,PERCENT OF TOTAL BILLED CHARGES
NS 500ML,J7030,HCPCS,636,RC,,BOTH,500,ML,81.62,32.65,UC HEALTH,UC HEALTH COMMERCIAL,71.01,87,,,OTHER,61.22,79.99,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UC HEALTH,UC HEALTH COMMERCIAL,4469.69,87,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,J9358,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UC HEALTH,UC HEALTH COMMERCIAL,4469.69,87,,,OTHER,28.63,5034.82,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,2509490,CDM,636,RC,,BOTH,1,ME,472.36,188.94,UC HEALTH,UC HEALTH COMMERCIAL,410.95,87,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,UC HEALTH,UC HEALTH COMMERCIAL,410.95,87,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
GLUCAGON 1 MG VIAL,J1610,HCPCS,636,RC,,BOTH,1,ME,472.36,188.94,UC HEALTH,UC HEALTH COMMERCIAL,410.95,87,,,OTHER,201.1,462.91,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,J3490,HCPCS,250,RC,,BOTH,0.125,ME,48.04,19.22,UC HEALTH,UC HEALTH COMMERCIAL,41.79,87,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UC HEALTH,UC HEALTH COMMERCIAL,4469.69,87,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
FAM-TRASTUZUMAB 100MG PWDR,C9399,HCPCS,636,RC,,BOTH,100,ME,5137.57,2055.03,UC HEALTH,UC HEALTH COMMERCIAL,4469.69,87,,,OTHER,3853.18,5034.82,PERCENT OF TOTAL BILLED CHARGES
DIGOXIN 0.125 MG TAB,2506740,CDM,250,RC,,BOTH,0.125,ME,48.04,19.22,UC HEALTH,UC HEALTH COMMERCIAL,41.79,87,,,OTHER,36.03,47.08,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,UC HEALTH,UC HEALTH COMMERCIAL,436.39,87,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,J3490,HCPCS,250,RC,,BOTH,,,501.6,200.64,UC HEALTH,UC HEALTH COMMERCIAL,436.39,87,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
ADVAIR INHALER 250/50,2508270,CDM,250,RC,,BOTH,,,501.6,200.64,UC HEALTH,UC HEALTH COMMERCIAL,436.39,87,,,OTHER,376.2,491.57,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,UC HEALTH,UC HEALTH COMMERCIAL,35.39,87,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
BUMETANIDE 1 MG VIAL,J3490,HCPCS,250,RC,,BOTH,1,ME,40.67,16.27,UC HEALTH,UC HEALTH COMMERCIAL,35.39,87,,,OTHER,30.5,39.86,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UC HEALTH,UC HEALTH COMMERCIAL,64.47,87,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0612,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UC HEALTH,UC HEALTH COMMERCIAL,64.47,87,,,OTHER,0.05,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UC HEALTH,UC HEALTH COMMERCIAL,64.47,87,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CALCIUM GLUCONATE 1MG/10ML,J0610,HCPCS,636,RC,,BOTH,10,ML,74.11,29.64,UC HEALTH,UC HEALTH COMMERCIAL,64.47,87,,,OTHER,55.58,72.62,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,UC HEALTH,UC HEALTH COMMERCIAL,17.21,87,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,J3490,HCPCS,250,RC,,BOTH,5,ME,19.78,7.91,UC HEALTH,UC HEALTH COMMERCIAL,17.21,87,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
CYCLOBENZAPRINE 5MG TAB,2505500,CDM,250,RC,,BOTH,5,ME,19.78,7.91,UC HEALTH,UC HEALTH COMMERCIAL,17.21,87,,,OTHER,14.83,19.38,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,UC HEALTH,UC HEALTH COMMERCIAL,235.49,87,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,J3490,HCPCS,250,RC,,BOTH,,,270.68,108.27,UC HEALTH,UC HEALTH COMMERCIAL,235.49,87,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
TIOTROPIUM BROMIDE INH,2509880,CDM,250,RC,,BOTH,,,270.68,108.27,UC HEALTH,UC HEALTH COMMERCIAL,235.49,87,,,OTHER,203.01,265.26,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,UC HEALTH,UC HEALTH COMMERCIAL,58.97,87,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,J0895,HCPCS,636,RC,,BOTH,500,ME,67.78,27.11,UC HEALTH,UC HEALTH COMMERCIAL,58.97,87,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
DEFEROXAMINE 500MG VIAL,2505960,CDM,636,RC,,BOTH,500,ME,67.78,27.11,UC HEALTH,UC HEALTH COMMERCIAL,58.97,87,,,OTHER,50.84,66.43,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% 50ML MDV,J0665,HCPCS,636,RC,,BOTH,50,ML,42.7,17.08,UC HEALTH,UC HEALTH COMMERCIAL,37.15,87,,,OTHER,0.02,41.84,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 1MG AMP,J3430,HCPCS,636,RC,,BOTH,1,ME,96.12,38.45,UC HEALTH,UC HEALTH COMMERCIAL,83.62,87,,,OTHER,72.09,94.2,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,UC HEALTH,UC HEALTH COMMERCIAL,55.01,87,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
DEXTROSE 50 ML SYRINGE,J3490,HCPCS,636,RC,,BOTH,50,ML,63.23,25.29,UC HEALTH,UC HEALTH COMMERCIAL,55.01,87,,,OTHER,47.43,61.97,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,UC HEALTH,UC HEALTH COMMERCIAL,20.91,87,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,J3490,HCPCS,250,RC,,BOTH,50,ME,24.03,9.61,UC HEALTH,UC HEALTH COMMERCIAL,20.91,87,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
TOPIRAMATE 50MG TABLET,2507500,CDM,250,RC,,BOTH,50,ME,24.03,9.61,UC HEALTH,UC HEALTH COMMERCIAL,20.91,87,,,OTHER,18.03,23.55,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UC HEALTH,UC HEALTH COMMERCIAL,42.91,87,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3371,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UC HEALTH,UC HEALTH COMMERCIAL,42.91,87,,,OTHER,6.16,48.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 500 MG VIAL,J3370,HCPCS,636,RC,,BOTH,500,ME,49.32,19.73,UC HEALTH,UC HEALTH COMMERCIAL,42.91,87,,,OTHER,36.99,48.33,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,0.02,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.5% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.43,20.17,UC HEALTH,UC HEALTH COMMERCIAL,43.87,87,,,OTHER,37.82,49.42,PERCENT OF TOTAL BILLED CHARGES
METOCLOPRAMIDE 5MG/ML VIAL,J2765,HCPCS,636,RC,,BOTH,5,ME,45.92,18.37,UC HEALTH,UC HEALTH COMMERCIAL,39.95,87,,,OTHER,34.44,45.01,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,UC HEALTH,UC HEALTH COMMERCIAL,19.45,87,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,J3490,HCPCS,250,RC,,BOTH,12.5,ME,22.35,8.94,UC HEALTH,UC HEALTH COMMERCIAL,19.45,87,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
CARVEDILOL 12.5MG TAB,2507510,CDM,250,RC,,BOTH,12.5,ME,22.35,8.94,UC HEALTH,UC HEALTH COMMERCIAL,19.45,87,,,OTHER,16.77,21.91,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,J3490,HCPCS,255,RC,,BOTH,30,ML,110.55,44.22,UC HEALTH,UC HEALTH COMMERCIAL,96.17,87,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
DIATRIZOATE MEGLUMINE 30ML,2508130,CDM,255,RC,,BOTH,30,ML,110.55,44.22,UC HEALTH,UC HEALTH COMMERCIAL,96.17,87,,,OTHER,82.91,108.33,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 0.9% NACL,J1580,HCPCS,636,RC,,BOTH,80,ME,68.12,27.25,UC HEALTH,UC HEALTH COMMERCIAL,59.26,87,,,OTHER,51.09,66.75,PERCENT OF TOTAL BILLED CHARGES
SPIRONOLACTONE 25 MG TAB,J3490,HCPCS,250,RC,,BOTH,25,ME,17.63,7.05,UC HEALTH,UC HEALTH COMMERCIAL,15.33,87,,,OTHER,13.22,17.27,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,UC HEALTH,UC HEALTH COMMERCIAL,29.22,87,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 500MG INJ,J0690,HCPCS,636,RC,,BOTH,500,ME,33.59,13.43,UC HEALTH,UC HEALTH COMMERCIAL,29.22,87,,,OTHER,25.19,32.92,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,J3490,HCPCS,250,RC,,BOTH,180,ME,59.19,23.67,UC HEALTH,UC HEALTH COMMERCIAL,51.49,87,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
DILTIAZEM CD 180MG CAP,2506840,CDM,250,RC,,BOTH,180,ME,59.19,23.67,UC HEALTH,UC HEALTH COMMERCIAL,51.49,87,,,OTHER,44.39,58,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,UC HEALTH,UC HEALTH COMMERCIAL,126.11,87,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2GM/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,144.95,57.98,UC HEALTH,UC HEALTH COMMERCIAL,126.11,87,,,OTHER,108.71,142.05,PERCENT OF TOTAL BILLED CHARGES
MENTHOL ZINCOX,J3490,HCPCS,250,RC,,BOTH,,,26.42,10.57,UC HEALTH,UC HEALTH COMMERCIAL,22.99,87,,,OTHER,19.82,25.89,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,UC HEALTH,UC HEALTH COMMERCIAL,274.14,87,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
ALBUMIN 25% 100ML,P9047,HCPCS,636,RC,,BOTH,100,ML,315.1,126.04,UC HEALTH,UC HEALTH COMMERCIAL,274.14,87,,,OTHER,55.73,308.8,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,J9190,HCPCS,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL 50 MG/10 ML VIAL,2508790,CDM,636,RC,,BOTH,50,ME,125,50,UC HEALTH,UC HEALTH COMMERCIAL,108.75,87,,,OTHER,93.75,122.5,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,UC HEALTH,UC HEALTH COMMERCIAL,104.82,87,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,J3490,HCPCS,250,RC,,BOTH,,,120.48,48.19,UC HEALTH,UC HEALTH COMMERCIAL,104.82,87,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,UC HEALTH,UC HEALTH COMMERCIAL,104.82,87,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
CLEOCININ D5W,2513570,CDM,250,RC,,BOTH,,,120.48,48.19,UC HEALTH,UC HEALTH COMMERCIAL,104.82,87,,,OTHER,90.36,118.08,PERCENT OF TOTAL BILLED CHARGES
GLYCOPYRROLATE 0.2 MG/ML,2509510,CDM,250,RC,,BOTH,0.2,ML,74.12,29.65,UC HEALTH,UC HEALTH COMMERCIAL,64.48,87,,,OTHER,55.59,72.64,PERCENT OF TOTAL BILLED CHARGES
HYDROCORT SOD.SUCC. 100MG VIAL,J1720,HCPCS,636,RC,,BOTH,100,ME,71.91,28.76,UC HEALTH,UC HEALTH COMMERCIAL,62.56,87,,,OTHER,53.93,70.47,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 40MG VIAL,J2920,HCPCS,636,RC,,BOTH,40,ME,58,23.2,UC HEALTH,UC HEALTH COMMERCIAL,50.46,87,,,OTHER,43.5,56.84,PERCENT OF TOTAL BILLED CHARGES
NS 250ML GLASS BOTTLE,J7030,HCPCS,636,RC,,BOTH,250,ML,79.33,31.73,UC HEALTH,UC HEALTH COMMERCIAL,69.02,87,,,OTHER,59.5,77.75,PERCENT OF TOTAL BILLED CHARGES
PROCHLORPERAZINE 10 MG VIAL,J0780,HCPCS,636,RC,,BOTH,10,ME,74.3,29.72,UC HEALTH,UC HEALTH COMMERCIAL,64.64,87,,,OTHER,55.73,72.81,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,UC HEALTH,UC HEALTH COMMERCIAL,14.43,87,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,J3490,HCPCS,250,RC,,BOTH,100,ME,16.59,6.64,UC HEALTH,UC HEALTH COMMERCIAL,14.43,87,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG TAB,2522260,CDM,250,RC,,BOTH,100,ME,16.59,6.64,UC HEALTH,UC HEALTH COMMERCIAL,14.43,87,,,OTHER,12.44,16.26,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2371,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,UC HEALTH,UC HEALTH COMMERCIAL,49.74,87,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
PHENYLEPHRINE 10MG VIAL,J2370,HCPCS,636,RC,,BOTH,10,ME,57.18,22.87,UC HEALTH,UC HEALTH COMMERCIAL,49.74,87,,,OTHER,42.88,56.03,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,UC HEALTH,UC HEALTH COMMERCIAL,88.12,87,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
TRACE MINERALS 1ML VIAL,J3490,HCPCS,636,RC,,BOTH,1,ML,101.29,40.52,UC HEALTH,UC HEALTH COMMERCIAL,88.12,87,,,OTHER,75.97,99.27,PERCENT OF TOTAL BILLED CHARGES
FOLIC ACID 1 MG TAB,J3490,HCPCS,250,RC,,BOTH,1,ME,17.34,6.94,UC HEALTH,UC HEALTH COMMERCIAL,15.09,87,,,OTHER,13.01,17,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,UC HEALTH,UC HEALTH COMMERCIAL,73.17,87,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
D5LR  1000ML,J7121,HCPCS,636,RC,,BOTH,1000,ML,84.11,33.64,UC HEALTH,UC HEALTH COMMERCIAL,73.17,87,,,OTHER,63.08,82.43,PERCENT OF TOTAL BILLED CHARGES
HYDRALAZINE 20 MG/ML VIAL,J0360,HCPCS,636,RC,,BOTH,20,ME,142.58,57.03,UC HEALTH,UC HEALTH COMMERCIAL,124.04,87,,,OTHER,106.94,139.73,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,UC HEALTH,UC HEALTH COMMERCIAL,40.12,87,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 20MG VIAL,J1940,HCPCS,636,RC,,BOTH,20,ME,46.12,18.45,UC HEALTH,UC HEALTH COMMERCIAL,40.12,87,,,OTHER,34.59,45.19,PERCENT OF TOTAL BILLED CHARGES
PATIENTS OWN MED,J3490,HCPCS,636,RC,,BOTH,,,0.52,0.21,UC HEALTH,UC HEALTH COMMERCIAL,0.45,87,,,OTHER,0.39,0.51,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,UC HEALTH,UC HEALTH COMMERCIAL,17.06,87,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,J3490,HCPCS,250,RC,,BOTH,10,ME,19.61,7.84,UC HEALTH,UC HEALTH COMMERCIAL,17.06,87,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
ESCITALAPRAM 10MG TAB,2504830,CDM,250,RC,,BOTH,10,ME,19.61,7.84,UC HEALTH,UC HEALTH COMMERCIAL,17.06,87,,,OTHER,14.71,19.22,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,UC HEALTH,UC HEALTH COMMERCIAL,51.58,87,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
DROPERIDOL 2.5MG/ML INJ,J1790,HCPCS,636,RC,,BOTH,2.5,ME,59.29,23.72,UC HEALTH,UC HEALTH COMMERCIAL,51.58,87,,,OTHER,44.47,58.1,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,UC HEALTH,UC HEALTH COMMERCIAL,121.07,87,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
CLONIDINE 1000MCG/10ML SDV PF,J0735,HCPCS,636,RC,,BOTH,10,ML,139.16,55.66,UC HEALTH,UC HEALTH COMMERCIAL,121.07,87,,,OTHER,104.37,136.38,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,UC HEALTH,UC HEALTH COMMERCIAL,15.06,87,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,J3490,HCPCS,250,RC,,BOTH,40,ME,17.31,6.92,UC HEALTH,UC HEALTH COMMERCIAL,15.06,87,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40 MG TAB,2509260,CDM,250,RC,,BOTH,40,ME,17.31,6.92,UC HEALTH,UC HEALTH COMMERCIAL,15.06,87,,,OTHER,12.98,16.96,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,UC HEALTH,UC HEALTH COMMERCIAL,47.58,87,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE 40MEQ VIAL,J3480,HCPCS,636,RC,,BOTH,,,54.69,21.88,UC HEALTH,UC HEALTH COMMERCIAL,47.58,87,,,OTHER,41.02,53.6,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.45,87,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
BUDESONIDE 0.5MG/2ML NEB,J3490,HCPCS,636,RC,,BOTH,0.5,ME,46.5,18.6,UC HEALTH,UC HEALTH COMMERCIAL,40.45,87,,,OTHER,34.87,45.57,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 60MG/0.9% NS 50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,64.59,25.84,UC HEALTH,UC HEALTH COMMERCIAL,56.19,87,,,OTHER,48.44,63.3,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,UC HEALTH,UC HEALTH COMMERCIAL,58.56,87,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
THIAMINE HCL 100 MG VIAL,J3411,HCPCS,636,RC,,BOTH,100,ME,67.31,26.93,UC HEALTH,UC HEALTH COMMERCIAL,58.56,87,,,OTHER,50.48,65.97,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,2511540,CDM,636,RC,,BOTH,,,146.98,58.79,UC HEALTH,UC HEALTH COMMERCIAL,127.87,87,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSSIS/TET VAC >7,90715,HCPCS,636,RC,,BOTH,,,146.98,58.79,UC HEALTH,UC HEALTH COMMERCIAL,127.87,87,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
GENTAMICIN 80MG VIAL,J1580,HCPCS,636,RC,,BOTH,80,ME,47.86,19.14,UC HEALTH,UC HEALTH COMMERCIAL,41.64,87,,,OTHER,35.89,46.9,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 4MEQ/ML 2ML VIAL,J3475,HCPCS,636,RC,,BOTH,2,ML,34.27,13.71,UC HEALTH,UC HEALTH COMMERCIAL,29.81,87,,,OTHER,25.7,33.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,UC HEALTH,UC HEALTH COMMERCIAL,48.64,87,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,55.91,22.36,UC HEALTH,UC HEALTH COMMERCIAL,48.64,87,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,UC HEALTH,UC HEALTH COMMERCIAL,48.64,87,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.5% 30ML,2502930,CDM,636,RC,,BOTH,30,ML,55.91,22.36,UC HEALTH,UC HEALTH COMMERCIAL,48.64,87,,,OTHER,41.93,54.79,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,UC HEALTH,UC HEALTH COMMERCIAL,56.26,87,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
AZITHROMYCIN 500MG VIAL,J0456,HCPCS,636,RC,,BOTH,500,ME,64.67,25.87,UC HEALTH,UC HEALTH COMMERCIAL,56.26,87,,,OTHER,48.5,63.38,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,2513040,CDM,636,RC,,BOTH,20,ME,44.88,17.95,UC HEALTH,UC HEALTH COMMERCIAL,39.05,87,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,UC HEALTH,UC HEALTH COMMERCIAL,39.05,87,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
FAMOTIDINE 20MG/2ML SDV,J3490,HCPCS,636,RC,,BOTH,20,ME,44.88,17.95,UC HEALTH,UC HEALTH COMMERCIAL,39.05,87,,,OTHER,33.66,43.98,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT 4MG,J3490,HCPCS,636,RC,,BOTH,4,ME,23.2,9.28,UC HEALTH,UC HEALTH COMMERCIAL,20.19,87,,,OTHER,17.4,22.74,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J0665,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,UC HEALTH,UC HEALTH COMMERCIAL,45.34,87,,,OTHER,0.02,51.08,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE 0.25% 30ML,J3490,HCPCS,636,RC,,BOTH,30,ML,52.12,20.85,UC HEALTH,UC HEALTH COMMERCIAL,45.34,87,,,OTHER,39.09,51.08,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,UC HEALTH,UC HEALTH COMMERCIAL,39.25,87,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,J1200,HCPCS,636,RC,,BOTH,50,ME,45.11,18.05,UC HEALTH,UC HEALTH COMMERCIAL,39.25,87,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
DIPHENHYDRAMINE 50 MG/ML VIAL,2506990,CDM,636,RC,,BOTH,50,ME,45.11,18.05,UC HEALTH,UC HEALTH COMMERCIAL,39.25,87,,,OTHER,33.84,44.21,PERCENT OF TOTAL BILLED CHARGES
METHLYPREDNISOLONE 125MG VIAL,J2930,HCPCS,636,RC,,BOTH,125,ME,66.23,26.49,UC HEALTH,UC HEALTH COMMERCIAL,57.62,87,,,OTHER,49.67,64.91,PERCENT OF TOTAL BILLED CHARGES
LORAZEPAM 2 MG/ML VIAL,J2060,HCPCS,636,RC,,BOTH,2,ME,55.93,22.37,UC HEALTH,UC HEALTH COMMERCIAL,48.66,87,,,OTHER,41.94,54.81,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,S0164,HCPCS,636,RC,,BOTH,40,ME,74.08,29.63,UC HEALTH,UC HEALTH COMMERCIAL,64.45,87,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
PANTOPRAZOLE INJ 40MG,2507670,CDM,636,RC,,BOTH,40,ME,74.08,29.63,UC HEALTH,UC HEALTH COMMERCIAL,64.45,87,,,OTHER,55.56,72.6,PERCENT OF TOTAL BILLED CHARGES
NS  500ML,J7040,HCPCS,636,RC,,BOTH,500,ML,175.19,70.08,UC HEALTH,UC HEALTH COMMERCIAL,152.41,87,,,OTHER,131.39,171.69,PERCENT OF TOTAL BILLED CHARGES
NON FORMULARY MED REC,2504941,CDM,636,RC,,BOTH,,,0.05,0.02,UC HEALTH,UC HEALTH COMMERCIAL,0.04,87,,,OTHER,0.03,0.05,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 15MG VIAL,J1885,HCPCS,636,RC,,BOTH,15,ME,49.58,19.83,UC HEALTH,UC HEALTH COMMERCIAL,43.13,87,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
DUONEB 0.5MG/3.ML,J7620,HCPCS,636,RC,,BOTH,3,ML,2.22,0.89,UC HEALTH,UC HEALTH COMMERCIAL,1.93,87,,,OTHER,1.66,2.17,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,UC HEALTH,UC HEALTH COMMERCIAL,45.59,87,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 2 ML AMP,J3010,HCPCS,636,RC,,BOTH,2,ML,52.4,20.96,UC HEALTH,UC HEALTH COMMERCIAL,45.59,87,,,OTHER,39.3,51.35,PERCENT OF TOTAL BILLED CHARGES
NS  250ML,J7050,HCPCS,636,RC,,BOTH,250,ML,83.9,33.56,UC HEALTH,UC HEALTH COMMERCIAL,72.99,87,,,OTHER,62.93,82.22,PERCENT OF TOTAL BILLED CHARGES
NS  1000ML,J7030,HCPCS,636,RC,,BOTH,1000,ML,122.12,48.85,UC HEALTH,UC HEALTH COMMERCIAL,106.24,87,,,OTHER,91.59,119.67,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,UC HEALTH,UC HEALTH COMMERCIAL,692.17,87,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
EPIPEN JR SYR,J0171,HCPCS,636,RC,,BOTH,0.1,ME,795.6,318.24,UC HEALTH,UC HEALTH COMMERCIAL,692.17,87,,,OTHER,596.7,779.69,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,UC HEALTH,UC HEALTH COMMERCIAL,44.19,87,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
DAKIN'S 0.125%,J9130,HCPCS,636,RC,,BOTH,100,ME,50.79,20.32,UC HEALTH,UC HEALTH COMMERCIAL,44.19,87,,,OTHER,38.09,49.77,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,UC HEALTH,UC HEALTH COMMERCIAL,63.58,87,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
AMINOPHYLLINE 500 MG VIAL,J0280,HCPCS,636,RC,,BOTH,500,ME,73.08,29.23,UC HEALTH,UC HEALTH COMMERCIAL,63.58,87,,,OTHER,54.81,71.62,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,UC HEALTH,UC HEALTH COMMERCIAL,67.26,87,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
CEFTAZIDIME 1 GM  VIAL,J0713,HCPCS,636,RC,,BOTH,1,GR,77.31,30.92,UC HEALTH,UC HEALTH COMMERCIAL,67.26,87,,,OTHER,57.98,75.76,PERCENT OF TOTAL BILLED CHARGES
NEOSTIGMINE 1MG/ML INJ,J2710,HCPCS,636,RC,,BOTH,1,ME,81.21,32.48,UC HEALTH,UC HEALTH COMMERCIAL,70.65,87,,,OTHER,60.91,79.59,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 100 MG/2 ML VIAL,J1165,HCPCS,636,RC,,BOTH,100,ME,31.36,12.54,UC HEALTH,UC HEALTH COMMERCIAL,27.28,87,,,OTHER,23.52,30.73,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,UC HEALTH,UC HEALTH COMMERCIAL,80.14,87,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
CEFOXITIN 2G VIAL,J0694,HCPCS,636,RC,,BOTH,2,GR,92.12,36.85,UC HEALTH,UC HEALTH COMMERCIAL,80.14,87,,,OTHER,69.09,90.28,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,UC HEALTH,UC HEALTH COMMERCIAL,226.5,87,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BENZTROPINE 1MG/ML VIAL,J0515,HCPCS,636,RC,,BOTH,1,ME,260.35,104.14,UC HEALTH,UC HEALTH COMMERCIAL,226.5,87,,,OTHER,195.26,255.14,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,UC HEALTH,UC HEALTH COMMERCIAL,409.42,87,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,J9040,HCPCS,636,RC,,BOTH,30,UN,470.6,188.24,UC HEALTH,UC HEALTH COMMERCIAL,409.42,87,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
BLEOMYCIN 30 UNIT VIAL,2509110,CDM,636,RC,,BOTH,30,UN,470.6,188.24,UC HEALTH,UC HEALTH COMMERCIAL,409.42,87,,,OTHER,352.95,461.19,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,UC HEALTH,UC HEALTH COMMERCIAL,72.35,87,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1GM/50ML,J0690,HCPCS,636,RC,,BOTH,50,ML,83.16,33.26,UC HEALTH,UC HEALTH COMMERCIAL,72.35,87,,,OTHER,62.37,81.5,PERCENT OF TOTAL BILLED CHARGES
NALOXONE 0.2MG AMP,J2310,HCPCS,636,RC,,BOTH,0.2,ME,117.05,46.82,UC HEALTH,UC HEALTH COMMERCIAL,101.83,87,,,OTHER,87.79,114.71,PERCENT OF TOTAL BILLED CHARGES
HYDROXYZINE HCL 50 MG/ML VIAL ,J3410,HCPCS,636,RC,,BOTH,50,ME,101.36,40.54,UC HEALTH,UC HEALTH COMMERCIAL,88.18,87,,,OTHER,76.02,99.33,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,UC HEALTH,UC HEALTH COMMERCIAL,58.01,87,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 1G VIAL,J0290,HCPCS,636,RC,,BOTH,1,GR,66.68,26.67,UC HEALTH,UC HEALTH COMMERCIAL,58.01,87,,,OTHER,50.01,65.35,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.02,87,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 500MG VIAL,J0696,HCPCS,636,RC,,BOTH,500,ME,123.01,49.2,UC HEALTH,UC HEALTH COMMERCIAL,107.02,87,,,OTHER,92.25,120.55,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,UC HEALTH,UC HEALTH COMMERCIAL,119.25,87,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
FLUCONAZOLE 400MG INJ,J1450,HCPCS,636,RC,,BOTH,400,ME,137.07,54.83,UC HEALTH,UC HEALTH COMMERCIAL,119.25,87,,,OTHER,102.8,134.33,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 500MG INJ,J1956,HCPCS,636,RC,,BOTH,500,ME,67.61,27.04,UC HEALTH,UC HEALTH COMMERCIAL,58.82,87,,,OTHER,50.71,66.26,PERCENT OF TOTAL BILLED CHARGES
PERFLUTREN  SDV,Q9957,HCPCS,636,RC,,BOTH,,,813.57,325.43,UC HEALTH,UC HEALTH COMMERCIAL,707.81,87,,,OTHER,610.18,797.3,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,UC HEALTH,UC HEALTH COMMERCIAL,54.38,87,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,J9130,HCPCS,636,RC,,BOTH,100,ME,62.5,25,UC HEALTH,UC HEALTH COMMERCIAL,54.38,87,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
DACARBAZINE,2513380,CDM,636,RC,,BOTH,100,ME,62.5,25,UC HEALTH,UC HEALTH COMMERCIAL,54.38,87,,,OTHER,46.88,61.25,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,UC HEALTH,UC HEALTH COMMERCIAL,39.22,87,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
BETAMETHASONE 6MG/ML INJ,J0702,HCPCS,636,RC,,BOTH,6,ME,45.08,18.03,UC HEALTH,UC HEALTH COMMERCIAL,39.22,87,,,OTHER,33.81,44.18,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UC HEALTH,UC HEALTH COMMERCIAL,113.08,87,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0689,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UC HEALTH,UC HEALTH COMMERCIAL,113.08,87,,,OTHER,1.3,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UC HEALTH,UC HEALTH COMMERCIAL,113.08,87,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G BAG,J0690,HCPCS,636,RC,,BOTH,1,GR,129.98,51.99,UC HEALTH,UC HEALTH COMMERCIAL,113.08,87,,,OTHER,97.49,127.38,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7060,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UC HEALTH,UC HEALTH COMMERCIAL,73.11,87,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UC HEALTH,UC HEALTH COMMERCIAL,73.11,87,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
D5W 1000ML,J7070,HCPCS,636,RC,,BOTH,1000,ML,84.03,33.61,UC HEALTH,UC HEALTH COMMERCIAL,73.11,87,,,OTHER,63.02,82.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,UC HEALTH,UC HEALTH COMMERCIAL,361.44,87,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 2ML CATHFLO,J2997,HCPCS,636,RC,,BOTH,2,ML,415.45,166.18,UC HEALTH,UC HEALTH COMMERCIAL,361.44,87,,,OTHER,93.26,407.14,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,UC HEALTH,UC HEALTH COMMERCIAL,403.21,87,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
CYCLOPHOSPHAMIDE 1GM/5ML,J9070,HCPCS,636,RC,,BOTH,5,ML,463.46,185.38,UC HEALTH,UC HEALTH COMMERCIAL,403.21,87,,,OTHER,347.6,454.19,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,UC HEALTH,UC HEALTH COMMERCIAL,1.92,87,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,J0640,HCPCS,636,RC,,BOTH,100,ME,2.21,0.88,UC HEALTH,UC HEALTH COMMERCIAL,1.92,87,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 100MG VIAL,2512600,CDM,636,RC,,BOTH,100,ME,2.21,0.88,UC HEALTH,UC HEALTH COMMERCIAL,1.92,87,,,OTHER,1.65,2.16,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 1000U/ML 2ML VIAL,J1644,HCPCS,636,RC,,BOTH,2,ML,78.89,31.56,UC HEALTH,UC HEALTH COMMERCIAL,68.63,87,,,OTHER,59.17,77.31,PERCENT OF TOTAL BILLED CHARGES
OXYTOCIN 20U/LR 1000 ML,J2590,HCPCS,636,RC,,BOTH,1000,ML,276.21,110.48,UC HEALTH,UC HEALTH COMMERCIAL,240.3,87,,,OTHER,207.15,270.68,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,UC HEALTH,UC HEALTH COMMERCIAL,66.43,87,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
CIPROFLOXACIN 400MG IVPB,J0744,HCPCS,636,RC,,BOTH,400,ME,76.36,30.54,UC HEALTH,UC HEALTH COMMERCIAL,66.43,87,,,OTHER,57.27,74.83,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UC HEALTH,UC HEALTH COMMERCIAL,74.11,87,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7042,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UC HEALTH,UC HEALTH COMMERCIAL,74.11,87,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
D51/2   1000 ML,J7799,HCPCS,636,RC,,BOTH,1000,ML,85.18,34.07,UC HEALTH,UC HEALTH COMMERCIAL,74.11,87,,,OTHER,63.88,83.48,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,UC HEALTH,UC HEALTH COMMERCIAL,267.71,87,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
ERTAPENEM 1G INJ,J1335,HCPCS,636,RC,,BOTH,1,GR,307.71,123.08,UC HEALTH,UC HEALTH COMMERCIAL,267.71,87,,,OTHER,230.78,301.56,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.52,87,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
DIAZEPAM 10 MG INJ,J3360,HCPCS,636,RC,,BOTH,10,ME,118.99,47.6,UC HEALTH,UC HEALTH COMMERCIAL,103.52,87,,,OTHER,89.24,116.61,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 2.25G VIAL,J2543,HCPCS,636,RC,,BOTH,2.25,GR,72.92,29.17,UC HEALTH,UC HEALTH COMMERCIAL,63.44,87,,,OTHER,54.69,71.46,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UC HEALTH,UC HEALTH COMMERCIAL,93.59,87,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0703,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UC HEALTH,UC HEALTH COMMERCIAL,93.59,87,,,OTHER,5.2,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UC HEALTH,UC HEALTH COMMERCIAL,93.59,87,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 1GM/D5W 50ML,J0692,HCPCS,636,RC,,BOTH,50,ML,107.57,43.03,UC HEALTH,UC HEALTH COMMERCIAL,93.59,87,,,OTHER,80.68,105.42,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,UC HEALTH,UC HEALTH COMMERCIAL,29.13,87,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,J9181,HCPCS,636,RC,,BOTH,20,ML,33.48,13.39,UC HEALTH,UC HEALTH COMMERCIAL,29.13,87,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
ETOPOSIDE INJ 20MG/ML,2507710,CDM,636,RC,,BOTH,20,ML,33.48,13.39,UC HEALTH,UC HEALTH COMMERCIAL,29.13,87,,,OTHER,25.11,32.81,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% SDV 2ML,J2001,HCPCS,636,RC,,BOTH,2,ML,48.52,19.41,UC HEALTH,UC HEALTH COMMERCIAL,42.21,87,,,OTHER,36.39,47.55,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UC HEALTH,UC HEALTH COMMERCIAL,81.1,87,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UC HEALTH,UC HEALTH COMMERCIAL,81.1,87,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,2501270,CDM,636,RC,,BOTH,3,GR,93.22,37.29,UC HEALTH,UC HEALTH COMMERCIAL,81.1,87,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN/SULBACT 3G VIAL,J0295,HCPCS,636,RC,,BOTH,3,GR,93.22,37.29,UC HEALTH,UC HEALTH COMMERCIAL,81.1,87,,,OTHER,69.92,91.36,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 30MG VIAL,J1885,HCPCS,636,RC,,BOTH,30,ME,57.77,23.11,UC HEALTH,UC HEALTH COMMERCIAL,50.26,87,,,OTHER,43.33,56.62,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 40MG VIAL,J1940,HCPCS,636,RC,,BOTH,40,ME,45.24,18.09,UC HEALTH,UC HEALTH COMMERCIAL,39.35,87,,,OTHER,33.93,44.33,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UC HEALTH,UC HEALTH COMMERCIAL,67.42,87,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3371,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UC HEALTH,UC HEALTH COMMERCIAL,67.42,87,,,OTHER,6.16,75.94,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1G INJ,J3370,HCPCS,636,RC,,BOTH,1,GR,77.49,31,UC HEALTH,UC HEALTH COMMERCIAL,67.42,87,,,OTHER,58.12,75.94,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM,J2250,HCPCS,636,RC,,BOTH,1,ME,50.03,20.01,UC HEALTH,UC HEALTH COMMERCIAL,43.53,87,,,OTHER,37.52,49.03,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,UC HEALTH,UC HEALTH COMMERCIAL,51.58,87,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 1G VIAL,J0690,HCPCS,636,RC,,BOTH,1,GR,59.29,23.71,UC HEALTH,UC HEALTH COMMERCIAL,51.58,87,,,OTHER,44.46,58.1,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UC HEALTH,UC HEALTH COMMERCIAL,319.73,87,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,Q5117,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UC HEALTH,UC HEALTH COMMERCIAL,319.73,87,,,OTHER,18.56,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UC HEALTH,UC HEALTH COMMERCIAL,319.73,87,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZUMAB-ANNS 420MG,J3590,HCPCS,636,RC,,BOTH,420,ME,367.51,147,UC HEALTH,UC HEALTH COMMERCIAL,319.73,87,,,OTHER,275.63,360.16,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,UC HEALTH,UC HEALTH COMMERCIAL,161.92,87,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
TRASTUZIMAB-DKST 420MG,Q5114,HCPCS,636,RC,,BOTH,420,ME,186.11,74.44,UC HEALTH,UC HEALTH COMMERCIAL,161.92,87,,,OTHER,65.75,182.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3372,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,UC HEALTH,UC HEALTH COMMERCIAL,99.42,87,,,OTHER,6.72,111.99,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.25G/250ML,J3490,HCPCS,636,RC,,BOTH,250,ML,114.27,45.71,UC HEALTH,UC HEALTH COMMERCIAL,99.42,87,,,OTHER,85.7,111.99,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J7517,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,UC HEALTH,UC HEALTH COMMERCIAL,4.52,87,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
MYCOPHENOLATE 250MG CAP,J3490,HCPCS,636,RC,,BOTH,250,ME,5.2,2.08,UC HEALTH,UC HEALTH COMMERCIAL,4.52,87,,,OTHER,3.9,5.09,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,UC HEALTH,UC HEALTH COMMERCIAL,42.71,87,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
FENTANYL CITRATE 5 ML AMP,J3010,HCPCS,636,RC,,BOTH,5,ML,49.09,19.64,UC HEALTH,UC HEALTH COMMERCIAL,42.71,87,,,OTHER,36.82,48.11,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J7613,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,UC HEALTH,UC HEALTH COMMERCIAL,0.7,87,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
ALBUTEROL 3 ML NEB,J3490,HCPCS,636,RC,,BOTH,3,ML,0.8,0.32,UC HEALTH,UC HEALTH COMMERCIAL,0.7,87,,,OTHER,0.6,0.79,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,UC HEALTH,UC HEALTH COMMERCIAL,792.28,87,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,J1740,HCPCS,636,RC,,BOTH,1,ME,910.67,364.27,UC HEALTH,UC HEALTH COMMERCIAL,792.28,87,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
IBANDRONATE,2511380,CDM,636,RC,,BOTH,1,ME,910.67,364.27,UC HEALTH,UC HEALTH COMMERCIAL,792.28,87,,,OTHER,683,892.46,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,UC HEALTH,UC HEALTH COMMERCIAL,3800.09,87,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
GOSERELIN ACETATE 10.8MG INJ,J9202,HCPCS,636,RC,,BOTH,10.8,ME,4367.93,1747.17,UC HEALTH,UC HEALTH COMMERCIAL,3800.09,87,,,OTHER,629.31,4280.57,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,UC HEALTH,UC HEALTH COMMERCIAL,1540.7,87,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,J2783,HCPCS,636,RC,,BOTH,0.5,ME,1770.92,708.37,UC HEALTH,UC HEALTH COMMERCIAL,1540.7,87,,,OTHER,385.85,1735.5,PERCENT OF TOTAL BILLED CHARGES
RASBURICASE,2505151,CDM,636,RC,,BOTH,0.5,ME,1770.92,708.37,UC HEALTH,UC HEALTH COMMERCIAL,1540.7,87,,,OTHER,1328.19,1735.5,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,UC HEALTH,UC HEALTH COMMERCIAL,686.44,87,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
EPIPEN 0.3MG ADULT,J0171,HCPCS,636,RC,,BOTH,0.3,ME,789.01,315.6,UC HEALTH,UC HEALTH COMMERCIAL,686.44,87,,,OTHER,591.76,773.23,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3372,HCPCS,636,RC,,BOTH,300,ML,129.54,51.82,UC HEALTH,UC HEALTH COMMERCIAL,112.7,87,,,OTHER,6.72,126.95,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.5G/300ML,J3490,HCPCS,636,RC,,BOTH,200,ML,129.54,51.82,UC HEALTH,UC HEALTH COMMERCIAL,112.7,87,,,OTHER,97.15,126.95,PERCENT OF TOTAL BILLED CHARGES
LEVOFLOXACIN 750MG/150ML PB,J1956,HCPCS,636,RC,,BOTH,750,ME,108,43.2,UC HEALTH,UC HEALTH COMMERCIAL,93.96,87,,,OTHER,81,105.84,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UC HEALTH,UC HEALTH COMMERCIAL,3765.93,87,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,J9217,HCPCS,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UC HEALTH,UC HEALTH COMMERCIAL,3765.93,87,,,OTHER,194.94,4242.08,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE ACETATE 22.5MG KIT,2504470,CDM,636,RC,,BOTH,22.5,ME,4328.65,1731.46,UC HEALTH,UC HEALTH COMMERCIAL,3765.93,87,,,OTHER,3246.49,4242.08,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG/300ML IV,J2020,HCPCS,636,RC,,BOTH,600,ME,207.7,83.08,UC HEALTH,UC HEALTH COMMERCIAL,180.7,87,,,OTHER,155.78,203.55,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,UC HEALTH,UC HEALTH COMMERCIAL,88.72,87,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 30MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,30,ME,101.98,40.79,UC HEALTH,UC HEALTH COMMERCIAL,88.72,87,,,OTHER,76.48,99.94,PERCENT OF TOTAL BILLED CHARGES
PIPERACIL/TAZOBACT 3.375G VIAL,J2543,HCPCS,636,RC,,BOTH,3.375,GR,166.16,66.46,UC HEALTH,UC HEALTH COMMERCIAL,144.56,87,,,OTHER,124.62,162.83,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3372,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,UC HEALTH,UC HEALTH COMMERCIAL,122.1,87,,,OTHER,6.72,137.54,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 1.75G/350ML,J3490,HCPCS,636,RC,,BOTH,350,ML,140.35,56.14,UC HEALTH,UC HEALTH COMMERCIAL,122.1,87,,,OTHER,105.26,137.54,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,UC HEALTH,UC HEALTH COMMERCIAL,72.24,87,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN ACETATE 4MCG INJ,J2597,HCPCS,636,RC,,BOTH,,,83.04,33.22,UC HEALTH,UC HEALTH COMMERCIAL,72.24,87,,,OTHER,6.58,81.38,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,UC HEALTH,UC HEALTH COMMERCIAL,76.45,87,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2 GM VIAL,J0692,HCPCS,636,RC,,BOTH,2,GR,87.87,35.15,UC HEALTH,UC HEALTH COMMERCIAL,76.45,87,,,OTHER,65.9,86.11,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,UC HEALTH,UC HEALTH COMMERCIAL,14.26,87,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4MG/ML MDV,J1100,HCPCS,636,RC,,BOTH,4,ME,16.4,6.56,UC HEALTH,UC HEALTH COMMERCIAL,14.26,87,,,OTHER,12.3,16.07,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,UC HEALTH,UC HEALTH COMMERCIAL,1405.89,87,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
MITOMYCIN 20MG VIAL,J9280,HCPCS,636,RC,,BOTH,20,ME,1615.97,646.39,UC HEALTH,UC HEALTH COMMERCIAL,1405.89,87,,,OTHER,70.38,1583.65,PERCENT OF TOTAL BILLED CHARGES
METHYLPREDNISOLONE 500MG VIAL,J2930,HCPCS,636,RC,,BOTH,500,ME,103.65,41.46,UC HEALTH,UC HEALTH COMMERCIAL,90.18,87,,,OTHER,77.74,101.58,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J2597,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,UC HEALTH,UC HEALTH COMMERCIAL,136.77,87,,,OTHER,6.58,154.06,PERCENT OF TOTAL BILLED CHARGES
DESMOPRESSIN 4MCG/ML,J3490,HCPCS,636,RC,,BOTH,4,ML,157.2,62.88,UC HEALTH,UC HEALTH COMMERCIAL,136.77,87,,,OTHER,117.9,154.06,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,UC HEALTH,UC HEALTH COMMERCIAL,3.62,87,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
DECADRON INTENSOL,J8540,HCPCS,636,RC,,BOTH,0.25,ME,4.17,1.67,UC HEALTH,UC HEALTH COMMERCIAL,3.62,87,,,OTHER,3.12,4.08,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,UC HEALTH,UC HEALTH COMMERCIAL,66.23,87,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
AMPICILLIN 2G VIAL,J0290,HCPCS,636,RC,,BOTH,2,GR,76.12,30.45,UC HEALTH,UC HEALTH COMMERCIAL,66.23,87,,,OTHER,57.09,74.6,PERCENT OF TOTAL BILLED CHARGES
KETOROLAC 60MG INJ,J1885,HCPCS,636,RC,,BOTH,60,ME,46.32,18.53,UC HEALTH,UC HEALTH COMMERCIAL,40.3,87,,,OTHER,34.74,45.39,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3372,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,UC HEALTH,UC HEALTH COMMERCIAL,125.09,87,,,OTHER,6.72,140.91,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 2G/400ML,J3490,HCPCS,636,RC,,BOTH,400,ML,143.78,57.51,UC HEALTH,UC HEALTH COMMERCIAL,125.09,87,,,OTHER,107.84,140.91,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,UC HEALTH,UC HEALTH COMMERCIAL,233.63,87,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,J3489,HCPCS,636,RC,,BOTH,4,ME,268.54,107.42,UC HEALTH,UC HEALTH COMMERCIAL,233.63,87,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONIC 4MG INJ,2508360,CDM,636,RC,,BOTH,4,ME,268.54,107.42,UC HEALTH,UC HEALTH COMMERCIAL,233.63,87,,,OTHER,201.4,263.17,PERCENT OF TOTAL BILLED CHARGES
KENALOG-40 INJ,J3301,HCPCS,636,RC,,BOTH,10,ME,65.27,26.11,UC HEALTH,UC HEALTH COMMERCIAL,56.79,87,,,OTHER,48.96,63.97,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM 2GM PREMIX BAG,J3475,HCPCS,636,RC,,BOTH,2,GR,101.76,40.71,UC HEALTH,UC HEALTH COMMERCIAL,88.54,87,,,OTHER,76.32,99.73,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,UC HEALTH,UC HEALTH COMMERCIAL,557.44,87,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,J2785,HCPCS,636,RC,,BOTH,5,ML,640.74,256.3,UC HEALTH,UC HEALTH COMMERCIAL,557.44,87,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
REGADENOSON 0.4MG/5ML,2516870,CDM,636,RC,,BOTH,5,ML,640.74,256.3,UC HEALTH,UC HEALTH COMMERCIAL,557.44,87,,,OTHER,480.56,627.93,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,UC HEALTH,UC HEALTH COMMERCIAL,43.13,87,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 100MCG/ML,J2354,HCPCS,636,RC,,BOTH,100,ML,49.57,19.83,UC HEALTH,UC HEALTH COMMERCIAL,43.13,87,,,OTHER,37.18,48.58,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,UC HEALTH,UC HEALTH COMMERCIAL,112.63,87,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
CEFEPIME 2G PREMIX IV,J0703,HCPCS,636,RC,,BOTH,2,GR,129.46,51.78,UC HEALTH,UC HEALTH COMMERCIAL,112.63,87,,,OTHER,5.2,126.87,PERCENT OF TOTAL BILLED CHARGES
PIPERACILLIN/TAZOBAC 4G/0.5 IV,J2543,HCPCS,636,RC,,BOTH,4,GR,166.16,66.47,UC HEALTH,UC HEALTH COMMERCIAL,144.56,87,,,OTHER,124.62,162.84,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,UC HEALTH,UC HEALTH COMMERCIAL,49.02,87,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 1G VIAL,J0696,HCPCS,636,RC,,BOTH,1,GR,56.34,22.54,UC HEALTH,UC HEALTH COMMERCIAL,49.02,87,,,OTHER,42.26,55.22,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,UC HEALTH,UC HEALTH COMMERCIAL,107.22,87,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 40MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,40,ME,123.25,49.3,UC HEALTH,UC HEALTH COMMERCIAL,107.22,87,,,OTHER,92.44,120.78,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,UC HEALTH,UC HEALTH COMMERCIAL,203.97,87,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
CEFAZOLIN 2G IVPB 50ML BAG,J0690,HCPCS,636,RC,,BOTH,50,ML,234.45,93.78,UC HEALTH,UC HEALTH COMMERCIAL,203.97,87,,,OTHER,175.84,229.76,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,UC HEALTH,UC HEALTH COMMERCIAL,42.49,87,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 4 MG INJ,J1100,HCPCS,636,RC,,BOTH,4,ME,48.84,19.54,UC HEALTH,UC HEALTH COMMERCIAL,42.49,87,,,OTHER,36.63,47.87,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,UC HEALTH,UC HEALTH COMMERCIAL,40.35,87,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,J2405,HCPCS,636,RC,,BOTH,4,ME,46.38,18.55,UC HEALTH,UC HEALTH COMMERCIAL,40.35,87,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON 4MG VIAL,2502720,CDM,636,RC,,BOTH,4,ME,46.38,18.55,UC HEALTH,UC HEALTH COMMERCIAL,40.35,87,,,OTHER,34.79,45.45,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,UC HEALTH,UC HEALTH COMMERCIAL,101.41,87,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
AMIODARONE 150MG/3ML VIAL,J0282,HCPCS,636,RC,,BOTH,150,ME,116.56,46.62,UC HEALTH,UC HEALTH COMMERCIAL,101.41,87,,,OTHER,87.42,114.23,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J2760,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,UC HEALTH,UC HEALTH COMMERCIAL,695.39,87,,,OTHER,466.54,783.31,PERCENT OF TOTAL BILLED CHARGES
PHENTOLAMINE 5MG/ML VIAL,J3490,HCPCS,636,RC,,BOTH,5,ME,799.3,319.72,UC HEALTH,UC HEALTH COMMERCIAL,695.39,87,,,OTHER,599.48,783.31,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,UC HEALTH,UC HEALTH COMMERCIAL,78.5,87,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,J1652,HCPCS,636,RC,,BOTH,2.5,ME,90.23,36.09,UC HEALTH,UC HEALTH COMMERCIAL,78.5,87,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
FONDAPARINUX SODIUM 2.5MG SYR,2500750,CDM,636,RC,,BOTH,2.5,ME,90.23,36.09,UC HEALTH,UC HEALTH COMMERCIAL,78.5,87,,,OTHER,67.67,88.43,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
VINORELBINE 10MG VIAL,J9390,HCPCS,636,RC,,BOTH,10,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 500MG INJ,J2185,HCPCS,636,RC,,BOTH,500,ME,64.96,25.98,UC HEALTH,UC HEALTH COMMERCIAL,56.52,87,,,OTHER,48.72,63.66,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML,J2250,HCPCS,636,RC,,BOTH,5,ML,50.52,20.21,UC HEALTH,UC HEALTH COMMERCIAL,43.95,87,,,OTHER,37.89,49.51,PERCENT OF TOTAL BILLED CHARGES
MIDAZOLAM 5MG/ML VIAL,J2250,HCPCS,636,RC,,BOTH,5,ME,58.31,23.32,UC HEALTH,UC HEALTH COMMERCIAL,50.73,87,,,OTHER,43.73,57.14,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,J9201,HCPCS,636,RC,,BOTH,1,GR,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 1G VIAL,2505240,CDM,636,RC,,BOTH,1,GR,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
PHENYTOIN 250 MG/5 ML VIAL,J1165,HCPCS,636,RC,,BOTH,250,ME,22.1,8.84,UC HEALTH,UC HEALTH COMMERCIAL,19.23,87,,,OTHER,16.57,21.66,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,UC HEALTH,UC HEALTH COMMERCIAL,5502.83,87,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
GA-68/GOZETOTIDE,A9596,HCPCS,636,RC,,BOTH,,,6325.09,2530.04,UC HEALTH,UC HEALTH COMMERCIAL,5502.83,87,,,OTHER,1024.25,6198.59,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,UC HEALTH,UC HEALTH COMMERCIAL,162.55,87,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,J9000,HCPCS,636,RC,,BOTH,10,ME,186.84,74.74,UC HEALTH,UC HEALTH COMMERCIAL,162.55,87,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
DOXORUBICIN 10MG INJ,2504590,CDM,636,RC,,BOTH,10,ME,186.84,74.74,UC HEALTH,UC HEALTH COMMERCIAL,162.55,87,,,OTHER,140.13,183.1,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,UC HEALTH,UC HEALTH COMMERCIAL,568.38,87,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,J3489,HCPCS,636,RC,,BOTH,1,ME,653.31,261.32,UC HEALTH,UC HEALTH COMMERCIAL,568.38,87,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
ZOLEDRONICACID MANNITOL WATER,2513160,CDM,636,RC,,BOTH,1,ME,653.31,261.32,UC HEALTH,UC HEALTH COMMERCIAL,568.38,87,,,OTHER,489.98,640.24,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% VIAL   SD,J2001,HCPCS,636,RC,,BOTH,10,ME,47.14,18.86,UC HEALTH,UC HEALTH COMMERCIAL,41.01,87,,,OTHER,35.35,46.2,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,UC HEALTH,UC HEALTH COMMERCIAL,49.19,87,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
FUROSEMIDE 100MG VIAL,J1940,HCPCS,636,RC,,BOTH,100,ME,56.54,22.62,UC HEALTH,UC HEALTH COMMERCIAL,49.19,87,,,OTHER,42.41,55.41,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,UC HEALTH,UC HEALTH COMMERCIAL,56.8,87,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,J9206,HCPCS,636,RC,,BOTH,20,ME,65.29,26.11,UC HEALTH,UC HEALTH COMMERCIAL,56.8,87,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
IRINOTECAN 20 MG/ML INJ,2505170,CDM,636,RC,,BOTH,20,ME,65.29,26.11,UC HEALTH,UC HEALTH COMMERCIAL,56.8,87,,,OTHER,48.96,63.98,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,UC HEALTH,UC HEALTH COMMERCIAL,113.26,87,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
FLUOROURACIL SD 50MG/ML PPX,J9190,HCPCS,636,RC,,BOTH,50,ME,130.18,52.07,UC HEALTH,UC HEALTH COMMERCIAL,113.26,87,,,OTHER,97.64,127.58,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,BOTH,,,51.37,20.55,UC HEALTH,UC HEALTH COMMERCIAL,44.69,87,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
POTASSIUM CHLORIDE,J3490,HCPCS,636,RC,,BOTH,,,51.37,20.55,UC HEALTH,UC HEALTH COMMERCIAL,44.69,87,,,OTHER,38.53,50.34,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,UC HEALTH,UC HEALTH COMMERCIAL,117.47,87,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
ROPIVICAINE 5MG/ML VIAL,J2795,HCPCS,636,RC,,BOTH,5,ME,135.02,54.01,UC HEALTH,UC HEALTH COMMERCIAL,117.47,87,,,OTHER,101.27,132.32,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 5OOOU/ML INJ,J1644,HCPCS,636,RC,,BOTH,5000,UN,53.84,21.54,UC HEALTH,UC HEALTH COMMERCIAL,46.84,87,,,OTHER,40.38,52.77,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,UC HEALTH,UC HEALTH COMMERCIAL,4111.39,87,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
LEUPROLIDE 45MG KIT,J9217,HCPCS,636,RC,,BOTH,45,ME,4725.73,1890.29,UC HEALTH,UC HEALTH COMMERCIAL,4111.39,87,,,OTHER,194.94,4631.22,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UC HEALTH,UC HEALTH COMMERCIAL,43.47,87,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0153,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UC HEALTH,UC HEALTH COMMERCIAL,43.47,87,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ADENOSINE 6 MG/2ML INJ,J0150,HCPCS,636,RC,,BOTH,6,ME,49.97,19.99,UC HEALTH,UC HEALTH COMMERCIAL,43.47,87,,,OTHER,37.48,48.97,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,UC HEALTH,UC HEALTH COMMERCIAL,133.77,87,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 60MG SYRINGE,J1650,HCPCS,636,RC,,BOTH,60,ME,153.76,61.51,UC HEALTH,UC HEALTH COMMERCIAL,133.77,87,,,OTHER,115.32,150.69,PERCENT OF TOTAL BILLED CHARGES
ONDANSETRON ODT HOME PACK,Q0162,HCPCS,636,RC,,BOTH,,,23.75,9.5,UC HEALTH,UC HEALTH COMMERCIAL,20.66,87,,,OTHER,17.81,23.28,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,UC HEALTH,UC HEALTH COMMERCIAL,9.77,87,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL 300MG 50ML MDV,J9267,HCPCS,636,RC,,BOTH,300,ME,11.23,4.49,UC HEALTH,UC HEALTH COMMERCIAL,9.77,87,,,OTHER,8.42,11,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,UC HEALTH,UC HEALTH COMMERCIAL,74.17,87,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,J0640,HCPCS,636,RC,,BOTH,350,ME,85.26,34.1,UC HEALTH,UC HEALTH COMMERCIAL,74.17,87,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 350MG VIAL,2512620,CDM,636,RC,,BOTH,350,ME,85.26,34.1,UC HEALTH,UC HEALTH COMMERCIAL,74.17,87,,,OTHER,63.94,83.55,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,UC HEALTH,UC HEALTH COMMERCIAL,63.63,87,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
OCTREOTIDE ACETATE 0.2MG/ML,J2354,HCPCS,636,RC,,BOTH,0.2,ML,73.14,29.26,UC HEALTH,UC HEALTH COMMERCIAL,63.63,87,,,OTHER,54.86,71.68,PERCENT OF TOTAL BILLED CHARGES
METHYLPRED 1G VIAL,J2930,HCPCS,636,RC,,BOTH,1,GR,172.48,68.99,UC HEALTH,UC HEALTH COMMERCIAL,150.05,87,,,OTHER,129.36,169.03,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE,J3475,HCPCS,636,RC,,BOTH,500,ME,77.51,31,UC HEALTH,UC HEALTH COMMERCIAL,67.43,87,,,OTHER,58.13,75.96,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,UC HEALTH,UC HEALTH COMMERCIAL,175.69,87,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,J1650,HCPCS,636,RC,,BOTH,80,ME,201.94,80.78,UC HEALTH,UC HEALTH COMMERCIAL,175.69,87,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 80MG INJ,2505150,CDM,636,RC,,BOTH,80,ME,201.94,80.78,UC HEALTH,UC HEALTH COMMERCIAL,175.69,87,,,OTHER,151.46,197.9,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,UC HEALTH,UC HEALTH COMMERCIAL,68.23,87,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
CEFTRIAXONE 2G,J0696,HCPCS,636,RC,,BOTH,2,GR,78.42,31.37,UC HEALTH,UC HEALTH COMMERCIAL,68.23,87,,,OTHER,58.82,76.85,PERCENT OF TOTAL BILLED CHARGES
PENICILLIN G POTASS 5MMU VIAL,J2540,HCPCS,636,RC,,BOTH,,,76.53,30.61,UC HEALTH,UC HEALTH COMMERCIAL,66.58,87,,,OTHER,57.4,75,PERCENT OF TOTAL BILLED CHARGES
MAGNESIUM SULFATE 5GM/10ML,J3475,HCPCS,636,RC,,BOTH,10,ML,88.79,35.52,UC HEALTH,UC HEALTH COMMERCIAL,77.25,87,,,OTHER,66.6,87.02,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,UC HEALTH,UC HEALTH COMMERCIAL,49.46,87,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
EPINEPHRINE 1MG SYRINGE,J0171,HCPCS,636,RC,,BOTH,1,ME,56.85,22.74,UC HEALTH,UC HEALTH COMMERCIAL,49.46,87,,,OTHER,42.64,55.71,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,UC HEALTH,UC HEALTH COMMERCIAL,3820.65,87,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,J9303,HCPCS,636,RC,,BOTH,100,ME,4391.55,1756.62,UC HEALTH,UC HEALTH COMMERCIAL,3820.65,87,,,OTHER,158.8,4303.72,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 100MG VIAL,2514280,CDM,636,RC,,BOTH,100,ME,4391.55,1756.62,UC HEALTH,UC HEALTH COMMERCIAL,3820.65,87,,,OTHER,3293.66,4303.72,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,UC HEALTH,UC HEALTH COMMERCIAL,93.08,87,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
DOPAMINE 400MG BAG,J1265,HCPCS,636,RC,,BOTH,400,ME,106.99,42.8,UC HEALTH,UC HEALTH COMMERCIAL,93.08,87,,,OTHER,80.25,104.85,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,UC HEALTH,UC HEALTH COMMERCIAL,1826.79,87,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 100 MG/4 ML,Q5107,HCPCS,636,RC,,BOTH,4,ML,2099.76,839.9,UC HEALTH,UC HEALTH COMMERCIAL,1826.79,87,,,OTHER,28.09,2057.76,PERCENT OF TOTAL BILLED CHARGES
PHYTONADIONE 10 MG AMP,J3430,HCPCS,636,RC,,BOTH,10,ME,147.4,58.96,UC HEALTH,UC HEALTH COMMERCIAL,128.23,87,,,OTHER,110.55,144.45,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,UC HEALTH,UC HEALTH COMMERCIAL,3757.02,87,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 30MG SDV,J9047,HCPCS,636,RC,,BOTH,30,ME,4318.42,1727.37,UC HEALTH,UC HEALTH COMMERCIAL,3757.02,87,,,OTHER,49.54,4232.05,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,UC HEALTH,UC HEALTH COMMERCIAL,296.95,87,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,341.32,136.53,UC HEALTH,UC HEALTH COMMERCIAL,296.95,87,,,OTHER,4.17,334.5,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514820,CDM,636,RC,,BOTH,10,ME,341.32,136.53,UC HEALTH,UC HEALTH COMMERCIAL,296.95,87,,,OTHER,255.99,334.5,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,UC HEALTH,UC HEALTH COMMERCIAL,82.66,87,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
D5NS K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,95.01,38,UC HEALTH,UC HEALTH COMMERCIAL,82.66,87,,,OTHER,71.26,93.11,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,UC HEALTH,UC HEALTH COMMERCIAL,221.89,87,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0131,HCPCS,636,RC,,BOTH,10,ME,255.05,102.02,UC HEALTH,UC HEALTH COMMERCIAL,221.89,87,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,UC HEALTH,UC HEALTH COMMERCIAL,221.89,87,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ACETYLCYSTEINE INJ,J0132,HCPCS,636,RC,,BOTH,100,ME,255.05,102.02,UC HEALTH,UC HEALTH COMMERCIAL,221.89,87,,,OTHER,191.29,249.95,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J1805,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,UC HEALTH,UC HEALTH COMMERCIAL,75.06,87,,,OTHER,0.23,84.55,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 100 MG/10 ML VIAL,J3490,HCPCS,636,RC,,BOTH,100,ME,86.28,34.51,UC HEALTH,UC HEALTH COMMERCIAL,75.06,87,,,OTHER,64.71,84.55,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,UC HEALTH,UC HEALTH COMMERCIAL,3312.02,87,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,J9179,HCPCS,636,RC,,BOTH,1,ME,3806.92,1522.77,UC HEALTH,UC HEALTH COMMERCIAL,3312.02,87,,,OTHER,144.55,3730.78,PERCENT OF TOTAL BILLED CHARGES
ERIBULIN 1MG VIAL,2514950,CDM,636,RC,,BOTH,1,ME,3806.92,1522.77,UC HEALTH,UC HEALTH COMMERCIAL,3312.02,87,,,OTHER,2855.19,3730.78,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G VIAL,J2185,HCPCS,636,RC,,BOTH,1,GR,135.9,54.36,UC HEALTH,UC HEALTH COMMERCIAL,118.23,87,,,OTHER,101.93,133.18,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,UC HEALTH,UC HEALTH COMMERCIAL,1216.53,87,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 10MG SDV,J9047,HCPCS,636,RC,,BOTH,10,ME,1398.31,559.33,UC HEALTH,UC HEALTH COMMERCIAL,1216.53,87,,,OTHER,49.54,1370.35,PERCENT OF TOTAL BILLED CHARGES
NITROGLYCERIN 50 MG/D5W100,J2305,HCPCS,636,RC,,BOTH,50,ME,126.32,50.53,UC HEALTH,UC HEALTH COMMERCIAL,109.9,87,,,OTHER,1.51,123.8,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,UC HEALTH,UC HEALTH COMMERCIAL,212.27,87,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,J1650,HCPCS,636,RC,,BOTH,100,ME,243.99,97.59,UC HEALTH,UC HEALTH COMMERCIAL,212.27,87,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
ENOXAPARIN 100MG INJ,2504240,CDM,636,RC,,BOTH,100,ME,243.99,97.59,UC HEALTH,UC HEALTH COMMERCIAL,212.27,87,,,OTHER,182.99,239.11,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1642,HCPCS,636,RC,,BOTH,10,UN,51.53,20.61,UC HEALTH,UC HEALTH COMMERCIAL,44.83,87,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
HEPARIN FLUSH SYRINGE,J1644,HCPCS,636,RC,,BOTH,1000,UN,51.53,20.61,UC HEALTH,UC HEALTH COMMERCIAL,44.83,87,,,OTHER,38.65,50.5,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,UC HEALTH,UC HEALTH COMMERCIAL,985.72,87,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-AXXQ 100MG,Q5121,HCPCS,636,RC,,BOTH,100,ME,1133.01,453.21,UC HEALTH,UC HEALTH COMMERCIAL,985.72,87,,,OTHER,25.59,1110.35,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,UC HEALTH,UC HEALTH COMMERCIAL,38.03,87,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ACYCLOVIR 500MG INJ,J0133,HCPCS,636,RC,,BOTH,500,ME,43.71,17.48,UC HEALTH,UC HEALTH COMMERCIAL,38.03,87,,,OTHER,32.78,42.84,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,UC HEALTH,UC HEALTH COMMERCIAL,1138.27,87,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,J9055,HCPCS,636,RC,,BOTH,2,ML,1308.36,523.34,UC HEALTH,UC HEALTH COMMERCIAL,1138.27,87,,,OTHER,77.16,1282.19,PERCENT OF TOTAL BILLED CHARGES
ERBITUX 2MG/ML,2503770,CDM,636,RC,,BOTH,2,ML,1308.36,523.34,UC HEALTH,UC HEALTH COMMERCIAL,1138.27,87,,,OTHER,981.27,1282.19,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,UC HEALTH,UC HEALTH COMMERCIAL,1735.69,87,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
BEVZCIZUMAB-BVZR 25MG/ML 100MG,Q5118,HCPCS,636,RC,,BOTH,100,ME,1995.05,798.02,UC HEALTH,UC HEALTH COMMERCIAL,1735.69,87,,,OTHER,21.8,1955.15,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,UC HEALTH,UC HEALTH COMMERCIAL,1560.34,87,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 100MG/10ML,Q5115,HCPCS,636,RC,,BOTH,10,ML,1793.49,717.4,UC HEALTH,UC HEALTH COMMERCIAL,1560.34,87,,,OTHER,32.53,1757.62,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,UC HEALTH,UC HEALTH COMMERCIAL,159.07,87,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,J0640,HCPCS,636,RC,,BOTH,500,ME,182.84,73.13,UC HEALTH,UC HEALTH COMMERCIAL,159.07,87,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
LEUCOVORIN 500MG VIAL,2507600,CDM,636,RC,,BOTH,500,ME,182.84,73.13,UC HEALTH,UC HEALTH COMMERCIAL,159.07,87,,,OTHER,137.13,179.18,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,UC HEALTH,UC HEALTH COMMERCIAL,75.35,87,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
FENTANYL 50MCG/ML  20ML  SDPF,J3010,HCPCS,636,RC,,BOTH,20,ML,86.61,34.64,UC HEALTH,UC HEALTH COMMERCIAL,75.35,87,,,OTHER,64.95,84.87,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,UC HEALTH,UC HEALTH COMMERCIAL,236.41,87,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,J9201,HCPCS,636,RC,,BOTH,2,GR,271.74,108.69,UC HEALTH,UC HEALTH COMMERCIAL,236.41,87,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
GEMCITABINE 2G VIAL,2514600,CDM,636,RC,,BOTH,2,GR,271.74,108.69,UC HEALTH,UC HEALTH COMMERCIAL,236.41,87,,,OTHER,203.8,266.3,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,UC HEALTH,UC HEALTH COMMERCIAL,40.87,87,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
SUCCINYL CHOLINE 20MG/ML INJ,J0330,HCPCS,636,RC,,BOTH,20,ME,46.97,18.79,UC HEALTH,UC HEALTH COMMERCIAL,40.87,87,,,OTHER,35.23,46.03,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,UC HEALTH,UC HEALTH COMMERCIAL,1258.14,87,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 5G,J1459,HCPCS,636,RC,,BOTH,5,GR,1446.14,578.46,UC HEALTH,UC HEALTH COMMERCIAL,1258.14,87,,,OTHER,50.25,1417.22,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,UC HEALTH,UC HEALTH COMMERCIAL,76.44,87,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
D51/2K20 1000ML,J3480,HCPCS,636,RC,,BOTH,1000,ML,87.86,35.14,UC HEALTH,UC HEALTH COMMERCIAL,76.44,87,,,OTHER,65.9,86.1,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,UC HEALTH,UC HEALTH COMMERCIAL,1289.18,87,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-ABDA 100MG,Q5104,HCPCS,636,RC,,BOTH,100,ME,1481.82,592.73,UC HEALTH,UC HEALTH COMMERCIAL,1289.18,87,,,OTHER,32.11,1452.18,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,UC HEALTH,UC HEALTH COMMERCIAL,19.77,87,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,J9360,HCPCS,636,RC,,BOTH,10,ME,22.73,9.09,UC HEALTH,UC HEALTH COMMERCIAL,19.77,87,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
VINBLASTINE 10MG INJ,2505100,CDM,636,RC,,BOTH,10,ME,22.73,9.09,UC HEALTH,UC HEALTH COMMERCIAL,19.77,87,,,OTHER,17.05,22.27,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,UC HEALTH,UC HEALTH COMMERCIAL,110.36,87,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
MEROPENEM 1G/50ML PB,J2184,HCPCS,636,RC,,BOTH,50,ML,126.85,50.74,UC HEALTH,UC HEALTH COMMERCIAL,110.36,87,,,OTHER,2.12,124.31,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,UC HEALTH,UC HEALTH COMMERCIAL,1003.92,87,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
INFLIXIMAB-DYYB 100MG,Q5103,HCPCS,636,RC,,BOTH,100,ME,1153.94,461.57,UC HEALTH,UC HEALTH COMMERCIAL,1003.92,87,,,OTHER,11.64,1130.86,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,UC HEALTH,UC HEALTH COMMERCIAL,565.33,87,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,J2469,HCPCS,636,RC,,BOTH,0.05,ML,649.81,259.92,UC HEALTH,UC HEALTH COMMERCIAL,565.33,87,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
PALONOSETRON 0.05MG/ML,2500420,CDM,636,RC,,BOTH,0.05,ML,649.81,259.92,UC HEALTH,UC HEALTH COMMERCIAL,565.33,87,,,OTHER,487.36,636.81,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J1836,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,UC HEALTH,UC HEALTH COMMERCIAL,59.93,87,,,OTHER,0.03,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UC HEALTH,UC HEALTH COMMERCIAL,9.14,87,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,Q9967,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UC HEALTH,UC HEALTH COMMERCIAL,9.14,87,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
FLAGYL,J3490,HCPCS,636,RC,,BOTH,10,ME,68.88,27.55,UC HEALTH,UC HEALTH COMMERCIAL,59.93,87,,,OTHER,51.66,67.51,PERCENT OF TOTAL BILLED CHARGES
IOHEXOL 350 UD 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,10.5,4.2,UC HEALTH,UC HEALTH COMMERCIAL,9.14,87,,,OTHER,7.88,10.29,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,UC HEALTH,UC HEALTH COMMERCIAL,38.66,87,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,J1100,HCPCS,636,RC,,BOTH,10,ME,44.44,17.78,UC HEALTH,UC HEALTH COMMERCIAL,38.66,87,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
DEXAMETHASONE 10MG/ML INJ,2506180,CDM,636,RC,,BOTH,10,ME,44.44,17.78,UC HEALTH,UC HEALTH COMMERCIAL,38.66,87,,,OTHER,33.33,43.55,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 100 MG SYRINGE,J2001,HCPCS,636,RC,,BOTH,100,ME,56.99,22.8,UC HEALTH,UC HEALTH COMMERCIAL,49.58,87,,,OTHER,42.74,55.85,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0136,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,UC HEALTH,UC HEALTH COMMERCIAL,170.77,87,,,OTHER,0.05,192.36,PERCENT OF TOTAL BILLED CHARGES
ACETAMINOPHEN 1000MG/100ML,J0131,HCPCS,636,RC,,BOTH,100,ML,196.28,78.51,UC HEALTH,UC HEALTH COMMERCIAL,170.77,87,,,OTHER,147.21,192.36,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,UC HEALTH,UC HEALTH COMMERCIAL,5905.65,87,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM CBQV 6MG SYR,Q5111,HCPCS,636,RC,,BOTH,6,ME,6788.1,2715.24,UC HEALTH,UC HEALTH COMMERCIAL,5905.65,87,,,OTHER,142.26,6652.34,PERCENT OF TOTAL BILLED CHARGES
PENICILL G BENZ 1.2MMU SYR,J0561,HCPCS,636,RC,,BOTH,,,527.8,211.12,UC HEALTH,UC HEALTH COMMERCIAL,459.19,87,,,OTHER,23.1,517.24,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,UC HEALTH,UC HEALTH COMMERCIAL,4141.25,87,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
PEGFILGRASTIM-JMDB 6MG/0.6ML,Q5108,HCPCS,636,RC,,BOTH,0.6,ML,4760.06,1904.02,UC HEALTH,UC HEALTH COMMERCIAL,4141.25,87,,,OTHER,172.24,4664.86,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,UC HEALTH,UC HEALTH COMMERCIAL,1750.66,87,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
ROMIPLOSTIM 125 MCG,J2796,HCPCS,636,RC,,BOTH,,,2012.25,804.9,UC HEALTH,UC HEALTH COMMERCIAL,1750.66,87,,,OTHER,101.2,1972.01,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,UC HEALTH,UC HEALTH COMMERCIAL,1177.2,87,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 75MG/0.5ML SYR,J2357,HCPCS,636,RC,,BOTH,75,ME,1353.1,541.24,UC HEALTH,UC HEALTH COMMERCIAL,1177.2,87,,,OTHER,38.65,1326.04,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,UC HEALTH,UC HEALTH COMMERCIAL,443.61,87,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 20,000U/ML",Q5106,HCPCS,636,RC,,BOTH,20000,UN,509.9,203.96,UC HEALTH,UC HEALTH COMMERCIAL,443.61,87,,,OTHER,7.89,499.7,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,UC HEALTH,UC HEALTH COMMERCIAL,3084.45,87,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 100MG SDV,J9308,HCPCS,636,RC,,BOTH,10,ME,3545.35,1418.14,UC HEALTH,UC HEALTH COMMERCIAL,3084.45,87,,,OTHER,73.13,3474.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 4%PF,J2001,HCPCS,636,RC,,BOTH,10,ME,49.11,19.64,UC HEALTH,UC HEALTH COMMERCIAL,42.72,87,,,OTHER,36.83,48.12,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 2% 10ML AMP,J2001,HCPCS,636,RC,,BOTH,10,ME,50.69,20.28,UC HEALTH,UC HEALTH COMMERCIAL,44.1,87,,,OTHER,38.02,49.68,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,UC HEALTH,UC HEALTH COMMERCIAL,1380.81,87,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
FULVESTRANT 500MG/10ML,J9395,HCPCS,636,RC,,BOTH,10,ML,1587.14,634.86,UC HEALTH,UC HEALTH COMMERCIAL,1380.81,87,,,OTHER,8.58,1555.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J2598,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,UC HEALTH,UC HEALTH COMMERCIAL,477.08,87,,,OTHER,1.97,537.4,PERCENT OF TOTAL BILLED CHARGES
VASOPRESSIN 20 U VIAL,J3490,HCPCS,636,RC,,BOTH,20,UN,548.37,219.35,UC HEALTH,UC HEALTH COMMERCIAL,477.08,87,,,OTHER,411.27,537.4,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,UC HEALTH,UC HEALTH COMMERCIAL,2773.17,87,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN IVIG 10% 10G,J1459,HCPCS,636,RC,,BOTH,10,GR,3187.56,1275.02,UC HEALTH,UC HEALTH COMMERCIAL,2773.17,87,,,OTHER,50.25,3123.8,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J2704,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,UC HEALTH,UC HEALTH COMMERCIAL,51.35,87,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 10MG/ML 20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,59.02,23.61,UC HEALTH,UC HEALTH COMMERCIAL,51.35,87,,,OTHER,44.27,57.84,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE O.5% 30ML SD,J2001,HCPCS,636,RC,,BOTH,30,ML,70.78,28.31,UC HEALTH,UC HEALTH COMMERCIAL,61.58,87,,,OTHER,53.09,69.36,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,UC HEALTH,UC HEALTH COMMERCIAL,2260.89,87,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
ABATACEPT,J0129,HCPCS,636,RC,,BOTH,,,2598.73,1039.49,UC HEALTH,UC HEALTH COMMERCIAL,2260.89,87,,,OTHER,44.98,2546.75,PERCENT OF TOTAL BILLED CHARGES
HEPARIN 25000U BAG,J1644,HCPCS,636,RC,,BOTH,25000,UN,106.82,42.73,UC HEALTH,UC HEALTH COMMERCIAL,92.93,87,,,OTHER,80.11,104.68,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UC HEALTH,UC HEALTH COMMERCIAL,786.76,87,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9034,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UC HEALTH,UC HEALTH COMMERCIAL,786.76,87,,,OTHER,14.52,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UC HEALTH,UC HEALTH COMMERCIAL,786.76,87,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
BENDAMUSTINE 25MG/ML MDV,J9033,HCPCS,636,RC,,BOTH,25,ME,904.33,361.73,UC HEALTH,UC HEALTH COMMERCIAL,786.76,87,,,OTHER,8.78,886.24,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,UC HEALTH,UC HEALTH COMMERCIAL,6559.42,87,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ,J9309,HCPCS,636,RC,,BOTH,1,ME,7539.56,3015.83,UC HEALTH,UC HEALTH COMMERCIAL,6559.42,87,,,OTHER,130.23,7388.77,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,UC HEALTH,UC HEALTH COMMERCIAL,9061.7,87,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
BENRALIZUMAB 30MG/ML SYR,J0517,HCPCS,636,RC,,BOTH,30,ME,10415.75,4166.3,UC HEALTH,UC HEALTH COMMERCIAL,9061.7,87,,,OTHER,173.51,10207.44,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1% 30ML VIAL  SD,J2001,HCPCS,636,RC,,BOTH,30,ML,50.36,20.14,UC HEALTH,UC HEALTH COMMERCIAL,43.81,87,,,OTHER,37.77,49.35,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,UC HEALTH,UC HEALTH COMMERCIAL,12058.13,87,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
ECULIZUMAB 300MG,J1300,HCPCS,636,RC,,BOTH,300,ME,13859.93,5543.97,UC HEALTH,UC HEALTH COMMERCIAL,12058.13,87,,,OTHER,236.99,13582.73,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,UC HEALTH,UC HEALTH COMMERCIAL,2091.86,87,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
OMALIZUMAB 150MG/ML,J2357,HCPCS,636,RC,,BOTH,150,ML,2404.44,961.78,UC HEALTH,UC HEALTH COMMERCIAL,2091.86,87,,,OTHER,38.65,2356.35,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UC HEALTH,UC HEALTH COMMERCIAL,4687.37,87,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,J9041,HCPCS,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UC HEALTH,UC HEALTH COMMERCIAL,4687.37,87,,,OTHER,2.17,5280.02,PERCENT OF TOTAL BILLED CHARGES
BORTEZOMIB 3.5MG VIAL,2511210,CDM,636,RC,,BOTH,3.5,ME,5387.78,2155.11,UC HEALTH,UC HEALTH COMMERCIAL,4687.37,87,,,OTHER,4040.84,5280.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,UC HEALTH,UC HEALTH COMMERCIAL,7609.52,87,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-AWWB 400 MG/16 ML,Q5107,HCPCS,636,RC,,BOTH,16,ML,8746.57,3498.63,UC HEALTH,UC HEALTH COMMERCIAL,7609.52,87,,,OTHER,28.09,8571.64,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,UC HEALTH,UC HEALTH COMMERCIAL,14193.71,87,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,J9303,HCPCS,636,RC,,BOTH,400,ME,16314.61,6525.84,UC HEALTH,UC HEALTH COMMERCIAL,14193.71,87,,,OTHER,158.8,15988.32,PERCENT OF TOTAL BILLED CHARGES
PANITUMUMAB 400MG,2514290,CDM,636,RC,,BOTH,400,ME,16314.61,6525.84,UC HEALTH,UC HEALTH COMMERCIAL,14193.71,87,,,OTHER,12235.96,15988.32,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9350,HCPCS,636,RC,,BOTH,4,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,660.61,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,J9351,HCPCS,636,RC,,BOTH,4,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
TOPOTECAN 4MG,2509810,CDM,636,RC,,BOTH,4,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
MAG SULF/WATER,J3475,HCPCS,636,RC,,BOTH,500,ME,473.17,189.27,UC HEALTH,UC HEALTH COMMERCIAL,411.65,87,,,OTHER,354.87,463.7,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,UC HEALTH,UC HEALTH COMMERCIAL,20369.82,87,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
LURBINECTEDIN 4MG,J9223,HCPCS,636,RC,,BOTH,4,ME,23413.59,9365.44,UC HEALTH,UC HEALTH COMMERCIAL,20369.82,87,,,OTHER,209.5,22945.32,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,UC HEALTH,UC HEALTH COMMERCIAL,848.3,87,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
"EPOETIN ALFA-EPBX 40,000U/ML",Q5106,HCPCS,636,RC,,BOTH,40000,UN,975.06,390.02,UC HEALTH,UC HEALTH COMMERCIAL,848.3,87,,,OTHER,7.89,955.56,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9299,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,32.64,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,J9999,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 10MG/4ML,C9453,HCPCS,636,RC,,BOTH,4,ML,3391.05,1356.42,UC HEALTH,UC HEALTH COMMERCIAL,2950.21,87,,,OTHER,2543.29,3323.23,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9145,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,64.19,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,J9999,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB 400MG,C9476,HCPCS,636,RC,,BOTH,400,ME,4989.98,1995.99,UC HEALTH,UC HEALTH COMMERCIAL,4341.28,87,,,OTHER,3742.49,4890.18,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,UC HEALTH,UC HEALTH COMMERCIAL,6988.42,87,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
BEVACIZUMAB-BVZR 25MG/ML 400MG,Q5118,HCPCS,636,RC,,BOTH,400,ME,8032.67,3213.07,UC HEALTH,UC HEALTH COMMERCIAL,6988.42,87,,,OTHER,21.8,7872.02,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,UC HEALTH,UC HEALTH COMMERCIAL,4126.22,87,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
IMMUNE GLOBULIN 20G,J1459,HCPCS,636,RC,,BOTH,20,GR,4742.78,1897.11,UC HEALTH,UC HEALTH COMMERCIAL,4126.22,87,,,OTHER,50.25,4647.92,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,UC HEALTH,UC HEALTH COMMERCIAL,467.64,87,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
BCG LI,J9030,HCPCS,636,RC,,BOTH,1,ME,537.52,215.01,UC HEALTH,UC HEALTH COMMERCIAL,467.64,87,,,OTHER,403.14,526.77,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,UC HEALTH,UC HEALTH COMMERCIAL,4098.98,87,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
MARGETUXIMAB-CMKB 250MG/10ML,J9353,HCPCS,636,RC,,BOTH,10,ML,4711.47,1884.59,UC HEALTH,UC HEALTH COMMERCIAL,4098.98,87,,,OTHER,49.39,4617.24,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,UC HEALTH,UC HEALTH COMMERCIAL,8849.58,87,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,J3101,HCPCS,636,RC,,BOTH,50,ME,10171.93,4068.77,UC HEALTH,UC HEALTH COMMERCIAL,8849.58,87,,,OTHER,160.77,9968.49,PERCENT OF TOTAL BILLED CHARGES
TENECTEPLASE 50MG,2506310,CDM,636,RC,,BOTH,50,ME,10171.93,4068.77,UC HEALTH,UC HEALTH COMMERCIAL,8849.58,87,,,OTHER,7628.95,9968.49,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,UC HEALTH,UC HEALTH COMMERCIAL,1507.37,87,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,J9305,HCPCS,636,RC,,BOTH,10,ME,1732.61,693.04,UC HEALTH,UC HEALTH COMMERCIAL,1507.37,87,,,OTHER,4.17,1697.96,PERCENT OF TOTAL BILLED CHARGES
PEMETREXED,2514790,CDM,636,RC,,BOTH,10,ME,1732.61,693.04,UC HEALTH,UC HEALTH COMMERCIAL,1507.37,87,,,OTHER,1299.46,1697.96,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,UC HEALTH,UC HEALTH COMMERCIAL,7916.68,87,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
RITUXIMAB-ABBS 500MG/50ML,Q5115,HCPCS,636,RC,,BOTH,50,ML,9099.63,3639.85,UC HEALTH,UC HEALTH COMMERCIAL,7916.68,87,,,OTHER,32.53,8917.64,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,J0894,HCPCS,636,RC,,BOTH,1,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DECITABINE,2513220,CDM,636,RC,,BOTH,1,ME,250,100,UC HEALTH,UC HEALTH COMMERCIAL,217.5,87,,,OTHER,187.5,245,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,UC HEALTH,UC HEALTH COMMERCIAL,6611.35,87,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
DURVALUMAB 500MG/10ML VIAL,J9173,HCPCS,636,RC,,BOTH,500,ME,7599.25,3039.7,UC HEALTH,UC HEALTH COMMERCIAL,6611.35,87,,,OTHER,84.55,7447.27,PERCENT OF TOTAL BILLED CHARGES
LEVETIRACETAM 500MG/5ML VIAL,J1953,HCPCS,636,RC,,BOTH,500,ME,35.72,14.29,UC HEALTH,UC HEALTH COMMERCIAL,31.08,87,,,OTHER,26.79,35.01,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UC HEALTH,UC HEALTH COMMERCIAL,43.72,87,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UC HEALTH,UC HEALTH COMMERCIAL,43.72,87,,,OTHER,0.02,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J0690,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UC HEALTH,UC HEALTH COMMERCIAL,43.72,87,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.25% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.25,20.1,UC HEALTH,UC HEALTH COMMERCIAL,43.72,87,,,OTHER,37.69,49.25,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UC HEALTH,UC HEALTH COMMERCIAL,72.97,87,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J2704,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UC HEALTH,UC HEALTH COMMERCIAL,72.97,87,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UC HEALTH,UC HEALTH COMMERCIAL,72.97,87,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,J3490,HCPCS,636,RC,,BOTH,50,ML,83.87,33.55,UC HEALTH,UC HEALTH COMMERCIAL,72.97,87,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 500MG/50ML,2514960,CDM,636,RC,,BOTH,50,ML,83.87,33.55,UC HEALTH,UC HEALTH COMMERCIAL,72.97,87,,,OTHER,62.9,82.19,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) 75/25 PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,87.37,34.95,UC HEALTH,UC HEALTH COMMERCIAL,76.01,87,,,OTHER,65.53,85.62,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALIN N) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,134.82,53.93,UC HEALTH,UC HEALTH COMMERCIAL,117.29,87,,,OTHER,101.12,132.12,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UC HEALTH,UC HEALTH COMMERCIAL,17005.06,87,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J2327,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UC HEALTH,UC HEALTH COMMERCIAL,17005.06,87,,,OTHER,15.75,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UC HEALTH,UC HEALTH COMMERCIAL,17005.06,87,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
RISANKIZUMAB-RZAA 600MG,J3590,HCPCS,636,RC,,BOTH,600,ME,19546.05,7818.42,UC HEALTH,UC HEALTH COMMERCIAL,17005.06,87,,,OTHER,14659.54,19155.13,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,UC HEALTH,UC HEALTH COMMERCIAL,6459.18,87,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,J9047,HCPCS,636,RC,,BOTH,60,ME,7424.35,2969.74,UC HEALTH,UC HEALTH COMMERCIAL,6459.18,87,,,OTHER,49.54,7275.86,PERCENT OF TOTAL BILLED CHARGES
CARFILZOMIB 60 MG VIAL,2510900,CDM,636,RC,,BOTH,60,ME,7424.35,2969.74,UC HEALTH,UC HEALTH COMMERCIAL,6459.18,87,,,OTHER,5568.26,7275.86,PERCENT OF TOTAL BILLED CHARGES
INSULIN (LANTUS SOLOSTAR) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,240.94,96.38,UC HEALTH,UC HEALTH COMMERCIAL,209.62,87,,,OTHER,180.71,236.12,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,UC HEALTH,UC HEALTH COMMERCIAL,2358.14,87,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,J0897,HCPCS,636,RC,,BOTH,60,ME,2710.5,1084.2,UC HEALTH,UC HEALTH COMMERCIAL,2358.14,87,,,OTHER,26.45,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UC HEALTH,UC HEALTH COMMERCIAL,2358.14,87,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UC HEALTH,UC HEALTH COMMERCIAL,2358.14,87,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 60MG,2513980,CDM,636,RC,,BOTH,60,ME,2710.5,1084.2,UC HEALTH,UC HEALTH COMMERCIAL,2358.14,87,,,OTHER,2032.88,2656.29,PERCENT OF TOTAL BILLED CHARGES
INSULIN (HUMALOG) PEN,J1815,HCPCS,636,RC,,BOTH,5,UN,303.8,121.52,UC HEALTH,UC HEALTH COMMERCIAL,264.31,87,,,OTHER,227.85,297.72,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,UC HEALTH,UC HEALTH COMMERCIAL,1846.35,87,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,J1451,HCPCS,636,RC,,BOTH,15,ME,2122.24,848.9,UC HEALTH,UC HEALTH COMMERCIAL,1846.35,87,,,OTHER,6.91,2079.8,PERCENT OF TOTAL BILLED CHARGES
FOMEPIZOLE,2514210,CDM,636,RC,,BOTH,15,ME,2122.24,848.9,UC HEALTH,UC HEALTH COMMERCIAL,1846.35,87,,,OTHER,1591.68,2079.8,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,UC HEALTH,UC HEALTH COMMERCIAL,6065.03,87,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
SACITUZUMAB-GOVITEC-HZLY 180MG,J9317,HCPCS,636,RC,,BOTH,180,ME,6971.3,2788.52,UC HEALTH,UC HEALTH COMMERCIAL,6065.03,87,,,OTHER,35.81,6831.87,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,UC HEALTH,UC HEALTH COMMERCIAL,767.63,87,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 80MG/4ML,Q0249,HCPCS,636,RC,,BOTH,4,ML,882.33,352.93,UC HEALTH,UC HEALTH COMMERCIAL,767.63,87,,,OTHER,661.75,864.68,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UC HEALTH,UC HEALTH COMMERCIAL,118.64,87,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9171,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UC HEALTH,UC HEALTH COMMERCIAL,118.64,87,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UC HEALTH,UC HEALTH COMMERCIAL,118.64,87,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,J9170,HCPCS,636,RC,,BOTH,80,ME,136.36,54.55,UC HEALTH,UC HEALTH COMMERCIAL,118.64,87,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
DOCETAXEL 80 MG/ML SDV,2514590,CDM,636,RC,,BOTH,80,ME,136.36,54.55,UC HEALTH,UC HEALTH COMMERCIAL,118.64,87,,,OTHER,102.27,133.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,UC HEALTH,UC HEALTH COMMERCIAL,929.34,87,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,1068.21,427.28,UC HEALTH,UC HEALTH COMMERCIAL,929.34,87,,,OTHER,6.34,1046.85,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2511990,CDM,636,RC,,BOTH,1,ME,1068.21,427.28,UC HEALTH,UC HEALTH COMMERCIAL,929.34,87,,,OTHER,801.16,1046.85,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,2501680,CDM,636,RC,,BOTH,1,ME,70.21,28.08,UC HEALTH,UC HEALTH COMMERCIAL,61.08,87,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,UC HEALTH,UC HEALTH COMMERCIAL,61.08,87,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SULFATE 1MG VIAL,J3490,HCPCS,636,RC,,BOTH,1,ME,70.21,28.08,UC HEALTH,UC HEALTH COMMERCIAL,61.08,87,,,OTHER,52.66,68.81,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,UC HEALTH,UC HEALTH COMMERCIAL,7176.91,87,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
BEZLOTOXUMAB 1000MG/40ML,J0565,HCPCS,636,RC,,BOTH,40,ML,8249.32,3299.73,UC HEALTH,UC HEALTH COMMERCIAL,7176.91,87,,,OTHER,41.86,8084.33,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,UC HEALTH,UC HEALTH COMMERCIAL,15958.94,87,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
RAMUCIRUMAB 10MG/ML 500MG,J9308,HCPCS,636,RC,,BOTH,500,ME,18343.61,7337.44,UC HEALTH,UC HEALTH COMMERCIAL,15958.94,87,,,OTHER,73.13,17976.74,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,UC HEALTH,UC HEALTH COMMERCIAL,3128.39,87,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
EPTINEZUMAB-JJMR 100MG,J3032,HCPCS,636,RC,,BOTH,100,ME,3595.85,1438.34,UC HEALTH,UC HEALTH COMMERCIAL,3128.39,87,,,OTHER,18.95,3523.93,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,UC HEALTH,UC HEALTH COMMERCIAL,30413.23,87,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
TILDRAKIZUMAB-ASMN 100MG,J3245,HCPCS,636,RC,,BOTH,100,ME,34957.74,13983.1,UC HEALTH,UC HEALTH COMMERCIAL,30413.23,87,,,OTHER,147.24,34258.59,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,UC HEALTH,UC HEALTH COMMERCIAL,21865.72,87,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,J2997,HCPCS,636,RC,,BOTH,100,ME,25133.01,10053.2,UC HEALTH,UC HEALTH COMMERCIAL,21865.72,87,,,OTHER,93.26,24630.35,PERCENT OF TOTAL BILLED CHARGES
ALTEPLASE 100MG VIAL,2500530,CDM,636,RC,,BOTH,100,ME,25133.01,10053.2,UC HEALTH,UC HEALTH COMMERCIAL,21865.72,87,,,OTHER,18849.76,24630.35,PERCENT OF TOTAL BILLED CHARGES
ONABOTULINUMTOXINA (BOTOX),J0585,HCPCS,636,RC,,BOTH,1,UN,1172.09,468.84,UC HEALTH,UC HEALTH COMMERCIAL,1019.72,87,,,OTHER,6.64,1148.65,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,UC HEALTH,UC HEALTH COMMERCIAL,1742.41,87,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,J9025,HCPCS,636,RC,,BOTH,1,ME,2002.77,801.11,UC HEALTH,UC HEALTH COMMERCIAL,1742.41,87,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
AZACITIDINE,2511840,CDM,636,RC,,BOTH,1,ME,2002.77,801.11,UC HEALTH,UC HEALTH COMMERCIAL,1742.41,87,,,OTHER,1502.08,1962.71,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,UC HEALTH,UC HEALTH COMMERCIAL,12791.85,87,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
OBINUTUZUMAB 1000MG SDV,J9301,HCPCS,636,RC,,BOTH,1000,ME,14703.28,5881.31,UC HEALTH,UC HEALTH COMMERCIAL,12791.85,87,,,OTHER,73.73,14409.21,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,UC HEALTH,UC HEALTH COMMERCIAL,5208.99,87,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 25MG,J0896,HCPCS,636,RC,,BOTH,25,ME,5987.34,2394.94,UC HEALTH,UC HEALTH COMMERCIAL,5208.99,87,,,OTHER,41.98,5867.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,UC HEALTH,UC HEALTH COMMERCIAL,5.06,87,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,J9263,HCPCS,636,RC,,BOTH,0.5,ME,5.81,2.33,UC HEALTH,UC HEALTH COMMERCIAL,5.06,87,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN,2513120,CDM,636,RC,,BOTH,0.5,ME,5.81,2.33,UC HEALTH,UC HEALTH COMMERCIAL,5.06,87,,,OTHER,4.36,5.7,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,UC HEALTH,UC HEALTH COMMERCIAL,60.85,87,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,J0461,HCPCS,636,RC,,BOTH,0.1,ME,69.94,27.98,UC HEALTH,UC HEALTH COMMERCIAL,60.85,87,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
ATROPINE SYRINGE 0.1MG,2505020,CDM,636,RC,,BOTH,0.1,ME,69.94,27.98,UC HEALTH,UC HEALTH COMMERCIAL,60.85,87,,,OTHER,52.46,68.54,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9299,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,32.64,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,J9999,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
NIVOLUMAB 100MG/10ML SDV,C9453,HCPCS,636,RC,,BOTH,100,ME,8562.45,3424.98,UC HEALTH,UC HEALTH COMMERCIAL,7449.33,87,,,OTHER,6421.83,8391.2,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,UC HEALTH,UC HEALTH COMMERCIAL,3959.52,87,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,BOTH,1,ME,4551.17,1820.47,UC HEALTH,UC HEALTH COMMERCIAL,3959.52,87,,,OTHER,14.4,4460.15,PERCENT OF TOTAL BILLED CHARGES
PACLITAXEL PROTEIN BOUND,2512870,CDM,636,RC,,BOTH,1,ME,4551.17,1820.47,UC HEALTH,UC HEALTH COMMERCIAL,3959.52,87,,,OTHER,3413.38,4460.15,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,UC HEALTH,UC HEALTH COMMERCIAL,992.78,87,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
REMDESIVIR 100MG INJ,J0248,HCPCS,636,RC,,BOTH,100,ME,1141.13,456.45,UC HEALTH,UC HEALTH COMMERCIAL,992.78,87,,,OTHER,6.36,1118.31,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,J2182,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,UC HEALTH,UC HEALTH COMMERCIAL,5461.65,87,,,OTHER,32,6152.2,PERCENT OF TOTAL BILLED CHARGES
MEPOLIZUMAB 100MG SDV,C9473,HCPCS,636,RC,,BOTH,100,ME,6277.76,2511.1,UC HEALTH,UC HEALTH COMMERCIAL,5461.65,87,,,OTHER,4708.32,6152.2,PERCENT OF TOTAL BILLED CHARGES
PEMBROLIZUMAB 100MG/4ML,J9271,HCPCS,636,RC,,BOTH,4,ML,9937.15,3974.86,UC HEALTH,UC HEALTH COMMERCIAL,8645.32,87,,,OTHER,60.18,9738.4,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,UC HEALTH,UC HEALTH COMMERCIAL,83.33,87,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,J1756,HCPCS,636,RC,,BOTH,20,ML,95.78,38.31,UC HEALTH,UC HEALTH COMMERCIAL,83.33,87,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
IRON SUCROSE INJ 20MG/ML,2504150,CDM,636,RC,,BOTH,20,ML,95.78,38.31,UC HEALTH,UC HEALTH COMMERCIAL,83.33,87,,,OTHER,71.84,93.87,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J2704,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,UC HEALTH,UC HEALTH COMMERCIAL,134.58,87,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
PROPOFOL 1G/100ML BOT,J3490,HCPCS,636,RC,,BOTH,100,ML,154.69,61.88,UC HEALTH,UC HEALTH COMMERCIAL,134.58,87,,,OTHER,116.02,151.6,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3111,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,11.22,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,J3590,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ROMOSOZUMAB AQQG 105MG/1.17ML,C9399,HCPCS,636,RC,,BOTH,1.17,ML,3177.04,1270.82,UC HEALTH,UC HEALTH COMMERCIAL,2764.03,87,,,OTHER,2382.78,3113.5,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9022,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,88.14,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,J9999,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
ATEZOLIZUMAB 60MG/20ML SDV,C9483,HCPCS,636,RC,,BOTH,60,ME,19004.41,7601.76,UC HEALTH,UC HEALTH COMMERCIAL,16533.84,87,,,OTHER,14253.31,18624.32,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UC HEALTH,UC HEALTH COMMERCIAL,13014.37,87,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1932,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UC HEALTH,UC HEALTH COMMERCIAL,13014.37,87,,,OTHER,46.22,14659.86,PERCENT OF TOTAL BILLED CHARGES
LANREOTIDE 120MG,J1930,HCPCS,636,RC,,BOTH,120,ME,14959.04,5983.62,UC HEALTH,UC HEALTH COMMERCIAL,13014.37,87,,,OTHER,50.4,14659.86,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,UC HEALTH,UC HEALTH COMMERCIAL,4625.48,87,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,J0897,HCPCS,636,RC,,BOTH,120,ME,5316.64,2126.66,UC HEALTH,UC HEALTH COMMERCIAL,4625.48,87,,,OTHER,26.45,5210.31,PERCENT OF TOTAL BILLED CHARGES
DENOSUMAB 120MG SDV,2514240,CDM,636,RC,,BOTH,120,ME,5316.64,2126.66,UC HEALTH,UC HEALTH COMMERCIAL,4625.48,87,,,OTHER,3987.48,5210.31,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,UC HEALTH,UC HEALTH COMMERCIAL,493.78,87,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE LIPOSOMAL 133MG,C9290,HCPCS,636,RC,,BOTH,133,ME,567.56,227.02,UC HEALTH,UC HEALTH COMMERCIAL,493.78,87,,,OTHER,425.67,556.21,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,UC HEALTH,UC HEALTH COMMERCIAL,29786.48,87,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
POLATUZUMAB VEDOTIN-PIIQ 140MG,J9309,HCPCS,636,RC,,BOTH,140,ME,34237.33,13694.93,UC HEALTH,UC HEALTH COMMERCIAL,29786.48,87,,,OTHER,130.23,33552.58,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J0665,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,UC HEALTH,UC HEALTH COMMERCIAL,44.24,87,,,OTHER,0.02,49.83,PERCENT OF TOTAL BILLED CHARGES
BUPIVICAINE 0.75% SDV 10ML,J3490,HCPCS,636,RC,,BOTH,10,ML,50.85,20.34,UC HEALTH,UC HEALTH COMMERCIAL,44.24,87,,,OTHER,38.14,49.83,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,UC HEALTH,UC HEALTH COMMERCIAL,157.45,87,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,J1453,HCPCS,636,RC,,BOTH,1,ME,180.98,72.39,UC HEALTH,UC HEALTH COMMERCIAL,157.45,87,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
FOSAPREPITANT,2515510,CDM,636,RC,,BOTH,1,ME,180.98,72.39,UC HEALTH,UC HEALTH COMMERCIAL,157.45,87,,,OTHER,135.73,177.36,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,UC HEALTH,UC HEALTH COMMERCIAL,14797.12,87,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
DARATUMUMAB-HYALUR-FIHJ,J9144,HCPCS,636,RC,,BOTH,10,ME,17008.18,6803.27,UC HEALTH,UC HEALTH COMMERCIAL,14797.12,87,,,OTHER,51.24,16668.02,PERCENT OF TOTAL BILLED CHARGES
LIDOCAINE 1G BAG,J2001,HCPCS,636,RC,,BOTH,1,GR,104.73,41.89,UC HEALTH,UC HEALTH COMMERCIAL,91.12,87,,,OTHER,78.55,102.64,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,UC HEALTH,UC HEALTH COMMERCIAL,2210.63,87,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB 200MG/10ML,Q0249,HCPCS,636,RC,,BOTH,10,ML,2540.95,1016.38,UC HEALTH,UC HEALTH COMMERCIAL,2210.63,87,,,OTHER,1905.71,2490.13,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,UC HEALTH,UC HEALTH COMMERCIAL,2135.21,87,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,2454.27,981.71,UC HEALTH,UC HEALTH COMMERCIAL,2135.21,87,,,OTHER,6.34,2405.18,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512020,CDM,636,RC,,BOTH,1,ME,2454.27,981.71,UC HEALTH,UC HEALTH COMMERCIAL,2135.21,87,,,OTHER,1840.7,2405.18,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,UC HEALTH,UC HEALTH COMMERCIAL,2574.37,87,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,J0881,HCPCS,636,RC,,BOTH,,,2959.05,1183.62,UC HEALTH,UC HEALTH COMMERCIAL,2574.37,87,,,OTHER,3.05,2899.87,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 200 MCG,2504290,CDM,636,RC,,BOTH,,,2959.05,1183.62,UC HEALTH,UC HEALTH COMMERCIAL,2574.37,87,,,OTHER,2219.29,2899.87,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,UC HEALTH,UC HEALTH COMMERCIAL,161.21,87,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,J9263,HCPCS,636,RC,,BOTH,100,ME,185.29,74.12,UC HEALTH,UC HEALTH COMMERCIAL,161.21,87,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
OXALIPLATIN 100MG INJ,2501950,CDM,636,RC,,BOTH,100,ME,185.29,74.12,UC HEALTH,UC HEALTH COMMERCIAL,161.21,87,,,OTHER,138.97,181.59,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,UC HEALTH,UC HEALTH COMMERCIAL,3959.54,87,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,J0717,HCPCS,636,RC,,BOTH,200,ME,4551.2,1820.48,UC HEALTH,UC HEALTH COMMERCIAL,3959.54,87,,,OTHER,4.85,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,UC HEALTH,UC HEALTH COMMERCIAL,3959.54,87,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
CERTOLIZUMAB 200MG,2503970,CDM,636,RC,,BOTH,200,ME,4551.2,1820.48,UC HEALTH,UC HEALTH COMMERCIAL,3959.54,87,,,OTHER,3413.4,4460.17,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,UC HEALTH,UC HEALTH COMMERCIAL,6869.34,87,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
TEZEPELUMAB-EKKO 210MG,J2356,HCPCS,636,RC,,BOTH,210,ME,7895.79,3158.32,UC HEALTH,UC HEALTH COMMERCIAL,6869.34,87,,,OTHER,18.69,7737.87,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,UC HEALTH,UC HEALTH COMMERCIAL,1802.12,87,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BELATACEPT 250MG,J0485,HCPCS,636,RC,,BOTH,250,ME,2071.4,828.56,UC HEALTH,UC HEALTH COMMERCIAL,1802.12,87,,,OTHER,4.07,2029.97,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,UC HEALTH,UC HEALTH COMMERCIAL,804.62,87,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
BUPIVACAINE LIPOSOMAL 266MG,C9290,HCPCS,636,RC,,BOTH,266,ME,924.85,369.94,UC HEALTH,UC HEALTH COMMERCIAL,804.62,87,,,OTHER,693.64,906.35,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,UC HEALTH,UC HEALTH COMMERCIAL,6238.8,87,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
INCLISIRAN 284MG,J1306,HCPCS,636,RC,,BOTH,284,ME,7171.03,2868.41,UC HEALTH,UC HEALTH COMMERCIAL,6238.8,87,,,OTHER,12.73,7027.61,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,UC HEALTH,UC HEALTH COMMERCIAL,40.91,87,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
CLINDAMYCIN 150MG/ML INJ,J3490,HCPCS,636,RC,,BOTH,150,ME,47.02,18.81,UC HEALTH,UC HEALTH COMMERCIAL,40.91,87,,,OTHER,35.27,46.08,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,UC HEALTH,UC HEALTH COMMERCIAL,3527.88,87,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,J0881,HCPCS,636,RC,,BOTH,,,4055.04,1622.02,UC HEALTH,UC HEALTH COMMERCIAL,3527.88,87,,,OTHER,3.05,3973.94,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN 300 MCG,2510300,CDM,636,RC,,BOTH,,,4055.04,1622.02,UC HEALTH,UC HEALTH COMMERCIAL,3527.88,87,,,OTHER,3041.28,3973.94,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UC HEALTH,UC HEALTH COMMERCIAL,15557.07,87,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,J0896,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UC HEALTH,UC HEALTH COMMERCIAL,15557.07,87,,,OTHER,41.98,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UC HEALTH,UC HEALTH COMMERCIAL,15557.07,87,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
LUSPATERCEPT-AAMT 75MG SDV,C9399,HCPCS,636,RC,,BOTH,75,ME,17881.69,7152.68,UC HEALTH,UC HEALTH COMMERCIAL,15557.07,87,,,OTHER,13411.27,17524.06,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,J2350,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,UC HEALTH,UC HEALTH COMMERCIAL,30022.71,87,,,OTHER,61.7,33818.69,PERCENT OF TOTAL BILLED CHARGES
OCRELIZUMAB 300MG/10ML,C9494,HCPCS,636,RC,,BOTH,10,ML,34508.87,13803.55,UC HEALTH,UC HEALTH COMMERCIAL,30022.71,87,,,OTHER,25881.65,33818.69,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,UC HEALTH,UC HEALTH COMMERCIAL,667.23,87,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ  300MCG/0.5ML,Q5101,HCPCS,636,RC,,BOTH,0.5,ML,766.93,306.77,UC HEALTH,UC HEALTH COMMERCIAL,667.23,87,,,OTHER,0.44,751.59,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,UC HEALTH,UC HEALTH COMMERCIAL,11408.38,87,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
VEDOLIZUMAB 300MG VIAL,J3380,HCPCS,636,RC,,BOTH,300,ME,13113.08,5245.23,UC HEALTH,UC HEALTH COMMERCIAL,11408.38,87,,,OTHER,22.94,12850.82,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UC HEALTH,UC HEALTH COMMERCIAL,25775.3,87,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,J9119,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UC HEALTH,UC HEALTH COMMERCIAL,25775.3,87,,,OTHER,28.96,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UC HEALTH,UC HEALTH COMMERCIAL,25775.3,87,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
CEMIPLIMAB-RWLC 350MG/7ML,C9044,HCPCS,636,RC,,BOTH,7,ML,29626.78,11850.71,UC HEALTH,UC HEALTH COMMERCIAL,25775.3,87,,,OTHER,22220.09,29034.24,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,UC HEALTH,UC HEALTH COMMERCIAL,4228.03,87,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,J3262,HCPCS,636,RC,,BOTH,1,ME,4859.8,1943.92,UC HEALTH,UC HEALTH COMMERCIAL,4228.03,87,,,OTHER,6.34,4762.61,PERCENT OF TOTAL BILLED CHARGES
TOCILIZUMAB,2512030,CDM,636,RC,,BOTH,1,ME,4859.8,1943.92,UC HEALTH,UC HEALTH COMMERCIAL,4228.03,87,,,OTHER,3644.85,4762.61,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,UC HEALTH,UC HEALTH COMMERCIAL,15513.04,87,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,J9306,HCPCS,636,RC,,BOTH,30,ML,17831.08,7132.43,UC HEALTH,UC HEALTH COMMERCIAL,15513.04,87,,,OTHER,16.19,17474.46,PERCENT OF TOTAL BILLED CHARGES
PERTUZUMAB 30MG/ML,2504050,CDM,636,RC,,BOTH,30,ML,17831.08,7132.43,UC HEALTH,UC HEALTH COMMERCIAL,15513.04,87,,,OTHER,13373.31,17474.46,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,UC HEALTH,UC HEALTH COMMERCIAL,825.35,87,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
FILGRASTIM-SNDZ 480 MCG,Q5101,HCPCS,636,RC,,BOTH,,,948.68,379.47,UC HEALTH,UC HEALTH COMMERCIAL,825.35,87,,,OTHER,0.44,929.71,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J2724,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UC HEALTH,UC HEALTH COMMERCIAL,1928.85,87,,,OTHER,15.78,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UC HEALTH,UC HEALTH COMMERCIAL,1928.85,87,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,J7168,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UC HEALTH,UC HEALTH COMMERCIAL,1928.85,87,,,OTHER,2.39,2172.73,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 500,C9132,HCPCS,636,RC,,BOTH,,,2217.07,886.83,UC HEALTH,UC HEALTH COMMERCIAL,1928.85,87,,,OTHER,1662.8,2172.73,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,UC HEALTH,UC HEALTH COMMERCIAL,5855.08,87,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,J0881,HCPCS,636,RC,,BOTH,500,ML,6729.98,2691.99,UC HEALTH,UC HEALTH COMMERCIAL,5855.08,87,,,OTHER,3.05,6595.38,PERCENT OF TOTAL BILLED CHARGES
DARBEPOETIN ALFA 500MCG/ML,2512120,CDM,636,RC,,BOTH,500,ML,6729.98,2691.99,UC HEALTH,UC HEALTH COMMERCIAL,5855.08,87,,,OTHER,5047.49,6595.38,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,UC HEALTH,UC HEALTH COMMERCIAL,647.09,87,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,J0878,HCPCS,636,RC,,BOTH,500,ME,743.79,297.51,UC HEALTH,UC HEALTH COMMERCIAL,647.09,87,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
DAPTOMYCIN 500MG VIAL,2510490,CDM,636,RC,,BOTH,500,ME,743.79,297.51,UC HEALTH,UC HEALTH COMMERCIAL,647.09,87,,,OTHER,557.84,728.91,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,UC HEALTH,UC HEALTH COMMERCIAL,1676.49,87,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERUMOXYTOL 510MG/17ML,Q0138,HCPCS,636,RC,,BOTH,17,ML,1927,770.8,UC HEALTH,UC HEALTH COMMERCIAL,1676.49,87,,,OTHER,0.41,1888.46,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,UC HEALTH,UC HEALTH COMMERCIAL,1682.68,87,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,J1439,HCPCS,636,RC,,BOTH,750,ME,1934.12,773.65,UC HEALTH,UC HEALTH COMMERCIAL,1682.68,87,,,OTHER,1.14,1895.44,PERCENT OF TOTAL BILLED CHARGES
FERRIC CARBOXYMAL INJ 750MG,2517300,CDM,636,RC,,BOTH,750,ME,1934.12,773.65,UC HEALTH,UC HEALTH COMMERCIAL,1682.68,87,,,OTHER,1450.59,1895.44,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,2519870,CDM,636,RC,,BOTH,,,10377.46,4150.98,UC HEALTH,UC HEALTH COMMERCIAL,9028.39,87,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUM PROTHROMBIN CPXL(PCC) 1000,C9159,HCPCS,636,RC,,BOTH,,,10377.46,4150.98,UC HEALTH,UC HEALTH COMMERCIAL,9028.39,87,,,OTHER,7783.1,10169.91,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J2724,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UC HEALTH,UC HEALTH COMMERCIAL,6378.96,87,,,OTHER,15.78,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UC HEALTH,UC HEALTH COMMERCIAL,6378.96,87,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,J7168,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UC HEALTH,UC HEALTH COMMERCIAL,6378.96,87,,,OTHER,2.39,7185.5,PERCENT OF TOTAL BILLED CHARGES
HUMAN PROTHROMBIN COMPLEX 1000,C9132,HCPCS,636,RC,,BOTH,,,7332.14,2932.86,UC HEALTH,UC HEALTH COMMERCIAL,6378.96,87,,,OTHER,5499.1,7185.5,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,UC HEALTH,UC HEALTH COMMERCIAL,127.87,87,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,90700,HCPCS,636,RC,,BOTH,,,146.98,58.79,UC HEALTH,UC HEALTH COMMERCIAL,127.87,87,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
PNEUMOCOCCAL VACCINE 0.5ML,2518440,CDM,636,RC,,BOTH,0.5,ML,295.08,118.03,UC HEALTH,UC HEALTH COMMERCIAL,256.72,87,,,OTHER,221.31,289.18,PERCENT OF TOTAL BILLED CHARGES
DIPTH/PERTUSS/TET VACCINE <7YR,2511640,CDM,636,RC,,BOTH,,,146.98,58.79,UC HEALTH,UC HEALTH COMMERCIAL,127.87,87,,,OTHER,110.24,144.04,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,UC HEALTH,UC HEALTH COMMERCIAL,1055.38,87,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
ESMOLOL 10MG/ML 250ML BAG,J3490,HCPCS,636,RC,,BOTH,10,ME,1213.08,485.23,UC HEALTH,UC HEALTH COMMERCIAL,1055.38,87,,,OTHER,909.81,1188.82,PERCENT OF TOTAL BILLED CHARGES
FLU VACCINE HIGH DOSE,2514130,CDM,636,RC,,BOTH,,,179.64,71.86,UC HEALTH,UC HEALTH COMMERCIAL,156.29,87,,,OTHER,134.73,176.05,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,Q2036,HCPCS,636,RC,,BOTH,,,64.97,25.99,UC HEALTH,UC HEALTH COMMERCIAL,56.52,87,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
INFLUENZA VACCINE-TRIVAL. 0.5,2511440,CDM,636,RC,,BOTH,,,64.97,25.99,UC HEALTH,UC HEALTH COMMERCIAL,56.52,87,,,OTHER,48.72,63.67,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,UC HEALTH,UC HEALTH COMMERCIAL,34.16,87,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,J3490,HCPCS,250,RC,,BOTH,,,39.27,15.71,UC HEALTH,UC HEALTH COMMERCIAL,34.16,87,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL HCL CONC,2510770,CDM,250,RC,,BOTH,,,39.27,15.71,UC HEALTH,UC HEALTH COMMERCIAL,34.16,87,,,OTHER,29.45,38.48,PERCENT OF TOTAL BILLED CHARGES
METHYLNALTREXONE BROMIDE,J2212,HCPCS,636,RC,,BOTH,0.1,ME,347.96,139.18,UC HEALTH,UC HEALTH COMMERCIAL,302.73,87,,,OTHER,1.21,341,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,UC HEALTH,UC HEALTH COMMERCIAL,57.48,87,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
VANCOMYCIN 750MG VIAL,J3490,HCPCS,636,RC,,BOTH,750,ME,66.07,26.43,UC HEALTH,UC HEALTH COMMERCIAL,57.48,87,,,OTHER,49.55,64.75,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,UC HEALTH,UC HEALTH COMMERCIAL,59.31,87,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
BAG-EMPTY 150ML,J3490,HCPCS,636,RC,,BOTH,150,ML,68.17,27.27,UC HEALTH,UC HEALTH COMMERCIAL,59.31,87,,,OTHER,51.13,66.81,PERCENT OF TOTAL BILLED CHARGES
RABIES IMM GLOB 1500U/ML 5ML,2515770,CDM,636,RC,,BOTH,5,ML,5629.18,2251.67,UC HEALTH,UC HEALTH COMMERCIAL,4897.38,87,,,OTHER,299.93,5516.59,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,UC HEALTH,UC HEALTH COMMERCIAL,13.52,87,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
IVERMECTIN 3MG,J3490,HCPCS,636,RC,,BOTH,3,ME,15.54,6.21,UC HEALTH,UC HEALTH COMMERCIAL,13.52,87,,,OTHER,11.65,15.23,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,2518680,CDM,636,RC,,BOTH,0.5,ML,110.93,44.37,UC HEALTH,UC HEALTH COMMERCIAL,96.51,87,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,UC HEALTH,UC HEALTH COMMERCIAL,96.51,87,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
TETANUS DIPTHERIA ADULT 0.5ML,J3490,HCPCS,636,RC,,BOTH,0.5,ML,110.93,44.37,UC HEALTH,UC HEALTH COMMERCIAL,96.51,87,,,OTHER,83.2,108.71,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,UC HEALTH,UC HEALTH COMMERCIAL,19.09,87,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 1.25MG INH PAK,J3490,HCPCS,636,RC,,BOTH,1.25,ME,21.94,8.78,UC HEALTH,UC HEALTH COMMERCIAL,19.09,87,,,OTHER,16.46,21.5,PERCENT OF TOTAL BILLED CHARGES
RABIES VACCINE,2520290,CDM,636,RC,,BOTH,,,870.92,348.37,UC HEALTH,UC HEALTH COMMERCIAL,757.7,87,,,OTHER,338.91,853.5,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,UC HEALTH,UC HEALTH COMMERCIAL,18.77,87,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
LEVALBUTEROL 0.63MG INH,J3490,HCPCS,636,RC,,BOTH,0.63,ME,21.57,8.63,UC HEALTH,UC HEALTH COMMERCIAL,18.77,87,,,OTHER,16.18,21.14,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
HYDROMORPHONE PCA,J3490,HCPCS,636,RC,,BOTH,,,75,30,UC HEALTH,UC HEALTH COMMERCIAL,65.25,87,,,OTHER,56.25,73.5,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.54,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
LINEZOLID 600MG,J3490,HCPCS,636,RC,,BOTH,600,ME,30.5,12.2,UC HEALTH,UC HEALTH COMMERCIAL,26.54,87,,,OTHER,22.88,29.89,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,UC HEALTH,UC HEALTH COMMERCIAL,48.93,87,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
IOHEXAL 180MG/20ML,J3490,HCPCS,636,RC,,BOTH,20,ML,56.24,22.5,UC HEALTH,UC HEALTH COMMERCIAL,48.93,87,,,OTHER,42.18,55.12,PERCENT OF TOTAL BILLED CHARGES
HALOPERIDOL 5 MG/ML AMP,J1630,HCPCS,636,RC,,BOTH,5,ME,88.26,35.3,UC HEALTH,UC HEALTH COMMERCIAL,76.78,87,,,OTHER,66.19,86.49,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,UC HEALTH,UC HEALTH COMMERCIAL,51.35,87,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
LABETALOL 20MG SYRINGE,J1920,HCPCS,250,RC,,BOTH,20,ME,59.02,23.61,UC HEALTH,UC HEALTH COMMERCIAL,51.35,87,,,OTHER,0.18,57.84,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,UC HEALTH,UC HEALTH COMMERCIAL,5.32,87,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,J7510,HCPCS,636,RC,,BOTH,3,ME,6.12,2.45,UC HEALTH,UC HEALTH COMMERCIAL,5.32,87,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
PREDNISOLONE 3MG/ML SYRUP,2519130,CDM,636,RC,,BOTH,3,ME,6.12,2.45,UC HEALTH,UC HEALTH COMMERCIAL,5.32,87,,,OTHER,4.59,5.99,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UC HEALTH,UC HEALTH COMMERCIAL,273.34,87,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,B4189,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UC HEALTH,UC HEALTH COMMERCIAL,273.34,87,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UC HEALTH,UC HEALTH COMMERCIAL,273.34,87,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES
AMINO ACID 8.5%/DEX 500ML,J3490,HCPCS,636,RC,,BOTH,500,ML,314.18,125.67,UC HEALTH,UC HEALTH COMMERCIAL,273.34,87,,,OTHER,235.64,307.9,PERCENT OF TOTAL BILLED CHARGES